Our goal is to produce core outcome sets of patient-rated and family care giver-rated Fluid Overload (FO) measures that can be applied across the FO severity continuum, developed for regulatory use. We propose to develop and validate a core set of publicly available clinical outcome assessments (COAs) of fluid overload (FO) as they relate to a range of chronic disorders that cause nephrotic syndrome (NS). These COAs will assess FO and its contribution to symptom burden, as well as impact on health-related quality of life (HRQOL). We anticipate creating patient-reported outcomes (PRO) and observer-reported outcomes (ObsRO).
In the two-year UG3 planning phase (2021-2023), we will work with a broad range of stakeholders, experts, and the FDA, to consider NS-associated FSGS, MCD and MN as an initial list of conditions and define a final target FO-associated set of diseases that are chronic, symptomatic, and have an impact on daily function and HRQOL (e.g., activities of daily living and instrumental activities of daily living). We propose to examine the relationships between self-reported FO, symptom burden, and HRQOL among both children and adults. Following extensive literature review and analysis of qualitative and quantitative data collected as part of our prior research, in collaboration with FDA investigators, we will conduct a gap analysis to refine and expand this set of COAs covering a range of FO content (e.g., edema, mobility, pain), impairment severity, and respondent type.
UG3 Phase Aims
Aim 1: To convene stakeholders, including patients, family care givers, clinicians, measurement experts, payers, regulators, and pharmaceutical industry representatives, around the topic of FO as it relates to approval of new drugs.
Aim 2: To confirm model conditions in which to test measures of FO with a spectrum of mild to severe FO-associated impairments, and then identify gaps, if any, in our proposed FO measures.
Aim 3: To propose interim and final plans for refining and testing FO PRO and ObsRO based on the FSGS-MCD PRO v1, newly collected information, and gap analysis.
Aim 4: To develop an ObsRO fit for use by parents/guardians of children with FO caused by nephrotic syndrome.
In the three-year UH3 implementation phase (2023-2026), we begin to conduct the approved research required for validation and in accordance with FDA recommendations. All work will draw on the input of stakeholders from the patient, family care giver, clinical, regulatory, payer, pharmaceutical industry, and researcher perspectives. Modification to the PROs and ObsROs proposed in the UG3 will derive from the FSGS-MCD PRO and PROMIS item banks. The FO measures will comprise a cross-cutting COA core set responsive to this grant mechanism.
UH3 Phase Aims
Aim 1: To produce a full-range FO PRO derived from mixed-methods research, preliminary FSGS-MCD PRO measures, and relevant PROMIS item banks.
Aim 2: To produce a full-range FO ObsRO derived from mixed-methods research, preliminary FSGS-MCD measures, and relevant PROMIS item banks.
Aim 3: To validate the FO PRO and ObsRO in longitudinal studies addressing children and adults with chronic health conditions associated with NS.
The impact of this work will be FDA standardized endpoints usable in future clinical trials.