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CompletedNCT03210688ADAPTinMCNUpdated Jan 24, 2025

Active Vitamin D and Reduced Dose Prednisolone for Treatment in Minimal Change Nephropathy

A Phase 4 interventional study of Prednisolone and Alfacalcidol in Minimal Change Disease and Nephrotic Syndrome, sponsored by University of Aarhus. Completed at 2 sites in Denmark. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-01-24.

Sponsored by University of Aarhus · Phase 4, Interventional, and Treatment

Phase
Phase 4
Study type
Interventional
Enrollment
71
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Traditionally MCN is treated with a high dose of prednisolone, which induces remission in 60-90% of patients. Prednisolone treatment contains numerous side effects and the current dose is empiric. Given the lack of efficacy evidence and the risk associated with the currently accepted treatment regimen there is a need to characterize the outcome in MCN further, and to establish new, and potentially less toxic treatment regimens.

The aim is to examine if treatment with reduced dose of prednisolone in combination with activated vitamin D is as effective as standard high dose prednisolone in achieving remission and preventing relapse in MCN, and if reduced dose prednisolone is associated with fewer side effects compared to standard dose. Furthermore, the study will examine the influence of prednisolone metabolism on the efficacy and side effects of prednisolone in the treatment of MCN.

02

Conditions studied

  • Minimal Change Disease
  • Nephrotic Syndrome

Keywords

  • Prednisolone
  • alfacalcidol
  • Minimal change nephropathy
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Biopsy proven minimal change nephropathy
  • If earlier minimal change: No relapse in 5 years, and earlier only treated with prednisolone
  • Nephrotic syndrome
  • Age more than 18 years

Exclusion criteria

Exclusion Criteria:

  • Cancer except from basal cells carcinoma
  • Lymphoproliferative disease
  • Pregnancy
  • eGFR \< 30 ml/min/1,73m2 (CKD-EPI)
  • Allergy
  • No danish language
  • No ability to give informed prove
04

Study design

Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
71 participants (actual)

Study arms

  • Active comparator
    High dose prednisolone

    Prednisolone 1 mg/kg/day

    Drug: Prednisolone

  • Experimental
    Alfacalcidol and low dose prednisolone

    Alfacalcidol 0,5 microgram/day and Prednisolone 0,5 mg/kg/day

    Drug: Prednisolone · Drug: Alfacalcidol

Interventions

  • DrugPrednisolone

    Tablet prednisolone

    Also known as: Prednisone

  • DrugAlfacalcidol

    Capsule alfacalcidol 0,5 microgram/day

05

What researchers measure

Primary outcomes

  1. Remission

    Time from treatment to remission and the frequency of patients reaching remission on treatment

    Time frame: 4 to 16 weeks

Secondary outcomes

  1. Relapse

    Frequency of relapse

    Time frame: 4 weeks to 1 year after remission

  2. Side effects to treatment

    The side effects to prednisolone are assessed using questionnaires by both patients and doctors, including SF36 and Cushing QoL. The Glucocorticoid Toxicity Index will be used to quantitate prednisolone-related morbidity.

    Time frame: 4 weeks to 1 year after remission

  3. Concentration of Prednisolone in saliva

    Measurement of prednisolone metabolism by saliva test and genetic analysis of specific liver enzymes

    Time frame: 4 weeks after initiating prednisolone treatment

  4. Rates of genetic polymorphism, including HLA variations

    Genomic HLA typing (HLA-class I: A, B and C and HLA-class II: DM, DO, DP, DQ and DR) will be performed to examine if specific HLA-alleles are more frequent in patients with MCN. Potential modifying genes that theoretically have pathophysiological impact on MCN will be sequenced using targeted next generation sequencing.

    Time frame: Blood test at baseline

06

Study locations

2 sites
  • Aarhus University Hospital
    Aarhus, Denmark
  • Regional Hospital Viborg
    Viborg, Denmark
07

References and documents

Publications

  • Azukaitis K, Palmer SC, Strippoli GF, Hodson EM. Interventions for minimal change disease in adults with nephrotic syndrome. Cochrane Database Syst Rev. 2022 Mar 1;3(3):CD001537. doi: 10.1002/14651858.CD001537.pub5. PubMed 35230699 ↗
  • Kristensen T, Birn H, Ivarsen P. A randomised controlled unblinded multicentre non-inferiority trial with activated vitamin D and prednisolone treatment in patients with minimal change nephropathy (ADAPTinMCN). Trials. 2021 Jul 12;22(1):442. doi: 10.1186/s13063-021-05393-4. PubMed 34247632 ↗

Individual participant data

Plan to share: Undecided

08

Registry details

Key details

Study ID
NCT03210688
Lead sponsor
University of Aarhus
Responsible party
Sponsor
First posted
Jul 7, 2017
Start date
May 1, 2018
Primary completion
Feb 14, 2024
Completion
Jan 21, 2025
Last update
Jan 24, 2025

Study contacts

Per Ivarsen
study chair · Aarhus University Hospital

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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