About this trial
The goal of this clinical trial is to learn if dupilumab works to treat severe nephrotic syndrome in children. It will also learn about the safety of dupilumab.
The main questions it aims to answer are:
* Does dupilumab reduce the time to relapse of nephrotic syndrome? * What medical problems do participants have when taking dupilumab?
Researchers will compare dupilumab to a placebo (a look-alike substance that contains no drug) to see if dupilumab works to treat severe nephrotic syndrome.
Participants will:
* Receive an injection of dupilumab or placebo (just under the skin) every 2 weeks (if ≥30kg) or every 4 weeks (if \<30kg) for 24 weeks (6 months) * Wean down their prednisolone dose after starting the injections of dupilumab or placebo * Visit the clinic once every 2 weeks for checkups and tests * Keep a nephrotic diary to record down the urine dipstick result each day, together with the dose of prednisolone taken
If protein returns in participant's urine, they will have completed the study at that point. However, if the participant is found to have received the placebo, they will be offered to receive dupilumab for up to 24 weeks.
Eligibility criteria
Qualifiers
Age between 6 years old and 18 years old at the point of recruitment with idiopathic nephrotic syndrome with disease onset between 1-18 years old
Steroid-dependent disease or frequently relapsing disease prior to commencement of maintenance immunosuppression
On oral prednisolone +/- mycophenolate or levamisole only as maintenance therapy for 6 months or more, and with inadequate disease control or steroid toxicity on therapy
Nephrotic relapse or partial relapse (clinical or biochemical) within the last 1 year either unprovoked or during prednisolone wean, and which responded to increase in steroids
Disqualifiers
Pre-existing ophthalmological conditions except refractive errors, squint or mild cataract
Current symptoms of helminth infection or travel to endemic areas, unless helminth infection is excluded
eGFR (by Bedside Schwartz equation) <60 ml/min/1.73m2
Received Rituximab or other B-cell depleting agents within the last 1 year
Trial design
Treatments tested in this trial
- Dupilumab
- Placebo
- Co-intervention of Prednisolone wean during randomised controlled phase
- Dupilumab open label extension phase
- Co-intervention of Prednisolone wean during open label extension phase
Treatment groups
Sponsors and collaborators
National University Hospital, Singapore
Lead sponsor
National Medical Research Council (NMRC), Singapore
Collaborator
KK Women's and Children's Hospital
Collaborator
National University of Singapore
Collaborator