Summary of findings for the main comparison. HC (13.5 mg/m²/day to 15.5 mg/m²/day): high morning dose vs high evening dose for treating CAH.
| HC (13.5 mg/m²/day to 15.5 mg/m²/day) high morning dose compared with high evening dose for treating CAH | ||||||
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Patient or population: people with CAH Settings: outpatients, tertiary centre Intervention: HC (13.5 mg/m²/day to 15.5 mg/m²/day): 50% daily dose in the morning followed by 25% at noon and 25% in the evening Comparison: HC (13.5 mg/m²/day to 15.5 mg/m²/day): 25% daily dose in the morning and 25% at noon followed by 50% in the evening | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (trials) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| High evening dose | High morning dose | |||||
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QoL Follow‐up: 4 weeks |
Outcome not reported. | NA | NA | NA | ||
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Androgen normalisation Follow‐up: 4 weeks |
See comments | NA | 15 (1 cross‐over trial) |
⊕⊝⊝⊝a,b,c very low |
17 OHP (nmol/L) Results for 17 OHP are presented as medians (IQR); 44 (16 to 116) for the high morning dose compared to 33 (15 to 76) for the high evening dose. Androstenedione (nmol/L) Results for androstenedione are presented as medians (IQR); 1.80 (1.0 to 3.0) for the high morning dose compared to 1.90 (1.20 to 6.50) for the high evening dose. Testosterone (nmol/L) Results for testosterone are presented as medians (IQR); 0.70 (0.30 to 2.30) for the high morning dose compared to 1.1 (0.60 to 2.70) for the high evening dose. DHEAS (nmol/L) Results for DHEAS are presented as medians (IQR); 0.20 (0.20 to 0.60) for the high morning dose compared to 0.40 (0.20 to 0.70) for the high evening dose. |
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Prevention of adrenal crisis Follow‐up: 4 weeks |
Outcome not reported. | NA | NA | NA | ||
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Presence of osteopenia Follow‐up: 4 weeks |
Outcome not reported. | NA | NA | NA | ||
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Presence of testicular or ovarian adrenal rest tumours Follow‐up: 4 weeks |
Outcome not reported. | NA | NA | NA | ||
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Subfertility Follow‐up: 4 weeks |
Outcome not reported. | NA | NA | NA | ||
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Final adult height Follow‐up: 4 weeks |
Outcome not reported | NA | NA | NA | ||
| *The basis for the assumed risk (e.g. the median control group risk across trials) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). 17 OHP: 17‐hydroxyprogesterone; CAH: congenital adrenal hyperplasia; CI: confidence interval; DHEAS: dehydroepiandrosterone sulphate; HC: hydrocortisone; IQR: interquartile range; NA: not applicable; QoL: quality of life. | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
a Downgraded once for high risk of bias due to incomplete outcome data and selective reporting. b Downgraded once due to potential risk of bias: unclear details related to methodological design. c Downgraded due to uncertainty: small sample size and wide IQR.