FP21-4 Continuous Subcutaneous Hydrocortisone Infusion (CSHI) Improves Quality-of-Life in Addison's Disease (AD)

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP21-HPA Axis: New Clinical Developments
Sunday, June 16, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 11:00 AM
Room 134 (Moscone Center)

Poster Board SUN-51
Marianne Oksnes*1, Sigridur Bjornsdottir2, Magnus Isaksson3, Roy Miodini Nilsen4, Siri Carlsen5, Olle Kampe6, Anna-Lena Hulting7, Sophie Bensing8, Eystein Sverre Husebye9 and Kristian Lovas1
1University of Bergen, Bergen, Norway, 2Karolinska Institution, Huddinge, Sweden, 3Uppsala University, 4Haukeland University hospital, Bergen, Norway, 5Stavanger University Hospital, Norway, 6Uppsala University, Uppsala, Sweden, 7Karolinska Univ Hosp, Stockholm, Sweden, 8Karolinska Institutet, Stockholm, Sweden, 9Haukeland Univ Hosp, Bergen, Norway
Background: Conventional glucocorticoid replacement therapy is unphysiological and does not restore quality-of-life (QoL) in Addison’s disease (AD). Here we compare continuous subcutaneous hydrocortisone infusion (CSHI) with regular oral replacement therapy on clinical parameters and QoL.


Design, Subjects, Measurements: We performed a cross-over randomised multi-centre trial, comparing 3 months of weight-adjusted thrice daily oral hydrocortisone (OHC) with 3 months on CSHI (NCT 01063569). Patients were examined at baseline and after 2 and 3 months in each treatment period. QoL was evaluated by Addiqol including the Addiqol short version, and the generic questionnaires SF-36 (Short Form-36) and PGWBI (Psychological General Well-Being Index). Statistical analyses were performed with linear mixed effects models with random intercepts.


Results: Thirty-three patients were included (8 males), the mean age (SD) was 48 years (11.7), and the mean AD duration 12.4 years (10.1). The median pre-treatment hydrocortisone equivalent dose was 0.36 mg/kg/d (range 0.21-0.74). Oral trial doses (median 0.23 mg/kg/day, range 0.2-0.5) were slightly lower than CSHI doses (median 0.28 mg/kg/24h, 0.24-0.5).There were no significant between-treatment differences for weight, waist- and hip circumference or systolic and diastolic blood pressure.

Addiqol scores increased during CSHI (p for trend <0.001) but where unchanged during OHC (p for trend =0.90), indicating that CSHI improves QoL in AD when compared to OHC (p for interaction =0.010). The Addiqol short version scores displayed a similar pattern (p for interaction =0.034).The PGWB total score improved during CSHI (p for trend=0.012), but the difference to OHC was not statistically significant (p for interaction=0.304). The subscales Vitality (p for trend <0.001) and Anxiety (p for trend =0.016) improved during CSHI, and scores were significantly better than for OHC (p for interaction=0.029 and p=0.04 respectively). The SF-36 detected QoL changes only in the Physical Function subscale, where CSHI scores improved (p for trend=0.076) and OHC scores were unchanged (p for trend=0.299), resulting in higher Qol scores for CSHI (p for interaction=0.027).


Conclusion: CSHI improves several QoL parameters in AD compared to OHC. Furthermore, the disease-specific Addiqol questionnaire was more responsive to QoL changes in AD than the generic SF-36 and PGWB questionnaires.

Nothing to Disclose: MO, SB, MI, RMN, SC, OK, ALH, SB, ESH, KL

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Euradrenal