{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T03:11:01Z","timestamp":1790392261337,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,8,8]],"date-time":"2020-08-08T00:00:00Z","timestamp":1596844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>Published studies exploring the metabolic effects of Modified\u2010Release Hydrocortisone (MR\u2010HC) replacement in patients with adrenal insufficiency (AI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare metabolic effects of MR\u2010HC with Standard Glucocorticoid (SG) replacement in adults with AI. Randomized control trials (RCTs) were meta\u2010analysed; non\u2010RCT studies described narratively with critical appraisal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>PubMed\/Medline, EMBASE, CINAHL and CENTRAL were searched to identify relevant articles, published before Aug 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study selection<\/jats:title><jats:p>All study types that reported metabolic profile (including anthropometric, glucose and lipid\u2010related parameters), on patients switched from SG to MR\u2010HC replacement. Following independent screening from two reviewers, 390 studies were identified, of which 9 studies were included for review (RCT, n\u00a0=\u00a02; non\u2010RCT, n\u00a0=\u00a07).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data extraction<\/jats:title><jats:p>Two independent reviewers assessed each paper for bias and data extraction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Meta\u2010analysis from RCTs (n\u00a0=\u00a02), 104 patients were switched from SG to MR\u2010HC replacement. Combining treatment effects, at 3\u2010months post\u2010therapy switch there was significant reduction in body weight (\u22120.82\u00a0kg; 95% CI: \u22121.24\u00a0kg to \u22120.40\u00a0kg; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001) and HbA1c (\u22120.13%; 95% CI: \u22120.214% to \u22120.045%; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.003). In the sub\u2010group with Diabetes Mellitus (DM), reduction in HbA1C was more pronounced (\u22120.52%; 95% CI: \u22120.82% to \u22120.23%; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). Non\u2010RCT studies showed improved anthropometric measures and glucose metabolism up to 48\u2010months following switch from SG to MR\u2010HC replacement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In adults with AI, replacement with MR\u2010HC associates with significant improvements in anthropometric measurements and HbA1c compared with SG replacement, particularly those with DM.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14275","type":"journal-article","created":{"date-parts":[[2020,7,4]],"date-time":"2020-07-04T05:26:42Z","timestamp":1593840402000},"page":"637-651","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Systematic review and meta\u2010analysis of the metabolic effects of modified\u2010release hydrocortisone versus standard glucocorticoid replacement therapy in adults with adrenal insufficiency"],"prefix":"10.1111","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9108-2085","authenticated-orcid":false,"given":"Christopher A.","family":"Bannon","sequence":"first","affiliation":[{"name":"Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK"},{"name":"Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0506-9384","authenticated-orcid":false,"given":"Daniel","family":"Gallacher","sequence":"additional","affiliation":[{"name":"Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Hanson","sequence":"additional","affiliation":[{"name":"Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK"},{"name":"Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harpal S.","family":"Randeva","sequence":"additional","affiliation":[{"name":"Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK"},{"name":"Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK"},{"name":"Centre of Applied Biological &amp; Exercise Sciences Faculty of Health &amp; Life Sciences Coventry University Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin O.","family":"Weickert","sequence":"additional","affiliation":[{"name":"Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK"},{"name":"Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK"},{"name":"Centre of Applied Biological &amp; Exercise Sciences Faculty of Health &amp; Life Sciences Coventry University Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0689-9195","authenticated-orcid":false,"given":"Thomas M.","family":"Barber","sequence":"additional","affiliation":[{"name":"Division of Biomedical Sciences Warwick Medical School University of Warwick Coventry UK"},{"name":"Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism University Hospitals Coventry and Warwickshire Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.17-3-258"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-801238-3.99423-6"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-36-6-1043"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61684-0"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5362.887"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(68)90948-3"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2006-0076"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2003.12.036"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-17-0154"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-16-0969"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13999"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-019-01146-y"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1530\/EC-18-0418"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6823-12-8"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-1926"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-00346"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(17)30398-4"},{"key":"e_1_2_8_19_1","unstructured":"Covidence.Covidence Systematic Review Software.Veritas Health Innovation Melbourne Australia.www.covidence.org. 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