DISTROFIA MUSCULAR DE DUCHENNE: UMA REVISAO DO TRATAMENTO COM CORTICOSTEROIDES

(especial para SIIC © Derechos reservados)
feder9.jpg Autor:
David Feder
Columnista Experto de SIIC

Institución:
Faculdade de Medicina do ABC


Artículos publicados por David Feder
Coautores
Luiza Panosso Macedo* Renata Schewed Razaboni** Helena Wohlers Sabo** Karina Perez Sacardo** 
Aluna do 3º ano do curso de medicina, Faculdade de Medicina do ABC, São Paulo, Brasil*
aluna do 3º ano do curso de medicina, Faculdade de Medicina do ABC, São Paulo, Brasil**
Recepción del artículo
14 de Abril, 2009
Aprobación
27 de Abril, 2009
Primera edición
19 de Octubre, 2009
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La Distrofia muscular de Duchenne (DMD es una afección hereditaria recesiva ligada al gen X, que afecta a 1 de cada 3.500 hombres y es causada por mutaciones en el gen que codifica la distrofina. La gran mayoría de los pacientes con DMD carecen de la proteína distrofina. Hasta contar con la terapia molecular, los corticosteroides aumentan temporalmente la función muscular. Varios estudios demostraron que la prednisona (0,75 mg / kg) y el deflazacort (0,9 mg / kg) aumentaron la masa muscular y retrasaron el avance de la DMD; el uso de esteroides retrasó la pérdida de la deambulación independiente, disminuyó la velocidad de la degeneración muscular y mejoró la función cardíaca y respiratoria. Además de sus efectos positivos sobre la preservación de la función muscular, la prednisona y el deflazacort se asocian también a efectos secundarios importantes. Deflazacort tiene menos efectos secundarios, pero aumenta el riesgo de catarata. Los efectos beneficiosos y los efectos secundarios de los corticosteroides deben ser monitorizados en forma cuidadosa.

Palabras clave
distrofia muscular de Duchenne, cromossomo X, corticostróides, distrofia muscular de Duchenne, corticosteroides, prednisona, deflazacort


Artículo completo

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Extensión:  +/-5.51 páginas impresas en papel A4
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Abstract
Duchenne muscular dystrophy (DMD) is an inherited X-linked recessive form of muscular dystrophy, which affects 1 in 3.500 men, and is caused by a mutation in the gen coding for the protein dystrophin. Most DMD patients show absence of dystrophin. Until a molecular therapy is available for this condition, corticosteroids temporary increase muscular function. Several studies have demonstrated that both prednisone (0.75 mg/kg) and deflazacort (0.9 mg/kg) increase muscular mass and delay DMD progression. The use of corticosteroids delay the loss of independent ambulation, the rate of muscular degeneration, and it also improves cardiac and respiratory function. Aside from their positive effects on motor function preservation, prednisone and deflazacort are associated with significant side effects. Deflazacort has fewer side effects, but the risk of developing cataracts is higher. The beneficial and side effects of corticosteroids must be carefully monitored.

Key words
Duchenne muscular dystrophy, corticosteroids, prednisone, deflazacort


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Neurología, Pediatría
Relacionadas: Atención Primaria, Farmacología, Fisiatría, Medicina Familiar, Medicina Farmacéutica, Medicina Interna



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Enviar correspondencia a:
David Feder, Faculdade de Medicina do ABC, Rua Thomas Carvalhal, 760 apto 11, São Paulo, Brasil
Bibliografía del artículo

1. Alman BA. Duchenne muscular dystrophy and steroids: pharmacologic treatment in the absence of effective gene therapy. Pediatr Orthop 25(4):554-6, 2005.
2. Balaban B et al. Corticosteroid treatment and functional improvement in Duchenne muscular dystrophy: Long-term effect. Am J Phys Med Rehabil 84:843-850, 2005.
3. Balagopal P et al. Oxandrolone enhances skeletal muscle and alters global gene expression profile in Duchenne muscular dystrophy. Am J Physiol Endocrinol Metab 209:530-539, 2005.
4. Beenakker EAC et al. Intermittent Prednisone therapy in Duchenne muscular dystrophy: a randomized controlled trial. Arch Neurol 62:128-132, 2005.
5. Biggar WD et al. Deflazacort treatment of Duchenne muscular dystrophy. The J Pediatr 138(1):45-50, 2001.
6. Biggar WD et al. Long-term benefits of deflazacort treatment for boys with Duchenne muscular dystrophy in their second decade. Neuromuscul Disord 16(4):249-55, 2006.
7. Bonifati DM et al. The glucocorticoid receptor N363S polymorphism and steroid response in Duchenne dystrophy. J Neurol Neurosurg Psychiatry 77(10):1177-9, 2006.
8. Brunelli S et al. Nitric oxide release combined with nonsteroidal antiinflamatory activity prevents muscular dystrophy pathology and enhances stem cell therapy. PNAS 104:264-269, 2007.
9. Bushby K, Griggs R. 145th ENMC International Workshop: Planning for a international trial of steroid dosage regimes in DMD (for DMD) Neuromuscul Disord 17:423-428, 2003.
10. Campbell C, Jacob P. Deflazacort for the treatment of Duchenne muscular dystrophy: A systematic review. BMC Neurology 3:7, 2007.
11. Carter GT et al. Effect of voluntary wheel-running exercise on muscles of the mdx mouse. Neuromuscul Disord 5(4):323-32, 1995.
12. Chakkalakal JV et al. Molecular, cellular, and pharmacological therapies for Duchenne/Becker muscular dystrophies. FASEB J 19(8):880-91, 2005.
13. Daftary AS et al. Effect of long-term steroids on cough efficiency and respiratory muscle strength in patients with Duchenne muscular dystrophy. Pediatrics 119:320-324, 2007.
14. Feder D. Langer AL. Uso dos corticóides no tratamento da Distrofia Muscular de Duchenne Jornal Brasileiro de Medicina 89(1):57-9, 2005.
15. Garrood P et al. Myoglobinuria in boys with Duchenne muscular dystrophy on corticosteroid therapy. Neuromuscul Disord 18:71-73, 2007.
16. Gati I et al. Effects of inhibitors of the arachidonic acid cascade on primary muscle culture from a Duchenne muscular dystrophy patient. Prostaglandins, Leukotrienes and Essential Falley Acids 77:217-223, 2007.
17. Hawker G et al. Alendronate in the treatment of low bone mass in steroid-treated boys with Duchenne`s muscular dystrophy. Arch Phys Medicine and Rehabilitation 86(2):284-8, 2005.
18. Houde S et al. Deflazacort use in Duchenne muscular dystrophy: An 8-year follow-up. Pediatr Neurol 38:200-206, 2008.
19. Hussein MR et al. The effect of glucocorticoid therapy on the inflammatory and dendritic cells in muscular dystrophies. Int J Exp Pathol 87(6):451-61, 2006.
20. Kinali M et al. Predictive factors for the development of scoliosis in Duchenne muscular dystrophy. Eur J Paediatr Neurol 11:160-166, 2007.
21. King WM et al. Orthopedic outcomes of long-term daily corticosteroid treatment in Duchenne muscular dystrophy. Neurology 68(19):1607-13, 2007.
22. Kocabas S et al. Anesthesic management of a child with Duchenne muscular dystrophy undergoing correction of Fallot's Tetralogy. Pediatric Anesthesia 18:439-452, 2008.
23. Markham LW et al. Steroid therapy and cardiac function in Duchenne muscular dystrophy. Pediatr Cardiol 26:768-771, 2005.
24. Markham LW et al. Corticosteroid treatment retards development of ventricular dysfunction in Duchenne muscular dystrophy. Neuromuscul Disord 18:365-370, 2008.
25. Mavrogeni S et al. Effect og deflazacort on cardiac and sternocleidomastoid muscles in Duchenne muscular dystrophy: A magnetic resonance imaging study. Eur J Paediat Neurol doi:10.1016/j.ejpn.2008.02.006, 2008.
26. Miura P et al. IRES-Mediated Translation of Utrophin a is enhance by glucocorticoid treatment in skeletal muscle cell. PLoS ONE 3(6)e2309. doi:10.1371/journal.pone0002309, 2008.
27. Moxley III RT ET al. Practice parameter: corticosteroid treatment of Duchenne dystrophy: report of the Quality Standars Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 64:13-20, 2005.
28. Muenster T et al. Reversal of rocuronium-induced neuromuscular blockade by pyridostigmine in patients with Duchenne muscular dystrophy. Pediat Anesthesia 18:251-25, 2008.
29. Parreira SLS et al. Quantification of muscle strength and motor ability in patients with Duchenne muscular dystrophy on steroid therapy. Arq Neuropsiquiatria 65(2-A):254-250, 2007.
30. Pastoret C, Sebille A. mdx mice show progressive weakness and muscle deterioration with age. J Neurological Sciences 129:97-105, 1995.
31. Pradham S. Prednisolone in Duchenne muscular dystrophy with imminent loss of ambulation. J Neurol 253(10):1309-16, 2006.
32. Radley HG et al. Duchenne muscular dystrophy: focus on pharmaceutical and nutritional interventions. IJBCB 39:469-477, 2007.
33. Söderpalm AC et al. Low bone mineral density and decreased bone turnover in Duchenne muscular dystrophy. Neuromuscul Disord 17:919-928, 2007
34. Stober JB. Therapeutics in Duchenne muscular dystrophy. NeuroRx 3(2):225-34, 2006.

 
 
 
 
 
 
 
 
 
 
 
 
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