Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
John Cavenagh, MBA, PhD, PA-C
OBJECTIVE: The objective of this selective systematic review is to determine whether or not continuous subcutaneous hydrocortisone infusion (CSHI) therapy improves vitality in adult patients with Addison’s disease when compared to oral hydrocortisone therapy.
STUDY DESIGN: This systematic review used three peer reviewed articles published in English. The articles were a crossover randomized control trial, a double bind placebo controlled clinical trial, and a case series published from 2007 to 2014.
DATA SOURCES: The crossover randomized control trial and the double blind, placebo randomized control trial compared adult patients with Addison’s disease vitality scores when taking oral hydrocortisone tablets to continuous subcutaneous hydrocortisone infusion therapy. The case series followed 7 patients with Addison’s disease when taking continuous subcutaneous hydrocortisone infusion therapy and measured their vitality scores. The peer reviewed articles were found using PubMed and Google Scholar.
OUTCOMES MEASURED: Vitality, the primary outcome, was measured by the Short Form-36 Health Survey (SF-36).
RESULTS: Data for all three articles was continuous and p-values were reported. The Lovas et al study reported a p-value of <0.05 and concluded that vitality scores are higher in patients with Addison’s disease taking CSHI therapy compared to their original therapy. The Gagliardi et al study and the Oksnes et al study report p values >0.05 suggesting that vitality scores comparing CSHI therapy to oral hydrocortisone therapy is not significantly different.
CONCLUSIONS: The data is inconclusive in determining if continuous subcutaneous hydrocortisone therapy improves vitality in patients with Addison’s disease compared to oral hydrocortisone therapy.
Rivas, Vanessa, "Does continuous subcutaneous hydrocortisone infusion therapy improve vitality in adult patients with Addison’s Disease when compared to oral hydrocortisone therapy?" (2018). PCOM Physician Assistant Studies Student Scholarship. 318.