Simple clinical audit and research for patient benefit
Is prednisolone 3.75mg once daily the ideal replacement therapy?
Evidence that we have obtained to date suggests that doses over 4mg of prednisolone are supraphysiological and replacement doses of 2mg to 4mg daily work well in many patients. It is becoming clear that we have used excessive doses of replacement, either with hydrocortisone or with prednisolone, and in the long term, this is likely to contribute to osteoporosis, hyperglycaemia, and increased cardiovascular morbidity and mortality.
In countries where the smallest dose of prednisolone available is 5mg, we suggest a trial of three quarters of a tablet daily, which will supply approximately 3.75mg daily. Practically this will involve breaking a 5mg tablet into half and half again:
Enrol patients who are either on hydrocortisone (any dose) or on prednisolone 5mg or more and who have been on a stable dose for at least 4 months.
On enrolment, measure the following (minimal data set):
Weight (kg), waist circumference (cm), hip circumference (cm), height (cm), BMI, blood pressure can be done in clinic at minimal cost although it needs someone to do it (and hence time).
What drugs are they on at present, and for how long has this been stable:
Also a questionnaire of well being.
Additional useful measurements:
Glucose handling (HBA1C), lipids.
Bone markers: calcium, vitamin D (possibly PTH)
If there is funding, the following can be added.
Osteocalcin, procollagen peptide, urine n telopeptide.
Then switch to 3.75mg of prednisolone (or 3mg or 4mg if that is available).
Review the patients after 4 months to check the same markers. Repeat the markers after a year.
