Oral corticosteroids and onset of cardiomyopathy in Duchenne muscular dystrophy

Brent J. Barber, Jennifer G. Andrews, Zhenqiang Lu, Nancy A. West, F. John Meaney, Elinora T. Price, Ashley Gray, Daniel W. Sheehan, Shree Pandya, Michele Yang, Christopher M Cunniff

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Abstract

Objective To estimate the age when cardiomyopathy develops in boys with Duchenne muscular dystrophy (DMD) and to analyze the effect of corticosteroid treatment on the age of cardiomyopathy onset. Study design We identified a population-based sample of 462 boys with DMD, born between 1982 and 2005, in 5 surveillance sites in the US. Echocardiographic and corticosteroid treatment data were collected. Cardiomyopathy was defined by a reduced fractional shortening (<28%) or ejection fraction (<55%). The age of cardiomyopathy onset was determined. Survival analysis was performed to determine the effects of corticosteroid treatment on cardiomyopathy onset. Results The mean (SD) age of cardiomyopathy onset was 14.3 (4.2) years for the entire population and 15.2 (3.4) years in corticosteroid-treated vs 13.1 (4.8) in non-treated boys. Survival analysis described a significant delay of cardiomyopathy onset for boys treated with corticosteroids (P <.02). By 14.3 years of age, 63% of non-treated boys had developed cardiomyopathy vs only 36% of those treated. Among boys treated with corticosteroids, there is a significant positive effect of duration of corticosteroid treatment on cardiomyopathy onset (P <.0001). For every year of corticosteroid treatment, the probability of developing cardiomyopathy decreased by 4%. Conclusions Oral corticosteroid treatment was associated with delayed cardiomyopathy onset. The duration of corticosteroid treatment also correlated positively with delayed cardiomyopathy onset. Our analysis suggests that a boy with DMD treated for 5 years with corticosteroids might experience a 20% decrease in the likelihood of developing cardiomyopathy compared with untreated boys.

Original languageEnglish (US)
JournalThe Journal of Pediatrics
Volume163
Issue number4
DOIs
StatePublished - Oct 2013

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Duchenne Muscular Dystrophy
Cardiomyopathies
Adrenal Cortex Hormones
Age of Onset
Survival Analysis
Therapeutics
Population

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Oral corticosteroids and onset of cardiomyopathy in Duchenne muscular dystrophy. / Barber, Brent J.; Andrews, Jennifer G.; Lu, Zhenqiang; West, Nancy A.; Meaney, F. John; Price, Elinora T.; Gray, Ashley; Sheehan, Daniel W.; Pandya, Shree; Yang, Michele; Cunniff, Christopher M.

In: The Journal of Pediatrics, Vol. 163, No. 4, 10.2013.

Research output: Contribution to journalArticle

Barber, BJ, Andrews, JG, Lu, Z, West, NA, Meaney, FJ, Price, ET, Gray, A, Sheehan, DW, Pandya, S, Yang, M & Cunniff, CM 2013, 'Oral corticosteroids and onset of cardiomyopathy in Duchenne muscular dystrophy', The Journal of Pediatrics, vol. 163, no. 4. https://doi.org/10.1016/j.jpeds.2013.05.060
Barber, Brent J. ; Andrews, Jennifer G. ; Lu, Zhenqiang ; West, Nancy A. ; Meaney, F. John ; Price, Elinora T. ; Gray, Ashley ; Sheehan, Daniel W. ; Pandya, Shree ; Yang, Michele ; Cunniff, Christopher M. / Oral corticosteroids and onset of cardiomyopathy in Duchenne muscular dystrophy. In: The Journal of Pediatrics. 2013 ; Vol. 163, No. 4.
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abstract = "Objective To estimate the age when cardiomyopathy develops in boys with Duchenne muscular dystrophy (DMD) and to analyze the effect of corticosteroid treatment on the age of cardiomyopathy onset. Study design We identified a population-based sample of 462 boys with DMD, born between 1982 and 2005, in 5 surveillance sites in the US. Echocardiographic and corticosteroid treatment data were collected. Cardiomyopathy was defined by a reduced fractional shortening (<28{\%}) or ejection fraction (<55{\%}). The age of cardiomyopathy onset was determined. Survival analysis was performed to determine the effects of corticosteroid treatment on cardiomyopathy onset. Results The mean (SD) age of cardiomyopathy onset was 14.3 (4.2) years for the entire population and 15.2 (3.4) years in corticosteroid-treated vs 13.1 (4.8) in non-treated boys. Survival analysis described a significant delay of cardiomyopathy onset for boys treated with corticosteroids (P <.02). By 14.3 years of age, 63{\%} of non-treated boys had developed cardiomyopathy vs only 36{\%} of those treated. Among boys treated with corticosteroids, there is a significant positive effect of duration of corticosteroid treatment on cardiomyopathy onset (P <.0001). For every year of corticosteroid treatment, the probability of developing cardiomyopathy decreased by 4{\%}. Conclusions Oral corticosteroid treatment was associated with delayed cardiomyopathy onset. The duration of corticosteroid treatment also correlated positively with delayed cardiomyopathy onset. Our analysis suggests that a boy with DMD treated for 5 years with corticosteroids might experience a 20{\%} decrease in the likelihood of developing cardiomyopathy compared with untreated boys.",
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N2 - Objective To estimate the age when cardiomyopathy develops in boys with Duchenne muscular dystrophy (DMD) and to analyze the effect of corticosteroid treatment on the age of cardiomyopathy onset. Study design We identified a population-based sample of 462 boys with DMD, born between 1982 and 2005, in 5 surveillance sites in the US. Echocardiographic and corticosteroid treatment data were collected. Cardiomyopathy was defined by a reduced fractional shortening (<28%) or ejection fraction (<55%). The age of cardiomyopathy onset was determined. Survival analysis was performed to determine the effects of corticosteroid treatment on cardiomyopathy onset. Results The mean (SD) age of cardiomyopathy onset was 14.3 (4.2) years for the entire population and 15.2 (3.4) years in corticosteroid-treated vs 13.1 (4.8) in non-treated boys. Survival analysis described a significant delay of cardiomyopathy onset for boys treated with corticosteroids (P <.02). By 14.3 years of age, 63% of non-treated boys had developed cardiomyopathy vs only 36% of those treated. Among boys treated with corticosteroids, there is a significant positive effect of duration of corticosteroid treatment on cardiomyopathy onset (P <.0001). For every year of corticosteroid treatment, the probability of developing cardiomyopathy decreased by 4%. Conclusions Oral corticosteroid treatment was associated with delayed cardiomyopathy onset. The duration of corticosteroid treatment also correlated positively with delayed cardiomyopathy onset. Our analysis suggests that a boy with DMD treated for 5 years with corticosteroids might experience a 20% decrease in the likelihood of developing cardiomyopathy compared with untreated boys.

AB - Objective To estimate the age when cardiomyopathy develops in boys with Duchenne muscular dystrophy (DMD) and to analyze the effect of corticosteroid treatment on the age of cardiomyopathy onset. Study design We identified a population-based sample of 462 boys with DMD, born between 1982 and 2005, in 5 surveillance sites in the US. Echocardiographic and corticosteroid treatment data were collected. Cardiomyopathy was defined by a reduced fractional shortening (<28%) or ejection fraction (<55%). The age of cardiomyopathy onset was determined. Survival analysis was performed to determine the effects of corticosteroid treatment on cardiomyopathy onset. Results The mean (SD) age of cardiomyopathy onset was 14.3 (4.2) years for the entire population and 15.2 (3.4) years in corticosteroid-treated vs 13.1 (4.8) in non-treated boys. Survival analysis described a significant delay of cardiomyopathy onset for boys treated with corticosteroids (P <.02). By 14.3 years of age, 63% of non-treated boys had developed cardiomyopathy vs only 36% of those treated. Among boys treated with corticosteroids, there is a significant positive effect of duration of corticosteroid treatment on cardiomyopathy onset (P <.0001). For every year of corticosteroid treatment, the probability of developing cardiomyopathy decreased by 4%. Conclusions Oral corticosteroid treatment was associated with delayed cardiomyopathy onset. The duration of corticosteroid treatment also correlated positively with delayed cardiomyopathy onset. Our analysis suggests that a boy with DMD treated for 5 years with corticosteroids might experience a 20% decrease in the likelihood of developing cardiomyopathy compared with untreated boys.

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