Guglieri, M; Bushby, K; McDermott, MP; Hart, KA; Tawil, R; Martens, WB; Herr, BE; ... Chang, T; + view all Guglieri, M; Bushby, K; McDermott, MP; Hart, KA; Tawil, R; Martens, WB; Herr, BE; McColl, E; Speed, C; Wilkinson, J; Kirschner, J; King, WM; Eagle, M; Brown, MW; Willis, T; Griggs, RC; Straub, V; van Ruiten, H; Childs, AM; Ciafaloni, E; Shieh, PB; Spinty, S; Maggi, L; Baranello, G; Butterfield, RJ; Horrocks, IA; Roper, H; Alhaswani, Z; Flanigan, KM; Kuntz, NL; Manzur, A; Darras, BT; Kang, PB; Morrison, L; Krzesniak-Swinarska, M; Mah, JK; Mongini, TE; Ricci, F; von der Hagen, M; Finkel, RS; O'Reardon, K; Wicklund, M; Kumar, A; McDonald, CM; Han, JJ; Joyce, N; Henricson, EK; Schara-Schmidt, U; Gangfuss, A; Wilichowski, E; Barohn, RJ; Statland, JM; Campbell, C; Vita, G; Vita, GL; Howard, JF; Hughes, I; McMillan, HJ; Pegoraro, E; Bello, L; Burnette, WB; Thangarajh, M; Chang, T; - view fewer (2022) Effect of Different Corticosteroid Dosing Regimens on Clinical Outcomes in Boys With Duchenne Muscular Dystrophy: A Randomized Clinical Trial. JAMA , 327 (15) pp. 1456-1468. 10.1001/jama.2022.4315.

Text jama_guglieri_2022_oi_220032_1649698918.79439.pdf - Other Access restricted to UCL open access staff Download (423kB)

Abstract

IMPORTANCE: Corticosteroids improve strength and function in boys with Duchenne muscular dystrophy. However, there is uncertainty regarding the optimum regimen and dosage. OBJECTIVE: To compare efficacy and adverse effects of the 3 most frequently prescribed corticosteroid regimens in boys with Duchenne muscular dystrophy. DESIGN, SETTING, AND PARTICIPANTS: Double-blind, parallel-group randomized clinical trial including 196 boys aged 4 to 7 years with Duchenne muscular dystrophy who had not previously been treated with corticosteroids; enrollment occurred between January 30, 2013, and September 17, 2016, at 32 clinic sites in 5 countries. The boys were assessed for 3 years (last participant visit on October 16, 2019). INTERVENTIONS: Participants were randomized to daily prednisone (0.75 mg/kg) (n = 65), daily deflazacort (0.90 mg/kg) (n = 65), or intermittent prednisone (0.75 mg/kg for 10 days on and then 10 days off) (n = 66). MAIN OUTCOMES AND MEASURES: The global primary outcome comprised 3 end points: rise from the floor velocity (in rise/seconds), forced vital capacity (in liters), and participant or parent global satisfaction with treatment measured by the Treatment Satisfaction Questionnaire for Medication (TSQM; score range, 0 to 100), each averaged across all study visits after baseline. Pairwise group comparisons used a Bonferroni-adjusted significance level of .017. RESULTS: Among the 196 boys randomized (mean age, 5.8 years [SD, 1.0 years]), 164 (84%) completed the trial. Both daily prednisone and daily deflazacort were more effective than intermittent prednisone for the primary outcome (P < .001 for daily prednisone vs intermittent prednisone using a global test; P = .017 for daily deflazacort vs intermittent prednisone using a global test) and the daily regimens did not differ significantly (P = .38 for daily prednisone vs daily deflazacort using a global test). The between-group differences were principally attributable to rise from the floor velocity (0.06 rise/s [98.3% CI, 0.03 to 0.08 rise/s] for daily prednisone vs intermittent prednisone [P = .003]; 0.06 rise/s [98.3% CI, 0.03 to 0.09 rise/s] for daily deflazacort vs intermittent prednisone [P = .017]; and −0.004 rise/s [98.3% CI, −0.03 to 0.02 rise/s] for daily prednisone vs daily deflazacort [P = .75]). The pairwise comparisons for forced vital capacity and TSQM global satisfaction subscale score were not statistically significant. The most common adverse events were abnormal behavior (22 [34%] in the daily prednisone group, 25 [38%] in the daily deflazacort group, and 24 [36%] in the intermittent prednisone group), upper respiratory tract infection (24 [37%], 19 [29%], and 24 [36%], respectively), and vomiting (19 [29%], 17 [26%], and 15 [23%]). CONCLUSIONS AND RELEVANCE: Among patients with Duchenne muscular dystrophy, treatment with daily prednisone or daily deflazacort, compared with intermittent prednisone alternating 10 days on and 10 days off, resulted in significant improvement over 3 years in a composite outcome comprising measures of motor function, pulmonary function, and satisfaction with treatment; there was no significant difference between the 2 daily corticosteroid regimens. The findings support the use of a daily corticosteroid regimen over the intermittent prednisone regimen tested in this study as initial treatment for boys with Duchenne muscular dystrophy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01603407

Download activity - last month

Export as XMLCSVJSON

Download activity - last 12 months

Export as CSVXMLJSON

Downloads by country - last 12 months

Export as JSONXMLCSV

Archive Staff Only

View Item