The Use of Prednisolone 2.5 mg Daily During Ramadan Fasting in Patients With Adrenal Insufficiency

IF 3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Clinical Endocrinology Pub Date : 2024-12-11 DOI:10.1111/cen.15176

Meng-Loong Mok, Nusrath Salma Farook, Nicholas Ken Yoong Hee, Tharsini Sarvanandan, Quan- Hziung Lim, Lee-Ling Lim, Shireene Vethakkan, Jeyakantha Ratnasingam

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引用次数: 0

Abstract

Background

A previous study had established the safety and preserved of quality of life in patients with adrenal insufficiency (AI) who received prednisolone 5 mg once daily at sahur (predawn) during Ramadan fasting. It has been postulated that a lower dose of prednisolone between 2 and 3 mg may be sufficient for glucocorticoid replacement in this group of patients. This study aimed to assess the safety and effect on quality of life in patients with AI given prednisolone 2.5 mg during Ramadan fasting.

Methods

Patients with AI on twice-daily hydrocortisone, who had low or moderate risk of adrenal crisis and intended to fast, were recruited. Patients were given prednisolone 2.5 mg once daily taken at sahur(predawn) and Ramadan education was given. Weight, sleep duration, physical activity, biochemical parameters and quality of life measurements (SF-36 questionnaire) were analysed at the end of Ramadan and compared against the patient's own baseline readings before the start of Ramadan.

Results

A total of 16 patients (10 men, median age 60 [50.3, 68] years) were recruited. All patients were on 15–20 mg of hydrocortisone (in divided doses) before Ramadan, and intended to fast. Five of the participants had type 2 diabetes with low IDF-DAR risk category. 18.7% of the participants were unable to complete all 29 days of fasting. Up to 62.5% of the participants reported at least one adverse event. There was a statistically significant reduction in weight (median: −1.6 [−2.5, −0.3] kg, p < .01), systolic blood pressure (median: −17.0 (−28.8, −4.3) mmHg, p < .01) and diastolic blood pressure (median: −13.0 (−17.8, −3.8) mmHg, p < .01). Quality of life measures were preserved in all domains.

Conclusion

With prednisolone 2.5 mg daily in Ramadan fasting, more than half of the participants experienced symptoms of AI, with significant reduction in weight and blood pressure. We conclude that prednisolone 2.5 mg daily is insufficient during the somewhat stressful state of Ramadan fasting. Further studies with prednisolone 3–4 mg daily in settings with readily available prednisolone 1 mg tablets may further elucidate the safety of using lower dose prednisolone in Muslim patients who fast with AI during Ramadan.

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肾上腺功能不全患者斋月禁食期间每日使用强的松龙2.5 mg。

背景：先前的一项研究已经确定了在斋月禁食期间每天sahur（黎明前）一次接受5mg强的松龙治疗的肾上腺功能不全（AI）患者的安全性和生活质量。据推测，在这组患者中，较低剂量的2 - 3mg强的松龙可能足以替代糖皮质激素。本研究旨在评估斋月禁食期间给予强的松龙2.5 mg对AI患者生活质量的安全性和影响。方法：招募每日2次氢化可的松治疗的具有低或中度肾上腺危机风险并打算禁食的AI患者。患者给予强的松龙2.5 mg，每日1次，于凌晨服用，并给予斋月教育。在斋月结束时分析体重、睡眠时间、体力活动、生化参数和生活质量测量（SF-36问卷），并与斋月开始前患者自己的基线读数进行比较。结果：共纳入16例患者（男性10例，中位年龄60[50.3,68]岁）。所有患者在斋月前服用15-20毫克氢化可的松（分剂量），并打算禁食。5名参与者患有低IDF-DAR风险类别的2型糖尿病。18.7%的参与者无法完成所有29天的禁食。多达62.5%的参与者报告了至少一次不良事件。结论：在斋月禁食期间，每天使用2.5 mg强的松龙，超过一半的参与者出现了AI症状，体重和血压显著降低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.