Cardiorespiratory Progression Over 5 Year and Role of Corticosteroids in Duchenne Muscular Dystrophy A Single-Site Retrospective Longitudinal Study

Trucco, Federica and Domingos, Joana P. and Tay, Chee Geap and Ridout, Deborah and Maresh, Kate and Munot, Pinki and Sarkozy, Anna and Robb, Stephanie and Quinlivan, Rosaline and Riley, Mollie and Burch, Michael and Fenton, Matthew and Wallis, Colin and Chan, Elaine and Abel, Francois and Manzur, Adnan Y. and Muntoni, Francesco (2020) Cardiorespiratory Progression Over 5 Year and Role of Corticosteroids in Duchenne Muscular Dystrophy A Single-Site Retrospective Longitudinal Study. CHEST, 158 (4). pp. 1606-1616. ISSN 00123692, DOI

Full text not available from this repository.


BACKGROUND: Corticosteroids (CSs) have prolonged survival and respiratory function in boys with Duchenne muscular dystrophy (DMD) when compared with CSs-naive boys. RESEARCH QUESTION: The differential impact of frequently used CSs and their regimens on long-term (> 5 years) cardiorespiratory progression in children with DMD is unknown. STUDY DESIGN AND METHODS: This was a retrospective longitudinal study including children with DMD followed at Dubowitz Neuromuscular Centre, Great Ormond Street Hospital London, England, from May 2000 to June 2017. Patients enrolled in any interventional clinical trials were excluded. We collected patients' anthropometrics and respiratory (FVC, FVC % predicted and absolute FVC, and noninvasive ventilation requirement NIV]) and cardiac (left ventricular shortening function LVFS%]) function. CSs-naive patients had never received CSs. Patients who were treated with CSs took either deflazacort or prednisolone, daily or intermittently (10 days on/10 days off) for > 1 month. Average longitudinal models were fitted for yearly respiratory (FVC % predicted) and cardiac (LVFS%) progression. A time-to-event analysis to FVC % predicted < 50%, NIV start, and cardiomyopathy (LVFS% < 28%) was performed in CS-treated (daily and intermittent) vs CS-naive patients. RESULTS: There were 270 patients, with a mean age at baseline of 6.2 +/- 2.3 years. The median follow-up time was 5.6 +/- 3.5 years. At baseline, 263 patients were ambulant. Sixty-six patients were treated with CSs daily, 182 patients underwent CSs intermittent > 60% treatment, and 22 were CS-naive patients. Yearly FVC % predicted declined similarly from 9 years (5.9% and 6.9% per year, respectively; P = .27) in the CSs-daily and CSs-intermittent groups. The CSs-daily group declined from a higher FVC % predicted than the CSs-intermittent group (P < .05), and both reached FVC % predicted < 50% and NIV requirement at a similar age, > 2 years later than the CS-naive group. LVFS% declined by 0.53% per year in the CSs-treated group irrespective of the CSs regimen, significantly slower (P < .01) than the CSs-naive group progressing by 1.17% per year. The age at cardiomyopathy was 16.6 years in the CSs-treated group (P < .05) irrespective of regimen and 13.9 years in the CSs-naive group. INTERPRETATION: CSs irrespective of the regimen significantly improved respiratory function and delayed NIV requirement and cardiomyopathy.

Item Type: Article
Funders: Great Ormond Street Hospital Trust, North Star network, Muscular Dystrophy UK, University College London, Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre
Uncontrolled Keywords: cardiorespiratory; corticosteroids; Duchenne muscular dystrophy
Subjects: R Medicine > RJ Pediatrics
Divisions: Faculty of Medicine > Paediatrics Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 29 Dec 2023 07:10
Last Modified: 29 Dec 2023 07:10

Actions (login required)

View Item View Item