Quality of life rated too negatively.

Abstract

The authors rate the quality of life of persons with adrenal cortical insufficiency, who are receiving glucocorticoid replacement, in rather too negative a way and explain the deficits with the timing of the glucocorticoid administration compared with the physiological secretion profile of cortisol in healthy persons (1). The physiological and pharmacodynamic effects of cortisol follow blood concentrations with a substantial delay. The authors emphasized the beneficial effects of a slow-release hydrocortisone preparation distributed by Viropharma, which needs to be taken once a day only, whereas the conventional basic substitution of adrenal insufficiency (AI) patients with hydrocortisone (HC) is given as two, rarely three, daily doses. At least four of the authors have received moneys from Viropharma, and all are participating in a register study sponsored by the company. Mention should have been made of the fact that the preparation distributed by Viropharma is about 20 times the price of hydrocortisone. If in the most important study of slow-release hydrocortisone (2) the latter had not been compared with three times daily unretarded HC but with prednisolone, which is effective for a longer duration, then it can be assumed that no advantage for the new preparation would have been found. Replacement therapy for AI patients, using 3–5 mg prednisolone in a single dose, is not a problem. In patients with primary AI the dose of 9-alpha-fluorcortisol as a mineralocorticoid (MC) has to be slightly higher than in those substitued with HC (3). In the study by Johannsson et al. (2) the advantage of the slow-release single dose of HC compared with 3 times daily HC (the mean daily dose of 30 mg in both groups was too high anyway) is hardly detectable. 15–25 mg HC is the regular dosage (4). Johannsson and one additional author hold equity interests in the manufacturing company, and further authors act as consultants to that company.