Though there is evidence it may help delay cardiac decline, more research is needed to fully understand the potential long-term effects of glucocorticoid therapy on heart function in patients with Duchenne muscular dystrophy (DMD), according to a review article recently published in the European Journal of Pediatrics.
Currently, glucocorticoids (such as prednisone, deflazacort and prednisolone), are the standard of care for patients with DMD. These drugs are known to be highly effective at reducing inflammation and prolonging the ability to walk, as well as increasing life expectancy.
“However, the effects of glucocorticoids on cardiac function in patients with DMD remain controversial,” the study’s authors wrote. While some studies show that glucocorticoids can improve heart function, others have found no impact, and some have even demonstrated that glucocorticoids can increase the risk of cardiac damage.
In their review, the authors identified 21 studies evaluating different aspects of glucocorticoid use on cardiovascular function among children with DMD.
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Of the studies examining the effects of glucocorticoids on overall cardiac function, 13 had positive findings. Across these studies, the median age of drug initiation ranged from 7 to 8.6 years. The authors found that only 25.5% of patients being treated with corticosteroids experienced disease progression during the follow-up period, compared to 58.2% of untreated patients.
Additionally, one study found that glucocorticoid type did not have a significant impact on cardiac outcomes, with all types improving heart function.
On the other hand, six studies found no effect of glucocorticoid use on cardiovascular health. However, none of them provided detailed information on disease progression, and only one described the timeline of glucocorticoid initiation and duration of therapy.
Furthermore, only one study assessed the impact of age at glucocorticoid initiation on cardiac function, finding that patients who began therapy at or before five years of age were at a higher risk of cardiomyopathy. However, the authors cautioned that this result may simply reflect the fact that these patients might have had poorer disease progression to begin with, prompting them to initiate glucocorticoids earlier.
The authors advocate for future studies that follow patients with DMD over time to study the long-term effects of glucocorticoids on heart health.
“Such studies will provide a more comprehensive understanding of the role of glucocorticoid therapy in managing cardiac function and improving outcomes for patients with DMD,” they concluded.
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