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A Comparison of Daily and Alternate-Day Prednisone Therapy in the Treatment of Duchenne Muscular Dystrophy
Gerald M. Fenichel, MD;
Jerry R. Mendell, MD;
Richard T. Moxley III, MD;
Robert C. Griggs, MD;
Michael H. Brooke, MD;
J. Phillip Miller;
Alan Pestronk, MD;
Jenny Robison, MS;
Wendy King, LPT;
Linda Signore, RN, MS;
Shree Pandya, MS;
Julaine Florence, MS;
Janine Schierbecker, PT;
Bradley Wilson
Arch Neurol. 1991;48(6):575-579.
Abstract
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• We previously reported the results of a randomized, double-blind 6-month trial of prednisone therapy in which 102 boys aged 5 to 15 years with Duchenne muscular dystrophy received daily doses of 1.5 and 0.75 mg/kg per day and were compared with those receiving placebo. The strength and function in both prednisone-treated groups improved equally and were significantly better than in the placebo group. To compare alternate-day and daily dosing of prednisone with respect to benefits and adverse side effects, the placebo group was started on alternate-day prednisone therapy, and the treatment group regimens were changed to equivalent doses of alternate-day prednisone without breaking the double-blind nature. At the end of 6 months, the group that was changed from daily to alternate-day therapy had declined in strength back to levels observed 12 months previously, at the start of daily therapy. The group in which alternate-day therapy was started showed a significant improvement in strength at 3 months, similar in magnitude to the response of boys treated with daily therapy. However, their strength declined significantly in the subsequent 3 months compared with boys who received daily therapy. The frequency of side effects was not significantly different for alternate-day therapy compared with daily therapy. We conclude that alternate-day prednisone therapy effectively increases strength but does not sustain the improvement to the same extent as daily therapy or mitigate side effects.
Author Affiliations
From the Department of Neurology, Vanderbilt University Medical Center, Nashville, Tenn (Dr Fenichel and Ms Robison); the Department of Neurology, The Ohio State University College of Medicine, Columbus (Dr Mendell and Mss King and Signore); the Department of Neurology, The University of Rochester (NY) (Drs Moxley and Griggs and Ms Pandya); the Department of Neurology, The Walter McKenzie Center for Health Sciences, Edmonton, Alberta (Dr Brooke); and the Department of Neurology (Dr Pestronk and Mss Florence and Schierbecker) and the Division of Biostatistics (Messrs Miller and Wilson), Washington University School of Medicine, St Louis, Mo.
Footnotes
Accepted for publication February 20, 1991.
Reprint requests to the Department of Neurology, Vanderbilt University Medical Center, 2100 Pierce Ave, Nashville, TN 37212 (Dr Fenichel).
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