Steroid therapy in patients with Duchenne muscular dystrophy was associated with a 76% lower mortality rate (HR 0.24; 95% CI 0.07-0.91; p=0.0351) compared to no steroid therapy.
Cohort (n=86)
Does steroid therapy reduce mortality and new-onset cardiomyopathy in patients with Duchenne muscular dystrophy treated with RAAS antagonists?
In patients with Duchenne muscular dystrophy, prophylactic steroid therapy is associated with significantly reduced all-cause mortality and a lower incidence of new-onset and progressive cardiomyopathy.
Hazard Ratio: 0.24 (95% CI 0.07–0.91)
Absolute Event Rate: 11% vs 43%
p-value: p=0.0351
OBJECTIVES: This study sought to determine the impact of steroid therapy on cardiomyopathy and mortality in patients with Duchenne muscular dystrophy (DMD). BACKGROUND: DMD is a debilitating X-linked disease that afflicts as many as 1 in 3,500 boys. Although steroids slow musculoskeletal impairment, the effects on cardiac function and mortality remain unknown. METHODS: We conducted a cohort study on patients with DMD treated with renin-angiotensin-aldosterone system antagonists with or without steroid therapy. RESULTS: Eighty-six patients, 9.1 ± 3.5 years of age, were followed for 11.3 ± 4.1 years. Seven of 63 patients (11%) receiving steroid therapy died compared with 10 of 23 (43%) not receiving steroid therapy (p = 0.0010). Overall survival rates at 5, 10, and 15 years of follow-up were 100%, 98.0%, and 78.6%, respectively, for patients receiving steroid therapy versus 100%, 72.1%, and 27.9%, respectively, for patients not receiving steroid therapy (log-rank p = 0.0005). In multivariate propensity-adjusted analyses, steroid use was associated with a 76% lower mortality rate (hazard ratio: 0.24; 95% confidence interval: 0.07 to 0.91; p = 0.0351). The mortality reduction was driven by fewer heart failure-related deaths (0% vs. 22%, p = 0.0010). In multivariate analyses, steroids were associated with a 62% lower rate of new-onset cardiomyopathy (hazard ratio: 0.38; 95% confidence interval: 0.16 to 0.90; p = 0.0270). Annual rates of decline in left ventricular ejection fraction (-0.43% vs. -1.09%, p = 0.0101) and shortening fraction (-0.32% vs. -0.65%, p = 0.0025) were less steep in steroid-treated patients. Consistently, the increase in left ventricular end-diastolic dimension was of lesser magnitude (+0.47 vs. +0.92 mm per year, p = 0.0105). CONCLUSIONS: In patients with DMD, steroid therapy is associated with a substantial reduction in all-cause mortality and new-onset and progressive cardiomyopathy.
Schram et al. (Wed,) conducted a cohort in Duchenne muscular dystrophy (n=86). Steroid therapy vs. No steroid therapy was evaluated on Mortality rate (HR 0.24, 95% CI 0.07 to 0.91, p=0.0351). Steroid therapy in patients with Duchenne muscular dystrophy was associated with a 76% lower mortality rate (HR 0.24; 95% CI 0.07-0.91; p=0.0351) compared to no steroid therapy.
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