Return of #TenTweetNephJC
✳️Rapid #NephJC catch-up✳️
Cochrane & KDIGO recommend children with steroid-sensitive nephrotic syndrome (SSNS) take low dose pred during upper resp tract infection (URTI) to ⬇️relapse risk, based on 4 small studies - does this hold up in a big RCT?
✳️Rapid #NephJC catch-up✳️
Cochrane & KDIGO recommend children with steroid-sensitive nephrotic syndrome (SSNS) take low dose pred during upper resp tract infection (URTI) to ⬇️relapse risk, based on 4 small studies - does this hold up in a big RCT?
What did I miss?
We actually covered two studies this week in collaboration with @ipnajc but we can’t do both in #TenTweetNephJC! We’ll focus on the PREDNOS-2 trial.
jamanetwork.com/journals/jamap…
We actually covered two studies this week in collaboration with @ipnajc but we can’t do both in #TenTweetNephJC! We’ll focus on the PREDNOS-2 trial.
jamanetwork.com/journals/jamap…
1 tweet methods
✅ 122 centres in UK
✅ Prospective, double-blind, placebo-controlled RCT
✅ Children aged 1-18, with 2 or more SSNS relapses in last year
✅ 6 days low dose pred, or placebo, at start of URTI
✅ Did they get proteinuria +++ or worse over next fortnight?
✅ 122 centres in UK
✅ Prospective, double-blind, placebo-controlled RCT
✅ Children aged 1-18, with 2 or more SSNS relapses in last year
✅ 6 days low dose pred, or placebo, at start of URTI
✅ Did they get proteinuria +++ or worse over next fortnight?
1 tweet results
🔹 56/134 in prednisolone arm had relapse of SSNS, versus 58/137 in placebo group (p=0.70)
🔹 56/134 in prednisolone arm had relapse of SSNS, versus 58/137 in placebo group (p=0.70)
Visual abstract literature review
Hats off to @ArchanaVajjala for this one - nicely shows PREDNOS-2 has a more robust design than previous studies, and is larger than all the others added together!
Hats off to @ArchanaVajjala for this one - nicely shows PREDNOS-2 has a more robust design than previous studies, and is larger than all the others added together!
Give me something clever to say
“The prior data led us astray - after all, a major drawback of crossover trials is that the effects of the 1st treatment can influence the response to the 2nd. These ‘carryover effects’, without a long enough washout period, can spoil a trial.”
“The prior data led us astray - after all, a major drawback of crossover trials is that the effects of the 1st treatment can influence the response to the 2nd. These ‘carryover effects’, without a long enough washout period, can spoil a trial.”
What was the consensus?
1️⃣ We can only do so many huge, 7 year, SSNS trials - this question is as settled as it will ever be, & repeating it would be a waste
2️⃣ >40% in our polls do use extra pred to try to prevent relapse during URTI ➡️ likely to be a practice-changing study!
1️⃣ We can only do so many huge, 7 year, SSNS trials - this question is as settled as it will ever be, & repeating it would be a waste
2️⃣ >40% in our polls do use extra pred to try to prevent relapse during URTI ➡️ likely to be a practice-changing study!
Quote of the fortnight!
“Small studies are cheaper and easier. They just don’t get us anywhere meaningful.”
@rheault_m
“Small studies are cheaper and easier. They just don’t get us anywhere meaningful.”
@rheault_m
https://twitter.com/rheault_m/status/1486172213262880772?s=21
I want more info
✅ Follow @Nichola70822357 & @profnickwebb (plus @ipnajc & @IPNA_PedNeph!)
✅ Read the fantastic summary of PREDNOS-2 (and the other paediatric SSNS pred trial!) from @JanaSharara
nephjc.com/news/prednos2
✅ Review the very nice VA by @drM_sudha
✅ Follow @Nichola70822357 & @profnickwebb (plus @ipnajc & @IPNA_PedNeph!)
✅ Read the fantastic summary of PREDNOS-2 (and the other paediatric SSNS pred trial!) from @JanaSharara
nephjc.com/news/prednos2
✅ Review the very nice VA by @drM_sudha
Final thoughts
✳️ There’s nothing like a great RCT to make your 281 page GN guideline out of date as soon as it’s published….
➡️ Next #NephJC - getting the timing of dialysis right in advanced CKD. See you 8 & 9 Feb!
bmj.com/content/375/bm…
Tweetorial by @jamiekwillows
✳️ There’s nothing like a great RCT to make your 281 page GN guideline out of date as soon as it’s published….
➡️ Next #NephJC - getting the timing of dialysis right in advanced CKD. See you 8 & 9 Feb!
bmj.com/content/375/bm…
Tweetorial by @jamiekwillows
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