NeSST2: A Multi-stage Clinical Study to Develop a Non-invasive Short Synacthen Test (SST)

SCH/12/043

Recently there has been concern about the effect of inhaled steroids, routinely used in the treatment of asthma, on the body's ability to produce its natural stress hormone cortisol. Failure of adequate cortisol production in times of stress e.g. illness, can result in serious illness or death. Patients receiving longterm steroid treatment may have reduced levels of cortisol and not be able to produce adequate amounts in times of need, a process called adrenal suppression. Initially it was thought that the absorption of inhaled steroids into the bloodstream would be too low to cause adrenal suppression however high profile deaths followed by a national survey revealed a number of fatal or near fatal cases of adrenal suppression. The vast majority of these were in children. Since then doctors have been encouraged to ensure that children on high doses of inhaled steroids carry a steroid alert card and that the ability of their adrenal glands to produce adequate amounts of cortisol is checked. However it is unknown what dose of inhaled steroids puts one at risk, whether age or gender affects one's risk and when to check the function of the adrenal gland. The Short Synacthen Test (SST) investigates the ability of the body's adrenal glands to produce cortisol. Presently the SST requires intravenous (i.v) cannulation through which Synacthen is injected to stimulate the adrenal glands and multiple blood samples are collected to assess the response in terms of cortisol production. It is invasive, time consuming and unpleasant for the child. Our project aims to produce a noninvasive alternative to the current SST, with Synacthen given nasally and using saliva to measure the subsequent production of cortisol. A noninvasive test will allow us to establish the first normal ranges for children and determine which children with asthma are at risk of adrenal suppression.

2012-10-12

2025-12-01

2025-12-01

Recruiting

Early phase I

12

Inclusion Criteria: Stage 1b+c: • Healthy, male volunteers aged between 18-64 with none of the exclusion criteria listed below. Stage 2: • Healthy children of either sex, aged between 2 and 15 years (up to their 16th birthday) with none of the exclusion criteria listed below. Stage 3: • Healthy children of both sexes, aged between 0-18 years without exclusion criteria 1,2,3,5,6,7,8,9,10,11,12,14 listed below. Stage 4: • Asthmatic children of both sexes, aged between 6 months and 15 years, prescribed regular inhaled corticosteroids and without exclusion criteria 1,5,9,10,11,12, and 14 listed below. Exclusion Criteria: 1. Past or present history of an endocrinopathy (all stages) 2. Past or present history of asthma (stages 1b+c,2,3) 3. Past or present history of allergic rhinitis (stages 1b+c,2,3) 4. Past or present history of peptic ulcer disease/GI bleed/significant dyspepsia (stages 1b+c,2) 5. Past history of intra-cranial or renal/adrenal pathology (all stages) 6. Presently on any medication (stages 1b+c,2,3) 7. Presently, or within the last 3 months, been prescribed any type of corticosteroid (oral, inhaled, nasal, rectal, intravenous, intramuscular, intra-articular, intra-ocular, topical) (stages 1b+c,2,3) 8. Ever been prescribed a prolonged course of oral corticosteroids (more than 1 month) (stages 1b+c,2,3) 9. Previous adverse reaction (including mild hypersensitivity) to ACTH or Synacthen (all stages) 10. Previous severe allergic reaction or anaphylaxis (all stages) 11. Coryzal symptoms within the last week (and will be asked to report any new symptoms occurring within 24 hours of the test) (all stages) 12. Current smoker (all stages) 13. Body Mass Index less than 18.5 or more than 30kg/m2 (stages 1b+c) outside 3rd to 97th centiles for ages and sex (stage 2) 14. Currently pregnant (stages 2,3,4) 15. Currently anaemic (stages 1b+c,2)

{'studyType': 'INTERVENTIONAL', 'phases': ['PHASE2'], 'designInfo': {'allocation': 'RANDOMIZED', 'interventionModel': 'SINGLE_GROUP', 'interventionModelDescription': 'Current stage is stage 3 (Sept 2023), an open label study of nasal Synacthen in healthy children aged 0-18 to derived normative reference data.\n\nPrevious stages:\n\n1a: 12 healthy adult males, 4 arms (dose selection studying nasal synacthen 100 mcg + chitosan, 500 mcg and 500 mcg + chitosan against 1mcg IV Synacthen)\n\n1b: 6 healthy adult males 1 arm (repeatability: two further 500 mcg + chitosan visits)\n\n1c: 12 healthy adult males 3 arms (dose rangign study: 500 mcg + chitosan, 1mg + chitosan against 250 mcg IV Synacthen comparator) 2: Healthy children aged 2-15 (500 mcg + chitosan, against 145 mcg/m2 IV Synacthen comparator)', 'primaryPurpose': 'DIAGNOSTIC', 'maskingInfo': {'masking': 'NONE'}}, 'enrollmentInfo': {'count': 12, 'type': 'ESTIMATED'}}

2023-09-07