The Use of Prednisolone 2.5 mg Daily During Ramadan Fasting in Patients With Adrenal Insufficiency
Authors' 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.
Study context
- Population
- Patients with adrenal insufficiency (AI) on twice-daily hydrocortisone (15–20 mg), low or moderate risk of adrenal crisis, intending to fast during Ramadan; 10 men, median age 60 [50.3, 68] years; 5 with T2D (low IDF-DAR risk)
- Participants
- 16 patients
- Exposure
- Prednisolone 2.5 mg once daily at sahur during Ramadan vs own pre-Ramadan baseline
- Prednisolone 2.5 mgn = 16
- Outcome
- Safety and quality of life (SF-36) with prednisolone 2.5 mg during Ramadan fasting
- Follow-up
- End of Ramadan vs baseline
Methodological detailsbefore-after comparison against own baseline
- Before-after comparison against own baseline
Main finding
As reported in the abstract
Weight change, median [IQR] kg, p < .01
−1.6
−2.5, −0.3
Systolic BP change, median mmHg, p < .01
−17.0
−28.8, −4.3
Diastolic BP change, median mmHg, p < .01
−13.0
−17.8, −3.8
Observational data: associations, not effects.
Further findings
Unable to complete all 29 days of fasting
- Participants unable to complete all 29 days of fasting
- 18.7%
Change in weight and blood pressure, end of Ramadan vs own baseline
- Weight change, median (IQR) kg, p < .01
- −1.6 [−2.5, −0.3]
- Systolic BP change, median mmHg, p < .01
- −17.0 (−28.8, −4.3)
- Diastolic BP change, median mmHg, p < .01
- −13.0 (−17.8, −3.8)
Quality of life (SF-36) · end of Ramadan
- Quality of life measures were preserved in all domains
Safety
- Participants reporting at least one adverse event (up to)
- 62.5%
Original publication
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