Comparison of Chronocort Versus Standard Hydrocortisone Replacement Therapy in Participants Aged 16 Years and Over With Congenital Adrenal Hyperplasia

Congenital Adrenal Hyperplasia Clinical Trial

— CONnECT  

Official title:

A Randomized, Double-Blind, Active-Controlled, Phase 3 Study of Chronocort Compared With Immediate-Release Hydrocortisone Replacement Therapy in Participants Aged 16 Years and Over With Congenital Adrenal Hyperplasia

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05063994
• Other study ID #: DIUR-014
• Status: Completed
• Phase: Phase 3
• Start date: December 13, 2021
• Est. completion date: February 2, 2024

Study information

• Verified date: March 2024
• Source: Diurnal Limited
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study is a randomized, double-blind, active-controlled, phase III study of Chronocort® compared with immediate-release hydrocortisone replacement therapy in participants aged 16 years and over with Congenital Adrenal Hyperplasia.

Description:

The study will compare the efficacy, safety and tolerability of twice daily Chronocort with twice daily immediate release hydrocortisone replacement therapy (IRHC) (Cortef®) over a randomized treatment period of up to 28 weeks in participants aged 16 years and over with known classic Congenital Adrenal Hyperplasia (CAH) due to 21 hydroxylase deficiency. The primary efficacy assessment of biochemical responder rate and the key secondary assessment of dose responder rate will be assessed after 28 weeks of randomized treatment.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 55
• Est. completion date: February 2, 2024
• Est. primary completion date: February 2, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 16 Years and older

Eligibility

Inclusion Criteria:

• Male or female participants must be aged 16 years or older at the time of signing the informed consent/assent.

• In participants aged <18 years, height velocity must be less than 2 cm/year in the last year and puberty must be completed (Tanner stage V).

• Participants with known classic CAH due to 21 hydroxylase deficiency diagnosed in childhood with documented (at any time) elevated 17-OHP and with or without elevated A4 and currently treated with hydrocortisone, prednisone, prednisolone or dexamethasone (or a combination of the aforementioned glucocorticoids) and on stable glucocorticoid therapy for a minimum of 3 months.

• Participants who are receiving fludrocortisone must be on a documented stable dose for a minimum of 3 months prior to enrollment and must have stable renin levels at screening.

• Female participants of childbearing potential and all male participants must agree to the use of an accepted method of contraception during the study.

• A female participant is eligible to participate if she is not pregnant, not breastfeeding, and she is either not a woman of childbearing potential (WOCBP) or has a negative pregnancy test at entry into the study. Note: females presenting with oligomenorrhea or amenorrhea who are aged =55 years should be considered potentially fertile and therefore should undergo pregnancy testing like all other female participants.

• Capable of giving signed informed consent/assent which includes compliance with requirements and restrictions listed in the informed consent form (ICF) and in this protocol.

Exclusion Criteria:

• Clinical or biochemical evidence of hepatic or renal disease e.g. creatinine >2 times the upper limit of normal (ULN) or elevated liver function tests (alanine aminotransferase [ALT] or aspartate aminotransferase [AST] >2 times the ULN).

• History of bilateral adrenalectomy.

• History of malignancy (other than basal cell carcinoma successfully treated >26 weeks prior to entry into the study).

• Participants who have type 1 diabetes or receive regular insulin, have uncontrolled diabetes, or have a screening HbA1c greater than 8%..

• Persistent signs of adrenal insufficiency or the participant does not tolerate treatment at the end of the 4-week run-in period.

• Participants with any other significant medical or psychiatric conditions that in the opinion of the Investigator would preclude participation in the study.

• Participants on regular daily inhaled, topical, nasal or oral steroids for any indication other than CAH.

• Co-morbid condition requiring daily administration of a medication or consumption of any material that interferes with the metabolism of glucocorticoids.

• Participants who are receiving <10 mg hydrocortisone dose at screening or the hydrocortisone dose equivalent.

• Participants anticipating regular prophylactic use of additional steroids e.g. for strenuous exercise.

• Participation in another clinical study of an investigational or licensed drug or device within the 12 weeks prior to screening.

• Inclusion in any natural history or translational research study that would require evaluation of androgen levels during the study period outside of this protocol's assessments.

• Participants who have previously been exposed to Chronocort in any Diurnal study.

• Participants who routinely work night shifts and so do not sleep during the usual night-time hours.

• Participants, who in the opinion of the Investigator, will be unable to comply with the requirements of the protocol.

• Participants with a known hypersensitivity to any of the components of the Chronocort capsules, the Cortef tablets, or the placebo capsules.

• Participants with congenital galactosemia, malabsorption of glucose and galactose, or who are lactase deficient.

• Participants with a body weight of 45 kg or less.

Related Conditions & MeSH terms

• Adrenal Hyperplasia, Congenital
• Adrenocortical Hyperfunction
• Adrenogenital Syndrome
• Congenital Adrenal Hyperplasia
• Hyperplasia

Intervention

Drug:
• Chronocort
Over-encapsulated hydrocortisone modified-release capsules for oral administration - 5mg and 10mg
• Cortef
Over-encapsulated immediate-release hydrocortisone capsules for oral administration - 5mg and 20mg

Locations

Country	Name	City	State
France	Diurnal Investigational Site in Pessac	Bordeaux
France	Diurnal Investigational Site in Caen	Caen	Normandy
France	Diurnal Investigational Site in Bron	Lyon
France	Diurnal Investigational Site in Paris	Paris
France	Diurnal Investigational Site in Toulouse	Toulouse
France	Diurnal Investigational Site in Toulouse (Children's Hospital)	Toulouse
Japan	Diurnal Investigational Site in Yushima	Bunkyo-Ku	Tokyo
Japan	Diurnal Investigational Site in Okura	Setagaya-Ku	Tokyo
Japan	Diurnal Investigational Site in Toyama	Shinjuku-Ku	Tokyo
Japan	Diurnal Investigational Site in Asahi-ku	Yokohama-shi	Kanagawa
United States	Diurnal Investigational Site in Michigan	Ann Arbor	Michigan
United States	Diurnal Investigational Site in Maryland	Bethesda	Maryland
United States	Diurnal Investigational Site in Dallas	Dallas	Texas
United States	Diurnal Investigational Site in Iowa	Iowa City	Iowa
United States	Diurnal Investigational Site in Jacksonville	Jacksonville	Florida
United States	Diurnal Investigational Site in Nevada	Las Vegas	Nevada
United States	Diurnal Investigational Site in Los Angeles	Los Angeles	California
United States	Diurnal Investigational Site in Milwaukee	Milwaukee	Wisconsin
United States	Diurnal Investigational Site in Orange	Orange	California
United States	Diurnal Investigational Site in Rochester	Rochester	Minnesota
United States	Diurnal Investigational Site in Seattle	Seattle	Washington

Sponsors (1)

Lead Sponsor	Collaborator
Diurnal Limited

Countries where clinical trial is conducted

United States,  France,  Japan, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment	This is one statistical measure of a combination of outcomes as listed below (menstrual regularity hirsutism, acne, TART, LH levels, sperm count, body weight, HbA1c, waist circumference, SF-36 and MAF). Outcomes for each measure are compared between individuals on a categorical basis - improved/not improved. Summary statistics of the outcomes show which arm has the most overall improvement in health status.	28 weeks
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment - Menstrual Regularity	The probability that a randomly chosen participant from the Chronocort arm shows more clinical benefit after 28 weeks of randomized treatment than a randomly chosen participant from the IRHC arm (the probability of net clinical benefit). The comparison between participants will be based on menstrual regularity, which is recorded using an electronic participant diary for all pre-menopausal women (only in pre menopausal women without hysterectomy and not using hormonal contraception)	28 weeks
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment - Hirsutism	The probability that a randomly chosen participant from the Chronocort arm shows more clinical benefit after 28 weeks of randomized treatment than a randomly chosen participant from the IRHC arm (the probability of net clinical benefit). The comparison between participants will be based on hirsutism (female only) using a Visual Analog Scale (VAS), which is a 10cm scale ranging from 'No Hair' to 'Most Hair Growth Ever Experienced' completed by participant and also objective hirsutism will be assessed by Investigator using the Ferriman-Gallway Score. A score of 1 to 4 is given for nine areas of the body. A total score less than 8 is considered normal, a score of 8 to 15 indicates mild hirsutism, and a score greater than 15 indicates moderate or severe hirsutism. A score of 0 indicates absence of terminal hair.	28 weeks
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment - Acne	The probability that a randomly chosen participant from the Chronocort arm shows more clinical benefit after 28 weeks of randomized treatment than a randomly chosen participant from the IRHC arm (the probability of net clinical benefit). The comparison between participants will be based on subjective acne (female only) using a Visual Analog Scale (VAS), which is a 10cm scale ranging from 'No Acne' to 'Worst Acne Ever' completed by the participant and also objective acne will be assessed using the Global Evaluation Acne (GEA) Scale, where a score of 1 to 5 is given by the Investigator, where 0 is 'Clear, no lesions', 1 is 'Almost clear. Almost no lesions', 2 is 'Mild', 3 is 'Moderate', 4 is 'Severe' and 5 is 'Very severe'.	28 weeks
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment - TART size	The probability that a randomly chosen participant from the Chronocort arm shows more clinical benefit after 28 weeks of randomized treatment than a randomly chosen participant from the IRHC arm (the probability of net clinical benefit). The comparison between participants will be based on TART size (men only) measured via ultrasound.	28 weeks
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment - LH Level	The probability that a randomly chosen participant from the Chronocort arm shows more clinical benefit after 28 weeks of randomized treatment than a randomly chosen participant from the IRHC arm (the probability of net clinical benefit). The comparison between participants will be based on LH levels (Men only).	28 weeks
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment - Sperm Count	The probability that a randomly chosen participant from the Chronocort arm shows more clinical benefit after 28 weeks of randomized treatment than a randomly chosen participant from the IRHC arm (the probability of net clinical benefit). The comparison between participants will be based on the sperm count (men only) measured by testing kit.	28 weeks
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment - Body weight	The probability that a randomly chosen participant from the Chronocort arm shows more clinical benefit after 28 weeks of randomized treatment than a randomly chosen participant from the IRHC arm (the probability of net clinical benefit). The comparison between participants will be based on body weight measured at every visit, with outer clothing and shoes removed.	28 weeks
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment - HbA1c	The probability that a randomly chosen participant from the Chronocort arm shows more clinical benefit after 28 weeks of randomized treatment than a randomly chosen participant from the IRHC arm (the probability of net clinical benefit). The comparison between participants will be based on HbA1c measured at each visit after visit 1.	28 weeks
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment - Waist Circumference	The probability that a randomly chosen participant from the Chronocort arm shows more clinical benefit after 28 weeks of randomized treatment than a randomly chosen participant from the IRHC arm (the probability of net clinical benefit). The comparison between participants will be based on waist circumference measured at every visit.	28 weeks
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment - SF-36®	The probability that a randomly chosen participant from the Chronocort arm shows more clinical benefit after 28 weeks of randomized treatment than a randomly chosen participant from the IRHC arm (the probability of net clinical benefit). The comparison between participants will be based on the self completed SF-36® total score. The SF-36 measures eight scales: physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). All components contribute in different proportions to the overall measures. Where the minimum score is 0 and maximum score is 100 and a high score is a more favorable score.	28 weeks
Other	To compare Chronocort to IRHC in terms of net clinical benefit after 28 weeks of randomized treatment - Multidimensional Assessment of Fatigue (MAF)	The probability that a randomly chosen participant from the Chronocort arm shows more clinical benefit after 28 weeks of randomized treatment than a randomly chosen participant from the IRHC arm (the probability of net clinical benefit). The comparison between participants will be based on the Multidimensional Assessment of Fatigue (MAF) score. The MAF is a 16 item scale that measures fatigue according to four dimensions: degree and severity, distress that it causes, timing of fatigue, and its impact on various activities of daily living, with a range of score from 1 - 10 per item to give a Global Fatigue Score of up to 50 with a high score indicating a worse outcome.	28 weeks
Other	To investigate the correlation between biochemical control at 10, 16 and 28 weeks after randomization with the total daily dose at the corresponding timepoints.	At each of 10, 16 and 28 weeks after randomization, investigate the total daily dose of steroid in participants in biochemical control.	10, 16 and 28 weeks of randomized treatment
Other	To compare Chronocort to IRHC in terms of the impact on QoL using the remaining self-completed SF-36® sub domains (excluding vitality).	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in QoL using the remaining self-completed SF 36® sub-domains (excluding vitality) will be summarized and compared between treatment arms. The SF-36 measures eight scales: physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). All components contribute in different proportions to the overall measures. Where the minimum score is 0 and maximum score is 100, a high score is a more favorable score.	Baseline to 4, 10, 16 and weeks of randomized treatment
Other	To compare Chronocort to IRHC in terms of the impact on the bone marker of osteocalcin.	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in osteocalcin levels will be summarized and compared between treatment arms.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Other	To compare Chronocort to IRHC in terms of the impact on alertness.	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in alertness will be summarized and compared between treatment arms. Alertness will be assessed using a Visual Analog Scale (VAS), which is a 10cm scale ranging from 'Brain Fog: unable to perform normal daily tasks' to 'Fully Alert: able to perform normal daily tasks easily'. A higher score indicates a better outcome.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Other	To compare Chronocort to IRHC in terms of the impact on 11 ketotestosterone.	The change from baseline to the end of 28 weeks of randomized treatment in serum 11 ketotestosterone levels will be summarized and compared between treatment arms.	28 weeks
Other	To compare Chronocort to IRHC in terms of the impact on dehydroepiandrosterone (DHEA)	The change from baseline to the end of 28 weeks of randomized treatment in serum DHEA levels will be summarized and compared between treatment arms.	28 weeks
Other	To compare Chronocort to IRHC in terms of the impact on total testosterone	The change from baseline to the end of 28 weeks of randomized treatment in serum total testosterone will be summarized and compared between treatment arms by sex.	28 weeks
Other	To compare Chronocort to IRHC in terms of the impact on follicle stimulating hormone (FSH) levels.	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in FSH levels (women only) will be summarized and compared between treatment arms.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Other	To assess dose changes over the study period - Incidence	The incidence of dose changes at each visit up to the end of 28 weeks of randomized treatment and overall will be summarized by treatment arm.	28 weeks
Other	To assess dose changes over the study period - Change in mg	The extent (in mg) of dose changes at each visit up to the end of 28 weeks of randomized treatment and overall will be summarized by treatment arm.	28 weeks
Other	To assess preference for treatment.	Participant preference for assigned treatment after 28 weeks of randomized treatment compared with previous treatments will be summarized by treatment arm. Preference of treatment will be assessed using a Visual Analog Scale (VAS), which is a 10cm scale where 0 indicates 'Strongly agree' and 10 indicates 'Strongly disagree', when asked if the participant prefers the study medication over their usual Hydrocortisone medication.	28 weeks
Other	To assess the safety and tolerability of Chronocort relative to IRHC.	The incidence, nature, severity, relatedness, duration, outcome, seriousness and expectedness of treatment emergent adverse events (TEAEs) will be tabulated by treatment arm. AEs of special interest will additionally be tabulated separately, with particular note of adrenal crises.	28 weeks
Other	To assess the need for use of additional glucocorticoid doses by recording of use of stress dosing rules - Incidence of use	The use of medication from the stress dosing packs or use of any additional glucocorticoid treatment during the study will be tabulated by treatment arm and recorded as incidence of use.	28 weeks
Other	To assess the need for use of additional glucocorticoid doses by recording of use of stress dosing rules - Duration of use	The use of medication from the stress dosing packs or use of any additional glucocorticoid treatment during the study will be tabulated by treatment arm and recorded as duration of use.	28 weeks
Other	To assess the need for use of additional glucocorticoid doses by recording of use of stress dosing rules - Dose of steroid	The use of medication from the stress dosing packs or use of any additional glucocorticoid treatment during the study will be tabulated by treatment arm and recorded as dose of steroid (in mg).	28 weeks
Other	To evaluate the safety of Chronocort compared to IRHC by assessment of safety laboratory assessments by number of participants with changes in safety laboratory assessments.	Safety laboratory assessments including hematology, clinical chemistry and urinalysis will be conducted at each visit after randomized treatment and their changes from baseline will be summarized by treatment arm and aggregated to number of participants with changes in safety laboratory assessments.	28 weeks (Assessed at baseline, 4, 10, 16 and 28 weeks)
Other	To evaluate the safety of Chronocort compared to IRHC by assessment of physical examination by number of participants with changes in physical examination.	A full physical examination to assess the participant's general appearance and overall health will be carried out and aggregated to number of participants with changes in physical examination.	28 weeks (Assessed at baseline and 28 weeks)
Other	To evaluate the safety of Chronocort compared to IRHC by assessment of vital signs by number of patients with changes in vital signs.	Vital signs will be measured at baseline, 4, 10, 16 and 28 weeks and their changes from baseline will be summarized by treatment arm and aggregated to number of participants with changes in vital signs.	28 weeks (Assessed at baseline, 4, 10, 16 and 28 weeks)
Other	To evaluate the safety of Chronocort compared to IRHC by assessment of electrocardiogram (ECG) by number of patients with changes in ECG.	A single 12-lead ECG will be recorded at baseline and 28 weeks and their changes from baseline will be summarized by treatment arm and aggregated to number of participants with changes in ECG.	28 weeks (Assessed at baseline and 28 weeks)
Primary	To compare Chronocort to IRHC in terms of biochemical responder rate after 28 weeks of randomized treatment - 17-OHP concentration	Biochemical control defined as a 17-OHP concentration equal to or below the upper limit for optimal control.	28 weeks
Primary	To compare Chronocort to IRHC in terms of biochemical responder rate after 28 weeks of randomized treatment - A4 concentration	Biochemical control defined as a A4 concentration equal to or below the upper limit for optimal control.	28 weeks
Primary	To compare Chronocort to IRHC in terms of biochemical responder rate after 28 weeks of randomized treatment - Total daily dose of Hydrocortisone	Biochemical control defined as receiving after 28 weeks of randomized treatment a total daily dose of hydrocortisone of not more than 25 mg (if the participant was in biochemical control at baseline) or not more than 30 mg (if the participant was not in biochemical control at baseline).	28 weeks
Secondary	To compare Chronocort to IRHC in terms of dose responder rate after 28 weeks of randomized treatment - Total daily dose	A dose responder defined as a participant receiving after 28 weeks of randomized treatment a total daily dose of hydrocortisone of not more than 25 mg.	28 weeks
Secondary	To compare Chronocort to IRHC in terms of dose responder rate after 28 weeks of randomized treatment - 17-OHP concentration	A dose responder defined as a participant in biochemical control at the 08:00 hours assessment after 28 weeks of randomized treatment (where in biochemical control is defined as a 17-OHP concentration equal to or below the upper limit for optimal control.	28 weeks
Secondary	To compare Chronocort to IRHC in terms of dose responder rate after 28 weeks of randomized treatment - A4 concentration	A dose responder defined as a participant in biochemical control at the 08:00 hours assessment after 28 weeks of randomized treatment (where in biochemical control is defined as an A4 concentration equal to or below the upper limit for optimal control.	28 weeks
Secondary	To compare Chronocort to IRHC in terms of total daily dose after 28 weeks of randomized treatment.	The total daily dose (mg) after 28 weeks of randomized treatment. The difference (Chronocort minus IRHC) between the mean total daily dose after 28 weeks of randomized treatment in each treatment arm will be estimated in the Fatigue Assessment Scale (FAS). Superiority of Chronocort to IRHC with respect to total daily dose after 28 weeks of randomized treatment will be declared if the 95% CI for the difference in means lies wholly below zero, provided that dose superiority of Chronocort to IRHC has been declared under the first key secondary efficacy objective.	28 weeks
Secondary	To compare Chronocort to IRHC in terms of biochemical responders at 4, 10, 16, and 28 weeks after randomization.	Whether or not the participant is a biochemical responder at 08:00 hours at 4, 10, 16 and 28 weeks after randomization are compared between treatment arms by calculating the difference in proportion of participants responding. These outcome variables are to be analyzed in the same manner as the primary efficacy outcome variable.	4, 10, 16 and 28 weeks after randomization
Secondary	To compare Chronocort to IRHC in terms of dose responders at 10, 16, and 28 weeks after randomization.	Whether or not the participant is a dose responder at 08:00 hours at 10, 16 and 28 weeks after randomization are compared between treatment arms by calculating the difference in proportion of participants responding. These outcome variables are to be analyzed in the same manner as the first key secondary outcome variable.	10, 16 and 28 weeks after randomization
Secondary	To compare Chronocort to IRHC in terms of total daily dose at 10, 16, and 28 weeks after randomization.	Total daily dose at 10, 16 and 28 weeks after randomization are compared between treatment arms by calculating the difference in mean total daily dose. These outcome variables are to be analyzed in the same manner as the second key secondary outcome variable.	10, 16 and 28 weeks after randomization
Secondary	To compare Chronocort to IRHC in terms of biochemical control at 10, 16, and 28 weeks after randomization.	Whether or not the participant is in biochemical control (provided total daily dose is not more than 30 mg) at 08:00 hours at 4, 10, 16 and 28 weeks after randomization are compared between treatment arms by calculating the difference in proportion of participants in control.	4, 10, 16 and 28 weeks after randomization
Secondary	To compare Chronocort to IRHC in terms of the impact on 17 OHP range.	The difference between the 08:00 and 13:00 measurements of 17-OHP levels at 4, 10, 16 and 28 weeks after randomization and their changes from baseline will be summarized and compared between treatment arms.	4, 10, 16 and 28 weeks after randomization
Secondary	To compare Chronocort to IRHC in terms of the impact on A4 range	The difference between the 08:00 and 13:00 measurements of A4 levels at 4, 10, 16 and 28 weeks after randomization and their changes from baseline will be summarized and compared between treatment arms.	4, 10, 16 and 28 weeks after randomization
Secondary	To compare Chronocort to IRHC in terms of the impact on mean 17-OHP and A4	The mean of the 08:00 and 13:00 measurements of 17-OHP levels and A4 levels at 4, 10, 16 and 28 weeks after randomization and their changes from baseline will be summarized and compared between treatment arms.	4, 10, 16 and 28 weeks after randomization
Secondary	To compare Chronocort to IRHC in terms of the impact on glucocorticoid dose - Total daily dose	The total daily glucocorticoid dose at 4, 10, 16 and 28 weeks after randomization will be summarized and compared between treatment arms.	4, 10, 16 and 28 weeks after randomization
Secondary	To compare Chronocort to IRHC in terms of the impact on glucocorticoid dose - Biochemical control	The relationship between daily glucocorticoid dose and biochemical control at 28 weeks after randomization will be explored.	28 weeks
Secondary	To compare Chronocort to IRHC in terms of changes in menstrual regularity.	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in menstrual regularity (only in pre menopausal women without hysterectomy and not using hormonal contraception) will be summarized and compared between treatment arms.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on luteinizing hormone (LH) levels.	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in LH levels (men only) will be summarized and compared between treatment arms.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on testicular adrenal rest tumors (TART) size.	The change from baseline to 28 weeks of randomized treatment in size of TART (men only) will be summarized and compared between treatment arms.	Baseline to 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on sperm count.	The change from baseline to 28 weeks of randomized treatment in sperm count (men only) will be summarized and compared between treatment arms.	Baseline to 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on subjective hirsutism in female participants	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in subjective hirsutism using a Visual Analog Scale (VAS) (women only), which is a 10cm scale ranging from 'No Hair' to 'Most Hair Growth Ever Experienced' will be summarized and compared between treatment arms.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on objective hirsutism in female participants	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in objective hirsutism using the Ferriman-Gallwey score (women only) will be summarized and compared between treatment arms.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on subjective acne in female participants.	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in subjective acne using a VAS (women only) will be summarized and compared between treatment arms. The scale used is a 10cm scale ranging from 'No Acne' to 'Worst Acne Ever'.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on objective acne in female participants	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in objective acne using the Global Evaluation Acne (GEA) scale (women only) will be summarized and compared between treatment arms. A score of 1 to 5 is given by the Investigator where 0 is 'Clear, no lesions', 1 is 'Almost clear. Almost no lesions', 2 is 'Mild', 3 is 'Moderate', 4 is 'Severe' and 5 is 'Very severe'.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on glycated hemoglobin (HbA1c) levels.	The change from screening to 4, 10, 16 and 28 weeks of randomized treatment in HbA1c levels will be summarized and compared between treatment arms.	Screening to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on waist circumference.	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in waist circumference will be summarized and compared between treatment arms.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on body weight.	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in body weight will be summarized and compared between treatment arms.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on Quality of Life (QoL) using the self-completed Medical Outcome Study 36-Item Short Form Health Survey (SF-36®) total score and the sub domain of vitality.	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in QoL using the self completed SF-36® total score and the sub domain of vitality will be summarized and compared between treatment arms. The SF-36 measures eight scales: physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). All components contribute in different proportions to the overall measures. Where the minimum score is 0 and maximum score is 100 and a high score is a more favorable score.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on QoL using the Multidimensional Assessment of Fatigue (MAF).	The MAF is a 16 item scale that measures fatigue according to four dimensions: degree and severity, distress that it causes, timing of fatigue, and its impact on various activities of daily living, with a range of score from 1 - 10 per item to give a Global Fatigue Score of up to 50 with a high score indicating a worse outcome.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To compare Chronocort to IRHC in terms of the impact on QoL using the EuroQol 5 level Standardized Health Questionnaire (EQ-5D-5L™).	The change from baseline to 4, 10, 16 and 28 weeks of randomized treatment in QoL using the EQ-5D-5L™ will be summarized and compared between treatment arms.The EQ-5D-5L is a self-assessed, QoL questionnaire. The scale measures on a 5-component scale including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Where the minimum score is 0 and maximum score is 100, a high score indicates a more favorable outcome.	Baseline to 4, 10, 16 and 28 weeks of randomized treatment
Secondary	To assess compliance over the study period.	The percentage treatment compliance between visits and overall will be summarized	28 weeks