ECE2024 Poster Presentations Adrenal and Cardiovascular Endocrinology (95 abstracts)
Impact of glucocorticoid-induced adrenal insufficiency on health-related quality of life in patients receiving long-term low dose prednisolone treatment: Results from the double edge-rescue trial
Marie Louise Lund 1 , Hajir Al-Jorani 2,3 , Jelena Stankovic 4,5 , Lise Sofie Bislev 4 , Jakob Bue Bjørner 6,7,8 , Victor Brun Boesen 1 , Louise Lehmann Christensen 2,3 , Ulla Feldt-Rasmussen 1 , AnjaFenger Dreyer 2,3 , Dorte Glintborg 2,3 , Annette Hansen 9 , Simon Bøggild Hansen 4,5 , Richard Christian Jensen 2 , Nanna Thurmann Jørgensen 1,10 , Marianne Klose 1 , Henning Locht 11 , Randi Tei 4 , Torquil Watt 1 , Paul M. Stewart 12 , Henrik Toft Sørensen 13 , Jens Otto Jørgensen 4,5 , Marianne Andersen 2,3 & Stina Willemoes Borresen 1
1Rigshospitalet, (1) Department of Endocrinology and Metabolism, København, Denmark; 2Odense University Hospital, (2) Department of Endocrinology, Odense, Denmark; 3University of Southern Denmark, (3) Research Unit OPEN, Department of Clinical Research, Odense, Denmark; 4Aarhus University Hospital, (4) Department of Endocrinology and Internal Medicine, Aarhus, Denmark; 5Aarhus University, (5) Department of Clinical Medicine, Aarhus, Denmark; 6University of Copenhagen, (6) Department of Public Health, København, Denmark; 7QualityMetric incorporated, LLC, Johnston, USA; 8National Research Centre for the Working Environment, Copenhagen, Denmark; 9Copenhagen University Hospital Herlev and Gentofte, Gentofte, (7) Center for Rheumatology and Spine Diseases, Gentofte, Denmark; 10(8) Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen, Denmark; 11Copenhagen University Hospital Bispebjerg and Frederiksberg, Frederiksberg, (9) Center for Rheumatology and Spine Diseases, Copenhagen, Denmark; 12University of Leeds, University of Leeds, Leeds, UK; 13Aarhus University Hospital, (11) Department of Clinical Epidemiology, Aarhus, Denmark
Objectives: The clinical impact of glucocorticoid-induced adrenal insufficiency in patients on low-dose prednisolone is unclear. We investigated the influence of adrenal function on health-related quality of life (HRQoL) in patients tapering prednisolone.
Method: Baseline data from an ongoing prospective randomised clinical trial including 278 patients with polymyalgia rheumatica/giant cell arteritis treated with prednisolone for ≥12 weeks, current dose ≤5 mg. Adrenal function, evaluated with a 250 μg ACTH-test, remained blinded until after HRQoL assessments. Fatigue was assessed under unstressed conditions five times daily for three days using a smartphone-based momentary item version of the Multidimensional Fatigue Inventory’s General Fatigue scale. Answers were provided on visual analogue 100-point scales and analysed with linear mixed models for repeated measures. Generic and disease-specific HRQoL was evaluated with SF36v2 and AddiQoL-30. Subgroup analyses of patients receiving i) 5mg and ii) <5 mg prednisolone/day were performed.
Results: Of 278 patients 55 (20%) treated with prednisolone for median 18 months (3-271 months), median current dose 5 mg (0.36–5 mg) had adrenal insufficiency. Fatigue measurements were available for 120 patients [response rate 65% (1171/1800 questions)]. Overall, no difference in fatigue was found between patients with normal vs insufficient adrenal function [adrenal insufficient 4.6 points less fatigue, S.E.:5.1, P=0.36]. Patients experienced insignificantly more fatigue the higher stimulated P-cortisol [3.6 points/100 nmol/l, S.E.:1.7, P=0.05]. No effect of adrenal function on diurnal variation of fatigue was found [P=0.81]. Subgroup analyses of patients treated with 5 mg and <5 mg prednisolone/day showed similar results. Among 205 responses, total AddiQoL-30-scores did not differ in patients with insufficient vs normal adrenal function [mean(S.D.) 88.7(12.5) vs 87.9(10.9), P=0.66]. Similar results were found for all AddiQoL-30-subscales. For patients treated with 5 mg/day prednisolone (n=121), AddiQoL-30 Symptoms was correlated to stimulated P-cortisol (more symptoms with higher cortisol) [−0.58points/100 nmol/l, 95%CI: −1.1 to −0.05, P=0.031]. Among 202 responses, no significant difference in SF36v2 scores appeared between patients with normal vs insufficient adrenal function, except the subscale Role Emotion, which correlated with stimulated P-cortisol (worse the higher stimulated P-cortisol) [Spearman correlation coefficient −0.16, P=0.020]. Glucocorticoid-subgroup analyses showed similar results.
Conclusions: In patients tapering prednisolone to ≤5 mg/day, we did not find lower HRQoL in patients with adrenal insufficiency. In contrast, SF36v2 Role Emotion and AddiQoL-30 Symptoms scores were significantly worse with higher stimulated P-cortisol, but with small effect sizes and thus unlikely clinically relevant. Patients might experience symptoms during stress. The prospective part of our study will monitor symptoms of adrenal insufficiency during stress.
EudraCT:2021-002528-18, Funding:NNF20OC0063280
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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