Short course daily prednisolone therapy during an upper respiratory tract infection in children with relapsing steroid-sensitive nephrotic syndrome (PREDNOS 2): protocol for a randomised controlled trial.
BACKGROUND
Relapses of childhood steroid-sensitive nephrotic syndrome (SSNS) are treated with a 4- to 8-week course of high-dose oral prednisolone, which may be associated with significant adverse effects. There is a clear association between upper respiratory tract infection (URTI) and relapse development. Previous studies in developing nations have suggested that introducing a 5- to 7-day course of daily prednisolone during an URTI may prevent a relapse developing and the need for a treatment course of high-dose prednisolone. The aim of PREDNOS 2 is to evaluate the effectiveness of a 6-day course of daily prednisolone therapy during an URTI in reducing the development of a subsequent relapse in a developed nation.


METHODS
The subjects will be 300 children with relapsing SSNS (≥2 relapses in preceding year), who will be randomised to receive either a 6-day course of daily prednisolone or no change to their current therapy (with the use of placebo to double blind) each time they develop an URTI over 12 months. A strict definition for URTI will be used. Subjects will be reviewed at 3, 6, 9 and 12 months to capture data regarding relapse history, ongoing therapy and adverse effect profile, including behavioural problems and quality of life. A formal health economic analysis will also be performed. The primary end point of the study will be the incidence of URTI-related relapse (3 days of Albustix +++) following the first infection during the 12-month follow-up period. DNA and RNA samples will be collected to identify a potential genetic cause for the disease. Subjects will be recruited from over 100 UK centres with the assistance of the Medicines for Children Research Network.PREDNOS 2 is funded by the National Institute for Health Research Health Technology Assessment Programme (11/129/261).


CONCLUSIONS
We propose that PREDNOS 2 will be a pivotal study that will inform the future standard of care for children with SSNS. If it is possible to reduce the disease relapse rate effectively and safely, this will reduce the morbidity and cost associated with drug treatment, notwithstanding hospital admission and parental absence from employment.


BACKGROUND
Current Controlled Trials (ISRCTN10900733).
Department of Paediatric Nephrology and NIHR/Wellcome Trust Children's Clinical Research Facility, University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, UK. nicholas.webb@cmft.nhs.uk.
Nicholas J A
NJ
Webb
Emma
E
Frew
Elizabeth A
EA
Brettell
David V
DV
Milford
Detlef
D
Bockenhauer
Moin A
MA
Saleem
Martin
M
Christian
Angela S
AS
Hall
Ania
A
Koziell
Heather
H
Maxwell
Shivram
S
Hegde
Eric R
ER
Finlay
Rodney D
RD
Gilbert
Jenny
J
Booth
Caroline
C
Jones
Karl
K
McKeever
Wendy
W
Cook
Natalie J
NJ
Ives
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D016527:Drug Costs; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D009404:Nephrotic Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D011239:Prednisolone / Q000008:administration & dosage* / Q000191:economics; D012008:Recurrence; D012107:Research Design; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D005938:Glucocorticoids; D011239:Prednisolone