Evaluation of a Nurse-led Program for the Prevention of Complications of Long-term Corticosteroid Therapy

NCT ID: NCT04909606

Last Updated: 2025-03-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

191 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-04-26

Study Completion Date

2026-10-31

Brief Summary

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Long term corticosteroid therapy concerns 0.5 to 1% of the population and about 2.5% of elderly subjects. It is currently used as a cornerstone therapy in a wide variety of clinical contexts. The central problematic of prolonged corticosteroid therapy is the burden of adverse events associated with its long term use, including bone, metabolic and infectious complications.

The management of patients for whom the prescription of long term corticosteroid therapy is indicated should include an evaluation of the individual risk and implementation of the appropriate preventive measures. Such an approach should particularly include cortisonic osteoporosis prevention, infectious prevention including vaccination, prevention of adrenal insufficiency, promotion of physical activity, as well as dietary management.

In France, nurse-led prevention programs are highly developed for patients initiating immunosuppressive targeted therapies. Conversely, there are no dedicated nurse-led programs for patients starting prolonged corticosteroid therapy, for several historical and economical reasons.

The implementation of such programs is likely to be beneficial at different levels, including the reduction of the number of adverse events and improvement of health-related quality of life.

The main objective of the study is to determine the long-term benefit of a nurse-led prevention program among patients starting long-term corticosteroids therapy, compared to routine care.

Detailed Description

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It is a PROBE (Prospective Randomized Open trial with a Blind Evaluation) study, in which the primary endpoint will be assessed at week-52 by an independent physician blinded to the participant's allocation group.

The target population is adult patients initiating a first sequence of long term corticosteroid therapy, to the exception of onco-hematological indications, severe chronic renal failure and organ transplant.

Patients in both groups will have baseline and week-52 standardized visits including clinical evaluation, routine biology, dual-energy X-ray absorptiometry and quality of life assessment (SF-36). Corticosteroid consumption will be collected throughout the study using a dedicated notebook. At the week-52 visit, the burden of adverse events related to the use of corticosteroids will be assessed through the glucocorticoid toxicity index (GTI), completed by the blinded physician.

Conditions

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Long Term Corticosteroid Therapy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Nurse-led prevention program

Patients will receive a general summary sheet of preventive measures associated with long term corticosteroids therapy (no individual assessment) in addition to the usual care provided by their physician

Group Type EXPERIMENTAL

nurse-led prevention program

Intervention Type OTHER

Subjects randomized to the nurse-led prevention program group will be evaluated by the dedicated nurse within 2 weeks following randomization (individual assessment)

The nurse-led prevention program will include:

1. A video explaining corticosteroids related adverse events and adequate preventive measures
2. An individual interview with the trained nurse
3. A consultation with a dietetician
4. An individual sheet summarizing appropriate non-pharmacological preventive measures for the participant
5. An individual sheet summarizing appropriate pharmacological preventive measures for the referent physician
6. Phone calls at week-12, week-24 and week-36 to ensure the appropriate implementation of preventive measures

Standard of care

Subjects randomized to the nurse-led prevention program group will be evaluated by the dedicated nurse within 2 weeks following randomization (individual assessment)

Group Type ACTIVE_COMPARATOR

Current care

Intervention Type OTHER

Subjects randomized to the standard of care group will receive a general summary sheet of preventive measures associated with long term corticosteroids therapy (no individual assessment) in addition to the usual care provided by their physician

Interventions

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nurse-led prevention program

Subjects randomized to the nurse-led prevention program group will be evaluated by the dedicated nurse within 2 weeks following randomization (individual assessment)

The nurse-led prevention program will include:

1. A video explaining corticosteroids related adverse events and adequate preventive measures
2. An individual interview with the trained nurse
3. A consultation with a dietetician
4. An individual sheet summarizing appropriate non-pharmacological preventive measures for the participant
5. An individual sheet summarizing appropriate pharmacological preventive measures for the referent physician
6. Phone calls at week-12, week-24 and week-36 to ensure the appropriate implementation of preventive measures

Intervention Type OTHER

Current care

Subjects randomized to the standard of care group will receive a general summary sheet of preventive measures associated with long term corticosteroids therapy (no individual assessment) in addition to the usual care provided by their physician

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients aged 18 or older
* Initiation of corticosteroids within 30 days prior to inclusion
* Estimated cumulative dosage of corticosteroids ≥ 2000 mg
* Affiliated member of the social security system

Exclusion Criteria

* Patients unable to give consent or unable to understand the protocol
* A patient who is not 'or is no longer' able to communicate remotely by telephone could not 'or no longer' be included in the study.
* Patients under guardianship
* Previous exposure to long-term corticosteroids
* Prescription of corticosteroids for the management of malignant neoplasms
* Severe chronic renal failure with clearance of creatinine \< 30 ml/min.
* History of organ transplantation
* Pregnant or breastfeeding women
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Brest

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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CHU Brest

Brest, , France

Site Status RECRUITING

CH La Rochelle

La Rochelle, , France

Site Status RECRUITING

CH Le Mans

Le Mans, , France

Site Status ENROLLING_BY_INVITATION

CH Le Puy en Velay

Le Puy-en-Velay, , France

Site Status RECRUITING

CH de Morlaix

Morlaix, , France

Site Status ENROLLING_BY_INVITATION

Countries

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France

Central Contacts

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Solen NICOL

Role: CONTACT

+33298145015

Dewi GELLEC, PH

Role: CONTACT

Facility Contacts

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Solen NICOL

Role: primary

+3302 98 14 50 15

Dewi GUELLEC, PH

Role: backup

Ophélie DUVAL

Role: primary

05 16 49 41 65

Sophie LENGAGNE, IDE

Role: primary

04 71 04 35 26

Benjamin CASTAGNE, Dr

Role: backup

04 71 04 14 03

Other Identifiers

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29BRC20.0119

Identifier Type: -

Identifier Source: org_study_id

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