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Pentoxifylline as a rescue treatment for DMD: a randomized double-blind clinical trial
D M Escolar1, A Zimmerman, T Bertorini
1Children’s National Medical Center, Washington, DC, USA. diana.escolar@gmail.com
Insights
Pentoxifylline (PTX) did not slow muscle strength decline in boys with Duchenne muscular dystrophy (DMD). This 12-month trial found no significant benefit of PTX compared to placebo in maintaining muscle function.
Area of Science:
- Neurology
- Pediatrics
- Pharmacology
Background:
- Duchenne muscular dystrophy (DMD) is a progressive genetic disorder causing muscle weakness.
- Current treatments for DMD, including corticosteroids, aim to slow disease progression.
- The potential of pentoxifylline (PTX) to modify DMD progression requires investigation.
Purpose of the Study:
- To evaluate if pentoxifylline (PTX) can slow the decline of muscle strength and function in ambulatory boys with Duchenne muscular dystrophy (DMD).
Main Methods:
- A 12-month, multicenter, randomized, double-blind, placebo-controlled trial.
- Participants were corticosteroid-treated boys with DMD receiving daily slow-release PTX or placebo.
- Primary outcome: change in quantitative muscle testing (QMT) total score; secondary outcomes included muscle strength, pulmonary function, and timed function tests.
Main Results:
- Sixty-four boys with DMD were randomized; no significant difference in total QMT scores between PTX and placebo groups after 12 months (p = 0.14).
- Most secondary outcomes also showed no significant differences between treatment groups.
- Pentoxifylline use was associated with mild to moderate gastrointestinal and hematologic adverse events.
Conclusions:
- Adding pentoxifylline to corticosteroid therapy did not improve or halt the deterioration of muscle strength and function in ambulatory boys with DMD over 12 months.
- This study provides Class I evidence that PTX is not effective in preventing functional decline in this patient population.
Objective:
To determine whether pentoxifylline (PTX) slows the decline of muscle strength and function in ambulatory boys with Duchenne muscular dystrophy (DMD).
Methods:
This was a multicenter, randomized, double-blinded, controlled trial comparing 12 months of daily treatment with PTX or placebo in corticosteroid-treated boys with DMD using a slow-release PTX formulation (~20 mg/kg/day). The primary outcome was the change in mean total quantitative muscle testing (QMT) score. Secondary outcomes included changes in QMT subscales, manual muscle strength, pulmonary function, and timed function tests. Outcomes were compared using Student t tests and a linear mixed-effects model. Adverse events (AEs) were compared using the Fisher exact test.
Results:
A total of 64 boys with DMD with a mean age of 9.9 ± 2.9 years were randomly assigned to PTX or placebo in 11 participating Cooperative International Neuromuscular Research Group centers. There was no significant difference between PTX and the placebo group in total QMT scores (p = 0.14) or in most of the secondary outcomes after a 12-month treatment. The use of PTX was associated with mild to moderate gastrointestinal or hematologic AEs.
Conclusion:
The addition of PTX to corticosteroid-treated boys with DMD at a moderate to late ambulatory stage of disease did not improve or halt the deterioration of muscle strength and function over a 12-month study period.
Classification Of Evidence:
This study provides Class I evidence that treatment with PTX does not prevent deterioration in muscle function or strength in corticosteroid-treated boys with DMD.
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