Steroid Management Overview
Corticosteroids, or steroids, are used in many other medical conditions worldwide. There is no doubt that steroids can benefit many people with Duchenne, but this benefit needs to be balanced with proactive management of possible side effects. Use of steroids is very important in Duchenne and should be discussed before a decline in physical function is seen.
Steroids are known to slow the decline in muscle strength and motor function in Duchenne. Corticosteroids are different from the anabolic steroids that are sometimes misused by athletes who want to become stronger. The goal of steroid therapy in Duchenne is to maintain muscle strength and function, helping you to walk longer, preserve your upper limb and respiratory function, and to help to avoid surgery to treat scoliosis (curvature of the spine).
- Steroids should be discussed at the time of diagnosis. The optimal time to start steroid use is during the ambulatory stage before there is significant physical decline (see Figure 4)
- The recommended national vaccination schedule should be complete before steroid treatment is started and varicella (chicken pox) immunity should be established. Vaccination recommendations from the Center for Disease Control and Prevention (CDC) for the US can be found here: www.ParentProjectMD.org/Vaccinations
- Recommendations for the UK and Ireland can be found here: https://www.nhs.uk/conditions/vaccinations/childhood-vaccines-timeline/ and https://www.hse.ie/eng/health/immunisation/. Please also consult your neuromuscular specialist for vaccination recommendations
- Prevention and management of steroid side effects needs to be proactive and anticipatory (see Table 2 in section: Steroid Side Effects: Recommended Monitoring and Intervention)