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Duchenne Muscular Dystrophy and Delandistrogene Moxeparvovec Gene Therapy in Children: A Systematic Review and
Breno Bopp Antonello1, Fabio Cargnelutti Fontoura1, Anna Luiza Braga Albuquerque2
1Franciscan University, Santa Maria, Brazil.
Insights
Delandistrogene moxeparvovec gene therapy shows promise for Duchenne muscular dystrophy (DMD) in young boys. The treatment improved key functional outcomes and dystrophin levels in a recent meta-analysis.
Area of Science:
- Neurology
- Genetics
- Pediatrics
Background:
- Duchenne muscular dystrophy (DMD) is a severe genetic disorder causing progressive muscle degeneration.
- Current treatments offer limited efficacy, necessitating novel therapeutic approaches.
- Delandistrogene moxeparvovec is an investigational gene therapy aiming to restore dystrophin production.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of delandistrogene moxeparvovec in ambulatory pediatric patients with DMD.
- To evaluate the impact of the gene therapy on functional outcomes and dystrophin expression.
Main Methods:
- Systematic search of Cochrane, PubMed, and Embase for relevant randomized controlled trials (RCTs) and cohort studies.
- Inclusion criteria: ambulatory male children (4-8 years) with DMD receiving delandistrogene moxeparvovec.
- Primary outcomes: NSAA score, 10-meter walk/run test (10MWR), time to rise (TTR), and dystrophin expression.
Main Results:
- Analysis included 302 participants from 4 studies (2 RCTs), with 107 receiving delandistrogene moxeparvovec.
- Significant improvements observed in NSAA scores (p=0.04) and TTR (p<0.01) at 1 year.
- Dystrophin content significantly increased (p<0.01), with improved 10MWR (p=0.02) in sensitivity analysis.
Conclusions:
- Delandistrogene moxeparvovec demonstrated efficacy in improving functional outcomes for ambulatory pediatric DMD patients.
- Despite high heterogeneity, the results are promising for this gene therapy.
- Further long-term RCTs are required to confirm safety and efficacy.
Background And Objectives:
Duchenne muscular dystrophy (DMD) is a progressive neuromuscular disorder caused by DMD pathogenic variants, leading to dystrophin deficiency, muscle degeneration, loss of ambulation, respiratory failure, and reduced life expectancy. Current treatments, such as corticosteroids and supportive care, offer limited long-term benefits. Delandistrogene moxeparvovec is a promising gene therapy developed to restore dystrophin expression and deliver microdystrophin to skeletal and cardiac muscles. This systematic review and meta-analysis evaluate the efficacy of this treatment in ambulatory pediatric patients with DMD.
Methods:
A systematic search of Cochrane, PubMed, and Embase identified randomized controlled trials (RCTs) and cohort studies on delandistrogene moxeparvovec in ambulatory male children (≥4 to <8 years) with DMD. Primary outcomes included NSAA score changes, a 10-meter walk/run test (10MWR), time to rise (TTR), and dystrophin expression. Study selection followed PRISMA guidelines, and statistical analyses were conducted using R software. The study was registered in PROSPERO (CRD42025635605).
Results:
We included 302 participants from 4 studies (2 RCTs). Follow-up ranged from 48 weeks to 5 years, with results analyzed at 1 year. Delandistrogene moxeparvovec was administered to 107 affected individuals, while 195 were in the control group. At 1 year, the therapy significantly improved NSAA scores (MD = 2.48, p = 0.04) and TTR (MD = -0.85, p < 0.01). Sensitivity analysis demonstrated improved 10MWR (MD = -0.71, p = 0.02). Muscle dystrophin content significantly increased (MD = 28.39, p < 0.01).
Discussion:
Delandistrogene moxeparvovec, despite high heterogeneity for the analysis, improved functional outcomes in ambulatory pediatric patients with DMD. Further long-term RCTs are needed to confirm its safety and efficacy.
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