Hydrocortisone suspensions superior to tablets for kids with congenital adrenal hyperplasia

USA: Treatment with alcohol-free hydrocortisone (HC) suspension compared to HC tablets decreases androgen exposure (shown by lower age z-scores) in children with congenital adrenal hyperplasia (CAH), says a recent study. Also, alcohol-free HC suspension allows lower average and cumulative daily HC dose and generates no significant differences in SDS in growth parameters. The study was published in the February 2022 issue of the Journal of the Endocrine Society. 

In order to control androgen production and avoid the negative effects of overtreatment young children with CAH require small doses (0.1-1.25 mg) of hydrocortisone. Prior to the recent US Food and Drug Administration approval of HC granules, the smallest commercially available HC formulation was a scored 5-mg tablet. There are limited options to achieve small doses; the options include using splitting tablets into quarters or eighths, dissolving tablets into the water, or using a pharmacy-compounded suspension, which is against the recommendation of the CAH Clinical Practice Guidelines. 

To work towards the above-mentioned problem, Kyriakie Sarafoglou, University of Minnesota Medical School, Minneapolis, MN, USA, and colleagues aimed to compare weight gain, growth, skeletal maturation, total cortisol exposure, and total daily hydrocortisone dose over the first 4 years of life in children with CAH treated with tablets vs children treated with an extemporaneously compounded alcohol-free HC suspension that allows dosing increments of 0.1 mg in a cross-sectional chart review.