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

Abstract

Corticosteroids (CSs) have prolonged survival and respiratory function in boys with Duchenne muscular dystrophy (DMD) when compared with CSs-naïve boys. The differential impact of frequently used CSs and their regimens on long-term (> 5 years) cardiorespiratory progression in children with DMD is unknown. 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-naïve patients had never received CSs. Patients who were treated with CSs took either deflazacort or prednisolone, daily or intermittently (10days on/10days off) for > 1month. 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) vsCS-naïve patients. 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-naïve 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-naïve 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-naïve 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-naïve group. CSs irrespective of the regimen significantly improved respiratory function and delayed NIV requirement and cardiomyopathy.