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. 2016 Jun:173:207-213.e3.
doi: 10.1016/j.jpeds.2016.02.067. Epub 2016 Mar 30.

Corticosteroid Treatment and Growth Patterns in Ambulatory Males with Duchenne Muscular Dystrophy

Molly M Lamb  1 , Nancy A West  2 , Lijing Ouyang  3 , Michele Yang  4 , David Weitzenkamp  4 , Katherine James  5 , Emma Ciafaloni  6 , Shree Pandya  6 , Carolyn DiGuiseppi  5 ; Muscular Dystrophy Surveillance, Research, and Tracking Network (MD STARnet)
Collaborators, Affiliations

Corticosteroid Treatment and Growth Patterns in Ambulatory Males with Duchenne Muscular Dystrophy

Molly M Lamb et al. J Pediatr. 2016 Jun.

Abstract

Objectives: To evaluate growth patterns of ambulatory males with Duchenne muscular dystrophy (DMD) treated with corticosteroids compared with ambulatory, steroid-naïve males with DMD and age-matched unaffected general-population males and to test associations between growth and steroid treatment patterns among treated males.

Study design: 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).

Results: Growth curves for ambulatory males treated with corticosteroids showed significantly shorter stature, heavier weight, and greater BMI compared with ambulatory, steroid-naïve 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.

Conclusion: 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.

Keywords: BMI; height; weight.

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Figures

Figure 1
Figure 1
Flowchart of exclusions to produce the analysis sample: the MD STARnet 2004-2012.
Figure 2
Figure 2
Height in males with DMD who were treated with corticosteroids for ≥6 months compared with height in steroid-naïve males with DMD ages 2-12 years: the MD STARnet 2004-2012.
Figure 3
Figure 3
Weight in males with DMD who were treated with corticosteroids for ≥6 months compared with weight in steroid-naïve males with DMD ages 2-12 years: the MD STARnet 2004-2012.
Figure 4
Figure 4
BMI in males with DMD who were treated with corticosteroids for ≥6 months compared with BMI in steroid-naïve males with DMD ages 2-12 years: the MD STARnet 2004-2012.
See this image and copyright information in PMC

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