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Abstract Details

Deflazacort or Prednisone Treatment for Duchenne Muscular Dystrophy: A Meta-Analysis of Disease Progression Rates in Recent Multicenter Clinical Trials
Child Neurology and Developmental Neurology
P1 - Poster Session 1 (5:30 PM-6:30 PM)
7-066

We compared the rates of decline in ambulatory function between patients receiving these corticosteroids, in conjunction with modern supportive care and physical therapy, on placebo arms of recent DMD trials.

 

Deflazacort and prednisone/prednisolone can slow the loss of ambulatory function in patients with Duchenne muscular dystrophy (DMD).

Ambulatory patients with DMD were included from placebo arms of recently concluded Phase III trials of ataluren (n=115, all with nonsense mutations) and tadalafil (n=116, unselected by genotype).  Both trials required ≥6 months of prior corticosteroid use and stable baseline dosing. Associations between corticosteroid type and 48-week changes in ambulatory function were estimated using mixed models with repeated measures analyses adjusting for baseline age, corticosteroid duration, and functional assessments including six minute walk distance (6MWD), visit week, and interactions between visit week and other characteristics. Placebo arm analytic results from Ataluren trial were extracted from a publication; placebo data from the tadalafil trial were analyzed directly. Adjusted differences between deflazacort and prednisone were pooled across trials in a meta-analysis.

Compared with patients receiving prednisone, those receiving deflazacort experienced slower declines, preserving 28.3 meters of 6MWD [95% confidence interval: (5.7, 50.9); p=0.01)], 2.9 seconds on rise from supine, [(0.9, 4.9); p<0.01], 2.3 seconds on 4 stair climb [(0.5, 4.1); p =0.01], and 1.15 points on NSAA total score [(-0.01, 2.3); p=0.05] in the meta-analysis results. Changes in 4 stair descend and 10 meter walk/run did not differ between groups. Associations were generally consistent in magnitude and direction across trials.  A limitation of this post-hoc analysis is that steroid assignment was not randomized, and results may be confounded by unobserved baseline differences.

In this adjusted analysis of corticosteroid groups from two clinical trials, patients receiving deflazacort experienced significantly slower rates of functional decline over 48 weeks than those receiving prednisone. 

 

Authors/Disclosures

PRESENTER
No disclosure on file
Traci Schilling No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Marcio N. Souza, MD (MRNeuro) Dr. Souza has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Lilly. Dr. Souza has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Novartis. Dr. Souza has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for TEVA. Dr. Souza has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Libbs. Dr. Souza has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Abbvie.
Stuart Peltz No disclosure on file
Basil T. Darras, MD (Children'S Hosp Boston Harvard Med School) The institution of Dr. Darras has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amicus. Dr. Darras has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Amicus. The institution of Dr. Darras has received research support from National Institutes of Health/National Institute of Neurological Disorders and Stroke,. The institution of Dr. Darras has received research support from Slaney Family Fund for SMA. The institution of Dr. Darras has received research support from Spinal Muscular Atrophy Foundation. The institution of Dr. Darras has received research support from CureSMA. The institution of Dr. Darras has received research support from Working on Walking Fund . The institution of Dr. Darras has received research support from CHERISH, CS2/CS12 . The institution of Dr. Darras has received research support from Biogen for CS11. The institution of Dr. Darras has received research support from AveXis. The institution of Dr. Darras has received research support from Sarepta Pharmaceuticals. The institution of Dr. Darras has received research support from PTC Therapeutics. The institution of Dr. Darras has received research support from Roche. The institution of Dr. Darras has received research support from Santhera. The institution of Dr. Darras has received research support from Scholar Rock. The institution of Dr. Darras has received research support from Fibrogen. The institution of Dr. Darras has received research support from Summit. Dr. Darras has received publishing royalties from a publication relating to health care. Dr. Darras has received publishing royalties from a publication relating to health care.
Perry Shieh, MD, PhD, FAAN (UCLA) Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sarepta. Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Argenx. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for CSL Behring. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Grifols. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Shieh has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Biogen. Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Argenx. Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Catalyst.
Craig McDonald, MD (UC Davis Dept. of PM&R) Dr. McDonald has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sarepta Therapeutics. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for PTC Therapeutics. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Solid Biosciences. Dr. McDonald has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sarepta Therapeutics. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Solid Biosciences. Dr. McDonald has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Edgewise Therapeutics. The institution of Dr. McDonald has received research support from Sarepta Therapeutics. The institution of Dr. McDonald has received research support from PTC Therapeutics. The institution of Dr. McDonald has received research support from Edgewise Therapeutics. The institution of Dr. McDonald has received research support from Capricor Therapeutics. The institution of Dr. McDonald has received research support from Italfarmaco. Dr. McDonald has received research support from NS Pharma. The institution of Dr. McDonald has received research support from NIH (NINDS). The institution of Dr. McDonald has received research support from Parent Project Muscular Dystrophy. The institution of Dr. McDonald has received research support from Muscular Dystrophy Association. Dr. McDonald has received personal compensation in the range of $500-$4,999 for serving as a Member National Advisory Board for Medical Rehabilitation Research with NIH.