BACKGROUND: This paper details the results of an evaluation of the level of consensus amongst clinicians on the use of ataluren in both ambulatory and non-ambulatory patients with nonsense mutation Duchenne muscular dystrophy (nmDMD). The consensus was derived using a modified Delphi methodology that involved an exploration phase and then an evaluation phase. METHODS: The exploration phase involved 90-minute virtual 1:1 interviews of 12 paediatric neurologists who cared for 30-120 DMD patients each and had patient contact every one or two weeks. The respondents managed one to ten nmDMD patients taking ataluren. The Discussion Guide for the interviews can be viewed as Appendix A. Following the exploration phase interviews, the interview transcripts were analysed by an independent party to identify common themes, views and opinions and developed 43 draft statements that the Steering Group (authors) reviewed, refined and endorsed a final list of 42 statements. Details of the recruitment of participants for the exploration and evaluation phases can be found under the Methods section. RESULTS: A consensus was agreed (> 66% of respondents agreeing) for 41 of the 42 statements using results from a consensus survey of healthcare professionals (n = 20) experienced in the treatment of nmDMD. CONCLUSIONS: The statements with a high consensus suggest that treatment with ataluren should be initiated as soon as possible to delay disease progression and allow patients to remain ambulatory for as long as possible. Ataluren is indicated for the treatment of Duchenne muscular dystrophy that results from a nonsense mutation in the dystrophin gene, in ambulatory patients aged 2 years and older (see Summary of Product Characteristics for each country).
- MeSH
- dítě MeSH
- Duchennova muskulární dystrofie * genetika terapie MeSH
- dystrofin genetika MeSH
- konsensus MeSH
- lidé MeSH
- nesmyslný kodon MeSH
- oxadiazoly * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Izrael MeSH
- Řecko MeSH
- Švédsko MeSH
- východní Evropa MeSH
BACKGROUND AND OBJECTIVES: Vamorolone is a dissociative agonist of the glucocorticoid receptor that has shown similar efficacy and reduced safety concerns in comparison with prednisone in Duchenne muscular dystrophy (DMD). This study was conducted to determine the efficacy and safety of vamorolone over 48 weeks and to study crossover participants (prednisone to vamorolone; placebo to vamorolone). METHODS: A randomized, double-blind, placebo-controlled and prednisone-controlled clinical trial of 2 doses of vamorolone was conducted in participants with DMD, in the ages from 4 years to younger than 7 years at baseline. The interventions were 2 mg/kg/d of vamorolone and 6 mg/kg/d of vamorolone for 48 weeks (period 1: 24 weeks + period 2: 24 weeks) and 0.75 mg/kg/d of prednisone and placebo for the first 24 weeks (before crossover). Efficacy was evaluated through gross motor outcomes and safety through adverse events, growth velocity, body mass index (BMI), and bone turnover biomarkers. This analysis focused on period 2. RESULTS: A total of 121 participants with DMD were randomized. Vamorolone at a dose of 6 mg/kg/d showed maintenance of improvement for all motor outcomes to week 48 (e.g., for primary outcome, time to stand from supine [TTSTAND] velocity, week 24 least squares mean [LSM] [SE] 0.052 [0.0130] rises/s vs week 48 LSM [SE] 0.0446 [0.0138]). After 48 weeks, vamorolone at a dose of 2 mg/kg/d showed similar improvements as 6 mg/kg/d for North Star Ambulatory Assessment (NSAA) (vamorolone 6 mg/kg/d-vamorolone 2 mg/kg/d LSM [SE] 0.49 [1.14]; 95% CI -1.80 to 2.78, p = 0.67), but less improvement for other motor outcomes. The placebo to vamorolone 6 mg/kg/d group showed rapid improvements after 20 weeks of treatment approaching benefit seen with 48-week 6 mg/kg/d of vamorolone treatment for TTSTAND, time to run/walk 10 m, and NSAA. There was significant improvement in linear growth after crossover in the prednisone to vamorolone 6 mg/kg/d group, and rapid reversal of prednisone-induced decline in bone turnover biomarkers in both crossover groups. There was an increase in BMI after 24 weeks of treatment that then stabilized for both vamorolone groups. DISCUSSION: Improvements of motor outcomes seen with 6 mg/kg/d of vamorolone at 24 weeks of treatment were maintained to 48 weeks of treatment. Vamorolone at a dose of 6 mg/kg/d showed better maintenance of effect compared with vamorolone at a dose of 2 mg/kg/d for most (3/5) motor outcomes. Bone morbidities of prednisone (stunting of growth and declines in serum bone biomarkers) were reversed when treatment transitioned to vamorolone. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT03439670. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for boys with DMD, the efficacy of vamorolone at a dose of 6 mg/kg/d was maintained over 48 weeks.
- MeSH
- biologické markery MeSH
- dítě MeSH
- Duchennova muskulární dystrofie * farmakoterapie MeSH
- lidé MeSH
- prednison škodlivé účinky MeSH
- předškolní dítě MeSH
- pregnadiendioly * škodlivé účinky MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- MeSH
- dítě MeSH
- Duchennova muskulární dystrofie * MeSH
- lidé MeSH
- osoby pečující o pacienty ekonomika MeSH
- rodiče psychologie MeSH
- služby péče o duševní zdraví * ekonomika organizace a řízení MeSH
- svépomocné skupiny ekonomika organizace a řízení MeSH
- týmová péče o pacienty ekonomika organizace a řízení MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- novinové články MeSH
- MeSH
- architektonická přístupnost MeSH
- Duchennova muskulární dystrofie * MeSH
- lidé MeSH
- sociální opora MeSH
- sociální podmínky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
BACKGROUND: Female carriers of dystrophin gene mutations (DMD-FC) were previously considered non-manifesting, but in recent decades, cardiomyopathy associated with muscular dystrophy and myocardial fibrosis has been described. Our study aimed to assess prospectively myocardial fibrosis in asymptomatic DMD-FC compared to a sex-matched control group (CG) with similar age distribution using native T1 mapping and extracellular volume (ECV) quantification by cardiovascular magnetic resonance (CMR) imaging. MATERIALS AND METHODS: 38 DMD-FC with verified genetic mutation and 22 healthy volunteers were included. Using CMR, native T1 relaxation time and ECV quantification were determined in each group. Late gadolinium enhancement (LGE) was assessed in all cases. RESULTS: There were 38 DMD-FC (mean age 39.1 ± 8.8 years) and 22 healthy volunteers (mean age 39.9 ± 12.6 years) imagined by CMR. The mean global native T1 relaxation time was similar for DMD-FC and CG (1005.1 ± 26.3 ms vs. 1003.5 ± 25.0 ms; p-value = 0.81). Likewise, the mean global ECV value was also similar between the groups (27.92 ± 2.02% vs. 27.10 ± 2.89%; p-value = 0.20). The segmental analysis of mean ECV values according to the American Heart Association classification did not show any differences between DMD-FC and CG. There was a non-significant trend towards higher mean ECV values of DMD-FC in the inferior and inferolateral segments of the myocardium (p-value = 0.075 and 0.070 respectively). CONCLUSION: There were no statistically significant differences in the mean global and segmental native T1 relaxation times and the mean global or segmental ECV values. There was a trend towards higher segmental mean ECV values of DMD-FC in the inferior and inferolateral walls of the myocardium.
- MeSH
- dospělí MeSH
- Duchennova muskulární dystrofie * genetika MeSH
- gadolinium MeSH
- kontrastní látky MeSH
- lidé středního věku MeSH
- lidé MeSH
- mutace MeSH
- myokard MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Spojené státy americké MeSH
Here, we present newly derived in vitro model for modeling Duchenne muscular dystrophy. Our new cell line was derived by reprogramming of peripheral blood mononuclear cells (isolated from blood from pediatric patient) with Sendai virus encoding Yamanaka factors. Derived iPS cells are capable to differentiate in vitro into three germ layers as verified by immunocytochemistry. When differentiated in special medium, our iPSc formed spontaneously beating cardiomyocytes. As cardiomyopathy is the main clinical complication in patients with Duchenne muscular dystrophy, the cell line bearing the dystrophin gene mutation might be of interest to the research community.
- MeSH
- amyotrofická laterální skleróza diagnóza komplikace MeSH
- dítě MeSH
- dospělí MeSH
- Duchennova muskulární dystrofie diagnóza komplikace MeSH
- lidé MeSH
- neuromuskulární nemoci * diagnóza klasifikace komplikace patofyziologie terapie MeSH
- poruchy dýchání diagnóza etiologie komplikace MeSH
- syndromy spánkové apnoe * diagnóza etiologie klasifikace terapie MeSH
- transkutánní měření krevních plynů metody MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- dlouhodobá péče metody MeSH
- Duchennova muskulární dystrofie * diagnóza genetika terapie MeSH
- genetická terapie metody MeSH
- hormony kůry nadledvin aplikace a dávkování terapeutické užití MeSH
- humanizované monoklonální protilátky aplikace a dávkování terapeutické užití MeSH
- kvalita života MeSH
- lidé MeSH
- neinvazivní ventilace MeSH
- opožděná puberta komplikace psychologie MeSH
- svépomocné skupiny MeSH
- týmová péče o pacienty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
Duchennova svalová dystrofie (DMD) je se svou incidencí 1 : 5 000 nově narozených chlapců nejčastějším svalovým onemocněním dětského věku. Je způsobena mutací v genu pro dystrofin, který se nalézá na X chromozomu. První příznaky zahrnují obvykle opoždění motorického vývoje, potíže s běháním nebo s chůzí do a ze schodů. Později se přidává slabost horních končetin, respirační insuficience a srdeční potíže, které bývají mezi 25.-30. rokem věku příčinou smrti.
Duchenne muscular dystrophy (DMD) is with its incidence 1 : 5 000 newborn males the most frequent muscle disease in childhood. It is caused by mutation in dystrophin gene located on X chromosome. First symptoms of DMD include delayed motor milestones, difficult running or climbing stairs, later we can see weakness of shoulder girdle. Cardiomyopathy and respiratory failure most often occur in the third decade. Because of new treatment possibilities, it is necessary to confirm diagnose as soon as possible. E. g. ataluren as a treatment for DMD boys can be used from the age of 2 years. We should test creatine kinase (which elevation more than 100x is typical for DMD) in all boys suspected from DMD as well as in all boys when we do any blood tests.
- Klíčová slova
- ataluren,
- MeSH
- dítě MeSH
- Duchennova muskulární dystrofie * diagnóza genetika patologie terapie MeSH
- kreatinkinasa analýza MeSH
- lidé MeSH
- oxadiazoly farmakologie terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- směrnice pro lékařskou praxi MeSH
