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Landfeldt E, Phung K, Zaman F, Åström E, Abner S, Lochmüller H, Sejersen T, Ward LM. Bisphosphonates in Glucocorticoid-Treated Patients With Duchenne Muscular Dystrophy: A Systematic Review and Grading of the Evidence. Neurology 2024; 102:e207948. [PMID: 38165327 PMCID: PMC10962906 DOI: 10.1212/wnl.0000000000207948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Bisphosphonates are routinely used to treat osteoporosis in patients with Duchenne muscular dystrophy (DMD), a rare, severely debilitating neuromuscular disease. We sought to synthesize and grade benefits and harms evidence of bisphosphonates in glucocorticoid-treated patients with DMD. METHODS In this systematic review (PROSPERO identifier: CRD42020157606), we searched MEDLINE, CINAHL, Embase, PsycINFO, Web of Science, and CENTRAL for articles published from inception up to and including March 31, 2023, reporting results in any language from any study type. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework. RESULTS We identified 19 publications involving 1,010 children and adults from 12 countries across all inhabited continents except South America. We found high-quality evidence that bisphosphonates significantly increase the areal lumbar spine bone mineral density (BMD) Z score in glucocorticoid-treated patients with DMD. The greatest improvements were recorded in controlled settings among patients treated with intravenous zoledronate. Evidence of benefits to fracture risks was inconclusive and/or of low quality, primarily due to lack of controlled data and small samples. Bisphosphonates were generally well-tolerated, although adverse events related to the first infusion (i.e., "acute phase reaction") were frequently reported. DISCUSSION There is high-quality evidence supporting the use of bisphosphonates to increase the areal lumbar spine BMD Z score in patients with DMD and glucocorticoid-induced osteoporosis. Our synthesis and grading affirm current recommendations put forward in the 2018 DMD Clinical Care Considerations and should be helpful in raising awareness about anticipated benefits of bisphosphonates, prevailing unmet needs, and potential safety issues in their use.
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Affiliation(s)
- Erik Landfeldt
- From the IQVIA (E.L.), Stockholm, Sweden; Division of Endocrinology (K.P., L.M.W.), Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Canada; Department of Women's and Children's Health (F.Z., E.Å., T.S.), Karolinska Institutet, Stockholm, Sweden; IQVIA (S.A.), London, United Kingdom; and Children's Hospital of Eastern Ontario Research Institute (H.L.); Division of Neurology, Department of Medicine, the Ottawa Hospital, Canada
| | - Kim Phung
- From the IQVIA (E.L.), Stockholm, Sweden; Division of Endocrinology (K.P., L.M.W.), Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Canada; Department of Women's and Children's Health (F.Z., E.Å., T.S.), Karolinska Institutet, Stockholm, Sweden; IQVIA (S.A.), London, United Kingdom; and Children's Hospital of Eastern Ontario Research Institute (H.L.); Division of Neurology, Department of Medicine, the Ottawa Hospital, Canada
| | - Farasat Zaman
- From the IQVIA (E.L.), Stockholm, Sweden; Division of Endocrinology (K.P., L.M.W.), Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Canada; Department of Women's and Children's Health (F.Z., E.Å., T.S.), Karolinska Institutet, Stockholm, Sweden; IQVIA (S.A.), London, United Kingdom; and Children's Hospital of Eastern Ontario Research Institute (H.L.); Division of Neurology, Department of Medicine, the Ottawa Hospital, Canada
| | - Eva Åström
- From the IQVIA (E.L.), Stockholm, Sweden; Division of Endocrinology (K.P., L.M.W.), Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Canada; Department of Women's and Children's Health (F.Z., E.Å., T.S.), Karolinska Institutet, Stockholm, Sweden; IQVIA (S.A.), London, United Kingdom; and Children's Hospital of Eastern Ontario Research Institute (H.L.); Division of Neurology, Department of Medicine, the Ottawa Hospital, Canada
| | - Sophia Abner
- From the IQVIA (E.L.), Stockholm, Sweden; Division of Endocrinology (K.P., L.M.W.), Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Canada; Department of Women's and Children's Health (F.Z., E.Å., T.S.), Karolinska Institutet, Stockholm, Sweden; IQVIA (S.A.), London, United Kingdom; and Children's Hospital of Eastern Ontario Research Institute (H.L.); Division of Neurology, Department of Medicine, the Ottawa Hospital, Canada
| | - Hanns Lochmüller
- From the IQVIA (E.L.), Stockholm, Sweden; Division of Endocrinology (K.P., L.M.W.), Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Canada; Department of Women's and Children's Health (F.Z., E.Å., T.S.), Karolinska Institutet, Stockholm, Sweden; IQVIA (S.A.), London, United Kingdom; and Children's Hospital of Eastern Ontario Research Institute (H.L.); Division of Neurology, Department of Medicine, the Ottawa Hospital, Canada
| | - Thomas Sejersen
- From the IQVIA (E.L.), Stockholm, Sweden; Division of Endocrinology (K.P., L.M.W.), Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Canada; Department of Women's and Children's Health (F.Z., E.Å., T.S.), Karolinska Institutet, Stockholm, Sweden; IQVIA (S.A.), London, United Kingdom; and Children's Hospital of Eastern Ontario Research Institute (H.L.); Division of Neurology, Department of Medicine, the Ottawa Hospital, Canada
| | - Leanne M Ward
- From the IQVIA (E.L.), Stockholm, Sweden; Division of Endocrinology (K.P., L.M.W.), Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Canada; Department of Women's and Children's Health (F.Z., E.Å., T.S.), Karolinska Institutet, Stockholm, Sweden; IQVIA (S.A.), London, United Kingdom; and Children's Hospital of Eastern Ontario Research Institute (H.L.); Division of Neurology, Department of Medicine, the Ottawa Hospital, Canada
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Phung K, Crabtree N, Connolly AM, Furlong P, Hoffman EP, Jackowski SA, Jayash SN, Johnson A, Koujok K, Munns CF, Niks E, Rauch F, Schrader R, Turner C, Vroom E, Weber DR, Wong BL, Guglieri M, Ward LM, Wong SC. Moving Beyond the 2018 Minimum International Care Considerations for Osteoporosis Management in Duchenne Muscular Dystrophy (DMD): Meeting Report from the 3rd International Muscle-Bone Interactions Meeting 7th and 14th November 2022. J Neuromuscul Dis 2024; 11:233-252. [PMID: 37980681 PMCID: PMC10789336 DOI: 10.3233/jnd-230176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Kim Phung
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicola Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Anne M. Connolly
- Nationwide Children’s Hospital, Ohio State University, Columbus, OH, USA
| | - Pat Furlong
- Parent Project Muscular Dystrophy, Washington, DC, USA
| | - Eric P. Hoffman
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences Binghamton University, State University of New York, Binghamton, NY, USA
| | - Stefan A. Jackowski
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Soher Nagi Jayash
- Roslin institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Khaldoun Koujok
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Craig F. Munns
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
- Department of Endocrinology and Diabetes, Queensland Children’s Hospital, Brisbane, QLD, Australia
| | - Erik Niks
- Leiden University Medical Center, Leiden, The Netherlands
| | - Frank Rauch
- Shriners Hospital for Children, Montreal, QC, Canada
| | | | | | | | | | | | | | - Leanne M. Ward
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Sze Choong Wong
- Correspondence to: Dr. Sze Choong Wong, Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF United Kingdom. Tel.: +44 141 451 5841; E-mail:
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Jayash SN, Hamoudi D, Stephen LA, Argaw A, Huesa C, Joseph S, Wong SC, Frenette J, Farquharson C. Anti-RANKL Therapy Prevents Glucocorticoid-Induced Bone Loss and Promotes Muscle Function in a Mouse Model of Duchenne Muscular Dystrophy. Calcif Tissue Int 2023; 113:449-468. [PMID: 37470794 PMCID: PMC10516841 DOI: 10.1007/s00223-023-01116-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/12/2023] [Indexed: 07/21/2023]
Abstract
Bisphosphonates prevent bone loss in glucocorticoid (GC)-treated boys with Duchenne muscular dystrophy (DMD) and are recommended as standard of care. Targeting receptor activator of nuclear factor kappa-B ligand (RANKL) may have advantages in DMD by ameliorating dystrophic skeletal muscle function in addition to their bone anti-resorptive properties. However, the potential effects of anti-RANKL treatment upon discontinuation in GC-induced animal models of DMD are unknown and need further investigation prior to exploration in the clinical research setting. In the first study, the effects of anti-RANKL and deflazacort (DFZ) on dystrophic skeletal muscle function and bone microstructure were assessed in mdx mice treated with DFZ or anti-RANKL, or both for 8 weeks. Anti-RANKL and DFZ improved grip force performance of mdx mice but an additive effect was not noted. However, anti-RANKL but not DFZ improved ex vivo contractile properties of dystrophic muscles. This functional improvement was associated with a reduction in muscle damage and fibrosis, and inflammatory cell number. Anti-RANKL treatment, with or without DFZ, also improved trabecular bone structure of mdx mice. In a second study, intravenous zoledronate (Zol) administration (1 or 2 doses) following 2 months of discontinuation of anti-RANKL treatment was mostly required to record an improvement in bone microarchitecture and biomechanical properties in DFZ-treated mdx mice. In conclusion, the ability of anti-RANKL therapy to restore muscle function has profound implications for DMD patients as it offers the possibility of improving skeletal muscle function without the steroid-related skeletal side effects.
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Affiliation(s)
- Soher Nagi Jayash
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG UK
| | - Dounia Hamoudi
- Centre de Recherche du Centre Hospitalier, Universitaire de Québec-Centre, Hospitalier de L’Université Laval, Université Laval, Quebec City, QC Canada
| | - Louise A. Stephen
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG UK
| | - Anteneh Argaw
- Centre de Recherche du Centre Hospitalier, Universitaire de Québec-Centre, Hospitalier de L’Université Laval, Université Laval, Quebec City, QC Canada
| | - Carmen Huesa
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Shuko Joseph
- Royal Hospital for Children Glasgow, School of Medicine, Dentistry and Nursing, Child Health, Queen Elizabeth University Hospital, Glasgow, UK
| | - Sze Choong Wong
- University of Glasgow/Royal Hospital for Children Glasgow, School of Medicine, Dentistry & Nursing, Child Health, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jérôme Frenette
- Centre de Recherche du Centre Hospitalier, Universitaire de Québec-Centre, Hospitalier de L’Université Laval, Université Laval, Quebec City, QC Canada
| | - Colin Farquharson
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG UK
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Scala R, Maqoud F, McClenaghan C, Harter TM, Perrone MG, Scilimati A, Nichols CG, Tricarico D. Zoledronic Acid Blocks Overactive Kir6.1/SUR2-Dependent K ATP Channels in Skeletal Muscle and Osteoblasts in a Murine Model of Cantú Syndrome. Cells 2023; 12:928. [PMID: 36980269 PMCID: PMC10047381 DOI: 10.3390/cells12060928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/24/2023] [Accepted: 03/11/2023] [Indexed: 03/22/2023] Open
Abstract
Cantú syndrome (CS) is caused by the gain of function mutations in the ABCC9 and KCNJ8 genes encoding, respectively, for the sulfonylureas receptor type 2 (SUR2) and the inwardly rectifier potassium channel 6.1 (Kir6.1) of the ATP-sensitive potassium (KATP) channels. CS is a multi-organ condition with a cardiovascular phenotype, neuromuscular symptoms, and skeletal malformations. Glibenclamide has been proposed for use in CS, but even in animals, the drug is incompletely effective against severe mutations, including the Kir6.1wt/V65M. Patch-clamp experiments showed that zoledronic acid (ZOL) fully reduced the whole-cell KATP currents in bone calvaria cells from wild type (WT/WT) and heterozygous Kir6.1wt/V65MCS mice, with IC50 for ZOL block < 1 nM in each case. ZOL fully reduced KATP current in excised patches in skeletal muscle fibers in WT/WT and CS mice, with IC50 of 100 nM in each case. Interestingly, KATP currents in the bone of heterozygous SUR2wt/A478V mice were less sensitive to ZOL inhibition, showing an IC50 of ~500 nM and a slope of ~0.3. In homozygous SUR2A478V/A478V cells, ZOL failed to fully inhibit the KATP currents, causing only ~35% inhibition at 100 μM, but was responsive to glibenclamide. ZOL reduced the KATP currents in Kir6.1wt/VMCS mice in both skeletal muscle and bone cells but was not effective in the SUR2[A478V] mice fibers. These data indicate a subunit specificity of ZOL action that is important for appropriate CS therapies.
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Affiliation(s)
- Rosa Scala
- Sections of Pharmacology, Medicinal Chemistry, Department of Pharmacy—Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy
| | - Fatima Maqoud
- Sections of Pharmacology, Medicinal Chemistry, Department of Pharmacy—Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy
| | - Conor McClenaghan
- Center for the Investigation of Membrane Excitability Diseases, Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Theresa M. Harter
- Center for the Investigation of Membrane Excitability Diseases, Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Maria Grazia Perrone
- Sections of Pharmacology, Medicinal Chemistry, Department of Pharmacy—Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy
| | - Antonio Scilimati
- Sections of Pharmacology, Medicinal Chemistry, Department of Pharmacy—Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy
| | - Colin G. Nichols
- Center for the Investigation of Membrane Excitability Diseases, Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Domenico Tricarico
- Sections of Pharmacology, Medicinal Chemistry, Department of Pharmacy—Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy
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Nasomyont N, Tian C, Hornung L, Khoury J, Hochwalt PM, Tilden JC, Wong BL, Rutter MM. The effect of oral bisphosphonate therapy on vertebral morphometry and fractures in patients with Duchenne muscular dystrophy and glucocorticoid-induced osteoporosis. Muscle Nerve 2021; 64:710-716. [PMID: 34506040 DOI: 10.1002/mus.27416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIMS Glucocorticoid-induced osteoporosis with vertebral fractures is frequent in patients with Duchenne muscular dystrophy (DMD). In this study, we evaluated the effects of oral bisphosphonate (BP) therapy on the prevalence and severity of vertebral fractures by vertebral morphometry assessment. METHODS We reviewed the records and radiographs of patients with DMD who had been treated with oral BP (weekly alendronate) and had undergone routine spine radiographic monitoring for glucocorticoid-induced osteoporosis at Cincinnati Children's Hospital Medical Center between 2010 and 2017. Study outcomes were thoracic and lumbar vertebral fracture prevalence and severity, assessed by Genant semiquantitative grading of vertebral morphometry, for up to 5 years of treatment. RESULTS Fifty-two patients (median age, 11.8 years; 88% prepubertal; 31% nonambulatory) had been treated with long-term glucocorticoids (median duration, 4.7 years at BP start). Most patients (75%) had mild vertebral height loss or fractures (Genant grade = 0 or 1) at baseline. The prevalence of vertebral fractures at each year of treatment was not statistically different from that at baseline (P = .08-1.00). Serial radiographs showed no longitudinal change in severity by Genant grade in most vertebrae (64%-80%). Improvement in vertebral fracture grade was observed in some patients. DISCUSSION We observed stable prevalence of vertebral fractures and no change in severity by Genant grade in most vertebrae for up to 5 years of treatment. Oral BP may mitigate development or progression of vertebral fractures and be beneficial for secondary prevention of glucocorticoid-induced osteoporosis in this population.
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Affiliation(s)
- Nat Nasomyont
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Cuixia Tian
- Division of Neurology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Lindsey Hornung
- Division of Biostatistics and Division of Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jane Khoury
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Biostatistics and Division of Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul M Hochwalt
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Brenda L Wong
- Department of Pediatrics, University of Massachusetts Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Meilan M Rutter
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Dimitri D, Echaniz-Laguna A, Mariette X. Risedronate-induced rhabdomyolysis in a patient with inflammatory myopathy. Joint Bone Spine 2020; 88:105090. [PMID: 33147494 DOI: 10.1016/j.jbspin.2020.105090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/15/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Dalia Dimitri
- Department of Neurology, hôpitaux universitaires Paris-Sud, Le-Kremlin-Bicêtre, France.
| | - Andoni Echaniz-Laguna
- Department of Neurology, hôpitaux universitaires Paris-Sud, Le-Kremlin-Bicêtre, France
| | - Xavier Mariette
- Department of Rheumatology, hôpitaux universitaires Paris-Sud, Le-Kremlin-Bicêtre, France
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Tian C, Wong BL, Hornung L, Khoury JC, Rybalsky I, Shellenbarger KC, Rutter MM. Oral bisphosphonate treatment in patients with Duchenne muscular dystrophy on long term glucocorticoid therapy. Neuromuscul Disord 2020; 30:599-610. [DOI: 10.1016/j.nmd.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/24/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022]
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Rhabdomyolysis and myoglobinuria following bisphosphonate infusion in patients with Duchenne muscular dystrophy. Neuromuscul Disord 2019; 29:567-568. [DOI: 10.1016/j.nmd.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/03/2019] [Indexed: 11/19/2022]
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