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Griffiths-Jones DJ, Garcia YS, Ryder WD, Pauling JD, Hall F, Lanyon P, Bhat S, Douglas K, Gunawardena H, Akil M, Anderson M, Griffiths B, Del Galdo F, Youssef H, Madhok R, Arthurs B, Buch M, Fligelstone K, Zubair M, Mason JC, Denton CP, Herrick AL. A Phase II randomized controlled trial of oral prednisolone in early diffuse cutaneous systemic sclerosis (PRedSS). Rheumatology (Oxford) 2023; 62:3133-3138. [PMID: 36637209 PMCID: PMC10473191 DOI: 10.1093/rheumatology/kead012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/13/2022] [Accepted: 12/26/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Although the painful and disabling features of early diffuse cutaneous SSc (dcSSc) have an inflammatory basis and could respond to corticosteroids, corticosteroids are a risk factor for scleroderma renal crisis. Whether or not they should be prescribed is therefore highly contentious. Our aim was to examine safety and efficacy of moderate-dose prednisolone in early dcSSc. METHODS PRedSS set out as a Phase II, multicentre, double-blind randomized controlled trial, converted to open-label during the Covid-19 pandemic. Patients were randomized to receive either prednisolone (∼0.3 mg/kg) or matching placebo (or no treatment during open-label) for 6 months. Co-primary endpoints were the HAQ Disability Index (HAQ-DI) and modified Rodnan skin score (mRSS) at 3 months. Over 20 secondary endpoints included patient reported outcome measures reflecting pain, itch, fatigue, anxiety and depression, and helplessness. Target recruitment was 72 patients. RESULTS Thirty-five patients were randomized (17 prednisolone, 18 placebo/control). The adjusted mean difference between treatment groups at 3 months in HAQ-DI score was -0.10 (97.5% CI: -0.29, 0.10), P = 0.254, and in mRSS -3.90 (97.5% CI: -8.83, 1.03), P = 0.070, both favouring prednisolone but not significantly. Patients in the prednisolone group experienced significantly less pain (P = 0.027), anxiety (P = 0.018) and helplessness (P = 0.040) than control patients at 3 months. There were no renal crises, but sample size was small. CONCLUSION PRedSS was terminated early primarily due to the Covid-19 pandemic, and so was underpowered. Therefore, interpretation must be cautious and results considered inconclusive, indicating the need for a further randomized trial. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT03708718.
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Affiliation(s)
- Deborah J Griffiths-Jones
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | | | - W David Ryder
- Manchester Clinical Trials Unit, The University of Manchester, Manchester, UK
| | - John D Pauling
- Department of Rheumatology, Royal United Hospitals Bath NHS Trust, Bath, UK
| | - Frances Hall
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter Lanyon
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, and Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Smita Bhat
- Department of Rheumatology, Ninewells Hospital and Medical School, Dundee, UK
| | - Karen Douglas
- Department of Rheumatology, Dudley Group NHSFT, Dudley, UK
| | - Harsha Gunawardena
- Rheumatology Department, North Bristol NHS Trust, and Academic Rheumatology, University of Bristol, Bristol, UK
| | - Mohammed Akil
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Marina Anderson
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Bridget Griffiths
- Department of Rheumatology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Francesco Del Galdo
- NIHR Biomedical Research Centre and Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Hazem Youssef
- Department of Rheumatology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Rajan Madhok
- Centre for Rheumatic Diseases, Glasgow Royal Infirmary, Glasgow, UK
| | - Barbara Arthurs
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Maya Buch
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Mohammed Zubair
- Research Governance and Integrity, The University of Manchester, Manchester, UK
| | - Justin C Mason
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
| | - Christopher P Denton
- Centre for Rheumatology, UCL Division of Medicine, Royal Free Campus, London, UK
| | - Ariane L Herrick
- NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Herrick AL, Griffiths-Jones DJ, Ryder WD, Mason JC, Denton CP. Clinical trial protocol: PRednisolone in early diffuse cutaneous Systemic Sclerosis (PRedSS). J Scleroderma Relat Disord 2020; 6:146-153. [PMID: 34222671 PMCID: PMC8216311 DOI: 10.1177/2397198320957552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/16/2020] [Indexed: 11/17/2022]
Abstract
Background: Many of the painful, disabling features of early diffuse cutaneous systemic
sclerosis have an inflammatory component and are potentially treatable with
corticosteroid therapy. These features include painful and itchy skin,
fatigue and musculoskeletal involvement. Yet many clinicians are
understandably reluctant to prescribe corticosteroids because of the concern
that these are a risk factor for scleroderma renal crisis. The aim of PRedSS
(PRednisolone in early diffuse cutaneous Systemic Sclerosis) is to evaluate
the efficacy and safety of moderate dose prednisolone in patients with early
diffuse cutaneous systemic sclerosis, specifically whether moderate dose
prednisolone is (a) effective in terms of reducing pain and disability, and
improving skin score and (b) safe, with particular reference to renal
function. Methods: PRedSS is a Phase II, multicentre, double-blind randomised controlled trial
which aims to recruit 72 patients with early diffuse cutaneous systemic
sclerosis. Patients are randomised to receive either prednisolone (dosage
approximately 0.3 mg/kg) or placebo therapy for 6 months. The two co-primary
outcome measures are the difference in mean Health Assessment Questionnaire
Disability Index at 3 months and the difference in modified Rodnan skin
score at 3 months. Secondary outcome measures include patient reported
outcome measures of itch, hand function, anxiety and depression, and
helplessness. Results: Recruitment commenced in December 2017 and after a slow start (due to delays
in opening centres) 25 patients have now been recruited. Conclusion: PRedSS should help to answer the question as to whether clinicians should or
should not prescribe prednisolone in early diffuse cutaneous systemic
sclerosis.
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Affiliation(s)
- Ariane L Herrick
- Division of Musculoskeletal and
Dermatological Sciences, Salford Royal NHS Foundation Trust, Manchester Academic
Health Science Centre, The University of Manchester, Manchester, UK
- Ariane L Herrick, Clinical Sciences
Building, Salford Royal Hospital, Stott Lane, Salford M6 8HD, UK.
| | - Deborah J Griffiths-Jones
- Division of Musculoskeletal and
Dermatological Sciences, Salford Royal NHS Foundation Trust, Manchester Academic
Health Science Centre, The University of Manchester, Manchester, UK
| | - W David Ryder
- Manchester Clinical Trials Unit, Jean
McFarlane Building, The University of Manchester, Manchester, UK
| | - Justin C Mason
- National Heart and Lung Institute,
Imperial College London, Hammersmith Hospital, London, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective
Tissue Diseases, University College London Division of Medicine, Royal Free Campus,
London, UK
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