Summary of findings 3. HC (10 mg/m²/day to 15 mg/m²/day) versus PD (2.4 mg/m²/day to 3.5 mg/m²/day) for treating CAH.
| HC (10 mg/m²/day to 15 mg/m²/day) versus PD (2.4 mg/m²/day to 3.5 mg/m²/day) for treating CAH | ||||||
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Patient or population: people with CAH Settings: outpatients, tertiary centre Intervention: HC (10 mg/m²/day to 15 mg/m²/day) Comparison: PD (2.4 mg/m²/day to 3.5 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 | |||||
| PD | HC | |||||
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QoL Follow‐up: 1 year |
Outcome not reported. | NA | NA | NA | ||
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Androgen normalisation Follow‐up: 1 year |
17 OHP (nmol/L) The mean level of 17 OHP across the prepubertals and pubertals group in the control group was 1737.00 nmol/L. |
17 OHP (nmol/L) The mean level of 17 OHP was 1189.10 nmol/L higher (51.08 lower to 2429.28 higher) with HC. |
44 (1 trial) |
⊕⊝⊝⊝a,b,c very low |
17 OHP (nmol/L) Data reported separately for pubertal and pre‐pubertal participants. Neither individual result was significant; for the pre‐pubertal participants, MD 1436.00 nmol/L (95% CI ‐127.38 to 2999.38) and for pubertal participants, MD 770.00 nmol/L (95% CI ‐1266.86 to 2806.86). |
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Androstenedione (nmol/L) The mean level of androstenedione across the prepubertals and pubertals group in the control group was 126.00 nmol/L |
Androstenedione (nmol/L) The mean level of androstenedione in the HC group was 57.75 nmol/L higher (11.19 higher to 104.31 higher). |
44 (1 trial) |
⊕⊝⊝⊝a,b,c very low |
Androstenedione (nmol/L) Data reported separately for pubertal and pre‐pubertal participants. Neither individual result was significant; for the pre‐pubertal participants, MD 63.00 nmol/L (95% CI ‐4.57 to 130.57) and for pubertal participants, MD 53.00 nmol/L (95% CI ‐11.25 to 117.25). |
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Testosterone (nmol/L) The mean testosterone level across the prepubertals and pubertals group in the control group was 82.00 nmol/L. |
Testosterone (nmol/L) The mean testosterone level in the hydrocortisone group was 38.55 nmol/L higher (6.48 lower to 83.58 higher). |
44 (1 trial) | ⊕⊝⊝⊝a,b,c very low |
Testosterone (nmol/L) Data reported separately for pubertal and pre‐pubertal participants. Neither individual result was significant; for the pre‐pubertal participants, MD 35.00 nmol/L (95% CI ‐29.13 to 99.13) and for pubertal participants, MD 42.00 nmol/L (95% CI ‐21.24 to 105.24). |
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Prevention of adrenal crisis Follow‐up: 1 year |
Outcome not reported. | NA | NA | NA | ||
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Presence of osteopenia Follow‐up: 1 year |
Outcome not reported. | NA | NA | NA | ||
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Presence of testicular or ovarian adrenal rest tumours Follow‐up: 1 year |
Outcome not reported. | NA | NA | NA | ||
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Subfertility Follow‐up: 1 year |
Outcome not reported. | NA | NA | NA | ||
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Final adult height Follow‐up: 1 year |
The mean height velocity in the PD group was 1.12. | The mean height velocity in the HC group was 0.26 higher (0.82 lower to 1.34 higher). | 44 (1 trial) |
⊕⊝⊝⊝a,b,c very low | The results are for height velocity which is a surrogate measure for final adult height. The ratio of bone age to chronological age (a further surrogate marker for final adult height) was also measured and results suggest no difference between the groups, MD 0.15 (95% CI ‐0.03 to 0.33). |
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| *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; MD: mean difference; 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 once due to imprecision: outcome was downgraded due to imprecision and uncertainty, very large CIs around the MD.