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.
Salient findings of the study include:
- No significant differences were found in height, weight, or body mass index z-scores at 4 years, and in predicted adult height, before or after adjusting for age at diagnosis and sex.
- Bone age z-scores averaged 2.8 SDs lower for patients on HC suspension compared with HC tablets after adjusting for age at diagnosis and sex.
- The suspension group received 30.4% lower average cumulative HC doses by their fourth birthday.
"Our findings indicate that treatment with alcohol-free HC suspension reduced androgen exposure, allowed lower average and cumulative daily HC dose versus HC tablet use, and generated no significant differences in SDS in growth parameters in children with CAH at 4 years of age," wrote the authors. "There is a need for longitudinal studies of treating with smaller HC doses during childhood."
Reference:
Heba Al-Rayess, O Yaw Addo, Elise Palzer, Mu'taz Jaber, Kristin Fleissner, James Hodges, Richard Brundage, Bradley S Miller, Kyriakie Sarafoglou, Bone Age Maturation and Growth Outcomes in Young Children with CAH Treated with Hydrocortisone Suspension, Journal of the Endocrine Society, Volume 6, Issue 2, February 2022, bvab193, https://doi.org/10.1210/jendso/bvab193
