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From the Department of Neurology (Dr. Moxley, S. Pandya), University of Rochester School of Medicine and Dentistry, NY; Division of Child Neurology (Dr. Ashwal), Department of Pediatrics, Loma Linda University School of Medicine; Department of Physical Medicine and Rehabilitation (Dr. McDonald), University of California–Davis School of Medicine, Sacramento; Department of Neurology (Dr. Connolly), Washington University School of Medicine (J. Florence), St. Louis, MO; Departments of Pediatrics and Neurology (Dr. Mathews), University of Iowa Hospitals, Iowa City; Institute for Molecular Genetics (Dr. Baumbach), Baylor College of Medicine, Houston, TX; Department of Orthopedic Surgery (Dr. Sussman), Shriners Hospitals for Children, Portland, OR; and Department of Zoology and Physiology (Dr. Wade), University of Wyoming, Laramie.
Address correspondence and reprint requests to American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116.
Abstract.
Background: The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence.
Objective: To review available evidence on corticosteroid treatment of boys with Duchenne dystrophy.
Methods: Relevant literature was reviewed, abstracted, and classified. Recommendations were based on a four-tiered scheme of evidence classification, and areas for future research are defined.
Results: Seven class I studies and numerous less rigorous trials all demonstrated that corticosteroid treatment for 6 months with prednisone (0.75 or 1.5 mg/kg/day) increased muscle strength, performance, and pulmonary function and significantly slowed the progression of weakness. Two class I trials examined the effect of lower dosage of prednisone (0.30 and 0.35 mg/kg/day), demonstrated lesser but similar benefits, and showed a lower frequency of side effects (e.g., weight gain). The only significant side effects in all class I trials were weight gain and development of a cushingoid facial appearance. One longer-term trial of daily prednisone (0.3 to 0.7 mg/kg/day), a class III study, showed prolongation of functional ability and slower progression of weakness in patients during 3 years of treatment. One class IV, open trial of alternate-day prednisone (2 mg/kg for 2 months, then two-thirds dose every other day) extended ambulation by approximately 2 years in treated compared with untreated patients. Deflazacort, a corticosteroid similar in structure to prednisone, produced similar improvement in muscle strength and function with a similar side effect profile.
Conclusions: Prednisone has been demonstrated to have a beneficial effect on muscle strength and function in boys with Duchenne dystrophy and should be offered (at a dose of 0.75 mg/kg/day) as treatment. If side effects require a decrease in prednisone, tapering to dosages as low as 0.3 mg/kg/day gives less robust but significant improvement. Deflazacort (0.9 mg/kg/day) can also be used for the treatment of Duchenne dystrophy in countries in which it is available. Benefits and side effects of corticosteroid therapy need to be monitored. The offer of treatment with corticosteroids should include a balanced discussion of potential risks.
Received March 3, 2004. Accepted in final form September 10, 2004.
Footnotes.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the January 11 issue to find the title link for this article.
Approved by the QSS on February 13, 2004; by the Practice Committee on August 7, 2004; and by the AAN Board of Directors on October 16, 2004.
Related Article
Neurology 2005 64: 2-3.
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