Growth pattern trajectories in boys with Duchenne muscular dystrophy.


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Authors
Stimpson, Georgia 
Raquq, Sarah 
Chesshyre, Mary 
Fewtrell, Mary 
Ridout, Deborah 
Abstract

OBJECTIVES: The objective of this study is to analyse retrospective, observational, longitudinal growth (weight, height and BMI) data in ambulatory boys aged 5-12 years with Duchenne muscular dystrophy (DMD). BACKGROUND: We considered glucocorticoids (GC) use, dystrophin isoforms and amenability to exon 8, 44, 45, 51 and 53 skipping drug subgroups, and the impact of growth on loss of ambulation. We analysed 598 boys, with 2604 observations. This analysis considered patients from the UK NorthStar database (2003-2020) on one of five regimes: "GC naïve", "deflazacort daily" (DD), "deflazacort intermittent" (DI), "prednisolone daily" (PD) and "prednisolone intermittent" (PI). A random slope model was used to model the weight, height and BMI SD scores (using the UK90). RESULTS: The daily regime subgroups had significant yearly height stunting compared to the GC naïve subgroup. Notably, the average height change for the DD subgroup was 0.25 SD (95% CI - 0.30, - 0.21) less than reference values. Those with affected expression of Dp427, Dp140 and Dp71 isoforms were 0.77 (95% CI 0.3, 1.24) and 0.82 (95% CI 1.28, 0.36) SD shorter than those with Dp427 and/or Dp140 expression affected respectively. Increased weight was not associated with earlier loss of ambulation, but taller boys still ambulant between the age of 10 and 11 years were more at risk of losing ambulation. CONCLUSION: These findings may provide further guidance to clinicians when counselling and discussing GCs commencement with patients and their carers and may represent a benchmark set of data to evaluate the effects of new generations of GC.

Description
Keywords
Deflazacort, Duchenne muscular dystrophy, Glucocorticoids, Growth, Isoforms, Prednisolone, Child, Dystrophin, Glucocorticoids, Humans, Male, Muscular Dystrophy, Duchenne, Prednisolone, Retrospective Studies, Walking
Journal Title
Orphanet J Rare Dis
Conference Name
Journal ISSN
1750-1172
1750-1172
Volume Title
17
Publisher
Springer Science and Business Media LLC
Sponsorship
Muscular Dystrophy UK (16NMDB-DB60-0004-5)