ECE2024 Poster Presentations Late-Breaking (77 abstracts)
Weaning patients off long-term low dose prednisolone: an international survey of current endocrine practice
Katharine Lazarus 1,2 , Pei Eng 1,3 , Kavita Narula 1,2 , Sirazum Choudhury 1,2,4 , Niamh Martin 1,2 , Florian Wernig 1,2 , Debbie Papadopoulou 1,2 , Tricia Tan 1,2,4 , Yasir Elhassan 5,6 , Anna Mitchell 7 , Helen Simpson 8 , Jessica Davis 9 , Roisin Evans 9 , Kate Single 9 & Karim Meeran 1,2
1Imperial College London, Hammersmith Campus, London, United Kingdom; 2Imperial College Healthcare NHS Trust, Endocrinology and Diabetes, United Kingdom; 3NUHS, Endocrinology, Singapore, Singapore; 4, Department of Clinical Biochemistry, London, United Kingdom; 5Queen Elizabeth Hospital Birmingham, Department of Endocrinology, Birmingham, United Kingdom; 6University of Birmingham, Birmingham, United Kingdom; 7Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; 8University College Hospital, Department of Diabetes and Endocrinology, London, United Kingdom; 9Society for Endocrinology and Bioscientifica, Stoke Gifford, United Kingdom
Background: Prolonged glucocorticoid (GC) use is associated with significant morbidity and mortality, including the development of glucocorticoid-induced adrenal insufficiency (GI-AI). There is currently no consensus regarding testing or weaning of GCs prescribed for non-endocrine conditions.
Aim: To assess the long-term GC weaning practice by endocrinologists in the UK and Southeast Asia.
Methods: An anonymous survey was disseminated to the clinical membership of the Society for Endocrinology (SfE) in May and June 2023, and the ASEAN Federation of Endocrine Societies (AFES) and the Endocrine and Metabolic Society of Singapore (EMSS) in November 2023 and February 2024.
Results: Respondents were asked about their management practice of a patient who no longer requires long-term prednisolone 5 mg daily for asthma, and has an early morning cortisol 98nmol/l. A total of 239 members (SfE 163; AFES/EMSS 76) responded. A Short Synacthen Test (SST) was the choice of 42.2% (SfE 54.0%; AFES/EMSS 30.3%) of respondents, whilst 35.4% (SfE 33.1%; AFES/EMSS 51.1%) wean further before cortisol assessment, and 9.5% (SfE 11.0%; AFES/EMSS 9.2 %) accept this morning cortisol as confirmatory of adrenal insufficiency. A switch from prednisolone to hydrocortisone prior to SST is the practice of 2.3% (SfE 3%; AFES/EMSS 1.3%) of all respondents. GC weaning was the practice of 78.2% (SfE 77.2%; AFES/EMSS 80.3%) of respondents; 27.7% (SfE 29.6%; AFES/EMSS 23.7%) wean down prednisolone, whilst 50.4% (SfE 47.3%; AFES/EMSS 56.6%) switch to hydrocortisone before weaning. Still, 12.6% continue GC replacement without further assessment; 8.0% with hydrocortisone and 4.6% continue 5 mg prednisolone. Most respondents (71.7%: SfE 62.1%; AFES/EMSS 92.1%) did not have a local steroid weaning protocol. Over half (54.8%: SfE 52.4%; AFES/EMSS 47.4%) continue follow-up until prednisolone is weaned off; 39.3% would follow-up three-monthly and 46.2% six-monthly. The commonest perceived causes for weaning failure were relapse of the underlying GC-treated condition (54.7%) and GC withdrawal symptoms (20.1%). Subsequently-confirmed hypothalamic-pituitary-adrenal axis suppression on prednisolone led to a clinical decision by 19.2% of respondents not to pursue further steroid weaning. A lack of evidence-based studies was highlighted as a major challenge (36.8% of respondents). Other challenges included limited follow-up capacity (5.2%), access to Synacthen (5.2%), access to prednisolone 1 mg tablets (2.7%), and difficulty engaging non-endocrinologists to support weaning (6.5%).
Discussion: There remains huge variation in the management of long-term GC weaning. There remains a need to develop an evidence-based approach for safe and effective GC weaning and hypothalamic-pituitary-adrenal axis assessment.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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