JAMA Netw Open
Once-daily prednisolone appears to be a safe alternative to hydrocortisone for adrenal replacement
In a double-blind, crossover randomized trial (NCT03936517) of 46 adults with adrenal insufficiency, once-daily low-dose prednisolone (2–5 mg) was compared with thrice-daily standard-dose hydrocortisone over two 4‑month periods. Prednisolone was associated with significantly slower bone turnover, reflected by lower osteocalcin, urinary N‑telopeptide, and procollagen type 1 N‑terminal propeptide levels. Modest but significant reductions in weight, BMI, waist circumference, and HbA1c were also observed. Safety measures and patient-reported quality of life didn't differ between regimens.
Clinical takeaway: Consider once‑daily low‑dose prednisolone as an alternative to multiple‑dose hydrocortisone in adults with adrenal insufficiency, particularly when regimen simplicity or cardiometabolic factors are priorities.
Source:
Choudhury S, et al. (2026, March 2). JAMA Netw Open. Prednisolone Once Daily vs Hydrocortisone Thrice Daily in Hypoadrenalism: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/41874506/
