Summary of findings 2. HC (15 mg/m²/day) versus PD (3 mg/m²/day) versus DXA (0.3 mg/m²/day) for treating CAH.
| HC (15 mg/m²/day) versus PD (3.0 mg/m²/day) versus DXA (0.3 mg/m²/day) for treating CAH | ||||||
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Patient or population: people with CAH Settings: outpatients, tertiary centre Intervention: HC (15 mg/m²/day) or PD (3.0 mg/m²/day) or DXA (0.3 mg/m²/day) Comparison: DXA (0.3 mg/m²/day) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (trials) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| DXA | HC or PD | |||||
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QoL Follow‐up: 6 weeks |
Outcome not reported. | NA | NA | NA | ||
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Androgen normalisation Follow‐up: 6 weeks |
See comments. | NA | 9 (1 cross‐over trial) |
⊕⊝⊝⊝a,b,c,d very low |
17 OHP (nmol/L) There were lower levels of 17 OHP reported in the DXA group compared to HC (P < 0.001) and compared to PD (P < 0.001). Androstenedione (nmol/L) Androstenedione levels were significantly lower with DXA when compared to HC (P = 0.016) and PD (P = 0.002). |
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Prevention of adrenal crisis Follow‐up: 6 weeks |
Outcome not reported. | NA | NA | NA | ||
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Presence of osteopenia Follow‐up: 6 weeks |
Outcome not reported. | NA | NA | NA | ||
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Presence of testicular or ovarian adrenal rest tumours Follow‐up: 6 weeks |
Outcome not reported. | NA | NA | NA | ||
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Subfertility Follow‐up: 6 weeks |
Outcome not reported. | NA | NA | NA | ||
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Final adult height Follow‐up: 6 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; DXA: dexamethasone; HC: hydrocortisone; NA: not applicable; PD: prednisolone; 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 risk of bias: unclear details related to methodological design. c Downgraded due to uncertainty: small sample size so P values should be interpreted with caution. d Downgraded once for lack of applicability as included study only includes children so results are not applicable to adults.