Corticosteroid Treatment and Growth Patterns in Ambulatory Males with Duchenne Muscular Dystrophy
Published Date:Mar 30 2016
Source:J Pediatr. 173:207-213.e3.
Pubmed Central ID:PMC5100357
Funding:U01 DD000187/DD/NCBDD CDC HHS/United States
U01 DD000189/DD/NCBDD CDC HHS/United States
U01 DD000190/DD/NCBDD CDC HHS/United States
U01 DD000191/DD/NCBDD CDC HHS/United States
To evaluate growth patterns of ambulatory males with Duchenne muscular dystrophy (DMD) treated with corticosteroids compared with ambulatory, steroid-naïlve males with DMD and age-matched unaffected general-population males and to test associations between growth and steroid treatment patterns among treated males.
Using data from the Muscular Dystrophy Surveillance, Tracking, and Research Network, we identified a total of 1768 height, 2246 weight, and 1755 body mass index (BMI) measurements between age 2 and 12 years for 324 ambulatory males who were treated with corticosteroids for at least 6 months. Growth curve comparisons and linear mixed-effects modeling, adjusted for race/ethnicity and birth year, were used to evaluate growth and steroid treatment patterns (age at initiation, dosing interval, duration, cumulative dose).
Growth curves for ambulatory males treated with corticosteroids showed significantly shorter stature, heavier weight, and greater BMI compared with ambulatory, steroid-naïlve males with DMD and general-population US males. Adjusted linear mixed-effects models for ambulatory males treated with corticosteroids showed that earlier initiation, daily dosing, longer duration, and greater dosages predicted shorter stature with prednisone. Longer duration and greater dosages predicted shorter stature for deflazacort. Daily prednisone dosing predicted lighter weight, but longer duration, and greater dosages predicted heavier weight. Early initiation, less than daily dosing, longer duration, and greater doses predicted greater BMIs. Deflazacort predicted shorter stature, but lighter weight, compared with prednisone.
Prolonged steroid use is significantly associated with short stature and heavier weight. Growth alterations associated with steroid treatment should be considered when making treatment decisions for males with DMD.
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