Corticosteroids prescribed from the age of 4 to 5 years in Duchenne muscular dystrophy enable the loss of walking to be delayed by at least 2 years and protect the respiratory function in particular. But between prednisone/prednisolone and deflazacort, the question remains: which one to prescribe?
A review of the literature analysed publications involving hundreds of patients: clinical trials, natural history studies, retrospective data, post-hoc follow-up, etc. It showed that :
- In patients treated with deflazacort, functional decline appeared to slow down more than with prednisone.
- Deflazacort was more effective in the short term on indicators such as time to loss of walking and speed of getting up from the floor, but in the long term this functional gain was equivalent to that obtained with prednisone. Overall, both corticosteroids delayed the loss of walking.
- Deflazacort increased the risk of bone loss, cataract and slowed growth more than prednisone/prednisolone.
- Prednisone, on the other hand, significantly increases weight gain and consequently increases the risk of behavioural problems.
- Daily prednisone (0.75 mg/kg/day) or deflazacort (0.9 mg/kg/day) appears to be more effective than alternating prednisone (0.75 mg/kg prednisone for 10 days and then a therapeutic window for 10 days and so on), as shown by the results of a trial cited in the study.
The difficulty in deciding between the two corticosteroids could be related to the variability of Duchenne disease phenotypes from one boy to another, making it difficult to finely assess the effects on walking or movement or strength of the two molecules.
