Functional and Clinical Outcomes Associated with Steroid Treatment among Non-ambulatory Patients with Duchenne Muscular Dystrophy1.

Abstract

BACKGROUND:

Evidence on the long-term efficacy of steroids in Duchenne muscular dystrophy (DMD) after loss of ambulation is limited.

OBJECTIVE:

Characterize and compare disease progression by steroid treatment (prednisone, deflazacort, or no steroids) among non-ambulatory boys with DMD.

METHODS:

Disease progression was measured by functional status (Performance of Upper Limb Module for DMD 1.2 [PUL] and Egen Klassifikation Scale Version 2 [EK] scale) and by cardiac and pulmonary function (left ventricular ejection fraction [LVEF], forced vital capacity [FVC] % -predicted, cough peak flow [CPF]). Longitudinal changes in outcomes, progression to key disease milestones, and dosing and body composition metrics were analyzed descriptively and in multivariate models.

RESULTS:

This longitudinal cohort study included 86 non-ambulatory patients with DMD (mean age 13.4 years; n = 40 [deflazacort], n = 29 [prednisone], n = 17 [no steroids]). Deflazacort use resulted in slower average declines in FVC % -predicted vs. no steroids (+3.73 percentage points/year, p < 0.05). Both steroids were associated with significantly slower average declines in LVEF, improvement in CPF, and slower declines in total PUL score and EK total score vs. no steroids; deflazacort was associated with slower declines in total PUL score vs. prednisone (all p < 0.05). Both steroids also preserved functional abilities considered especially important to quality of life, including the abilities to perform hand-to-mouth function and to turn in bed at night unaided (all p < 0.05 vs. no steroids).

CONCLUSIONS:

Steroid use after loss of ambulation in DMD was associated with delayed progression of important pulmonary, cardiac, and upper extremity functional deficits, suggesting some benefits of deflazacort over prednisone.

• Authors: Craig M McDonald, Oscar H Mayer, Kan N Hor, Debra Miller, Nathalie Goemans, Erik K Henricson, Jessica R Marden, Jonathan Freimark, Henry Lane, Adina Zhang, Molly Frean, Panayiota Trifillis, Karyn Koladicz, James Signorovitch, PRO-DMD-01 consortium investigators
• Journal: Journal of neuromuscular diseases (J Neuromuscul Dis) Vol. 10 Issue 1 Pg. 67-79 ( 2023) ISSN: 2214-3602 [Electronic] Netherlands
• PMID: 36565131 (Publication Type: Journal Article)

Chemical References

• Prednisone

Topics

• Male
• Humans
• Adolescent
• Prednisone (therapeutic use)
• Stroke Volume
• Longitudinal Studies
• Quality of Life
• Ventricular Function, Left
• Muscular Dystrophy, Duchenne
• Disease Progression