Effect of long-term use of corticosteroids on cataracts and high intraocular pressure in patients with Duchenne muscular dystrophy

ZHAO Shuang; CHEN A'nan; WANG Shaoxia; CHEN Xinyu; ZHANG Shu; ZHAO Jie; WU Shiwen

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Medical Journal of the Chinese People Armed Police Forces ›› 2021, Vol. 32 ›› Issue (6) : 480-485.

Effect of long-term use of corticosteroids on cataracts and high intraocular pressure in patients with Duchenne muscular dystrophy

ZHAO Shuang¹, CHEN A'nan², WANG Shaoxia², CHEN Xinyu², ZHANG Shu², ZHAO Jie³, WU Shiwen²

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Abstract

Objective To analyze the effects of long-term use of corticosteroids on high intraocular pressure and cataracts and related risk factors in patients with Duchenne muscular dystrophy (DMD). Methods The data on 158 DMD patients with detailed results of eye examinations and treated between August 2018 and December 2020 was retrospectively analyzed. According to whether corticosteroids were taken for a minimum of six months, the patients were divided into the corticosteroids group (n=103 cases) and corticosteroids free group (n=31 cases), so 24 cases that had taken corticosteroids for less than six months were not included in this study. The incidence of cataracts and high intraocular pressure in different groups was compared. Logistic regression analysis was used to study the correlations between cataracts and high intraocular pressure on one hand and age, duration of medication, types of corticosteroids, BMI, DP260 and DP71 on the other hand. Results In the corticosteroids free group, 1 case with intraocular pressure was reported, and no cataract was revealed. In the corticosteroids group, there were 13 cases (12.6%) with cataracts and 24 cases (23.3%) with high intraocular pressure, 1 case because of cataract was treated with surgery. Long-term use of corticosteroids was more likely to cause cataracts or high intraocular pressure (P<0.01). The incidence of cataracts and high intraocular pressure was 27.3% (3/11) and 27.3% (3/11) in the deflaxacort group (n=11), respectively, compared with 10.9% (10/92) and 22.8% (21/92) in the prednisone group. As indicated by logistic regression analysis, the incidence of cataracts was related to the type and duration corticosteroids. Moreover, there was no significant correlation between high intraocular pressure and age, duration of medication, types of hormones taken, BMI, DP260 or DP71. Conclusions DMD patients are more vulnerable to cataracts and high intraocular pressure after long-term use of corticosteroids. The types of corticosteroids taken and duration of medication are independent risk factors for cataracts. Besides, the longer corticosteroids are taken, the more likely deflazacort is to lead to cataracts.

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Duchenne muscular dystrophy / cataract / high intraocular pressure

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ZHAO Shuang, CHEN A'nan, WANG Shaoxia, CHEN Xinyu, ZHANG Shu, ZHAO Jie, WU Shiwen. Effect of long-term use of corticosteroids on cataracts and high intraocular pressure in patients with Duchenne muscular dystrophy[J]. Medical Journal of the Chinese People Armed Police Forces. 2021, 32(6): 480-485

References

[1] Waldrop M A,Flanigan K M.Update in Duchenne and Becker muscular dystrophy[J].Curr Opin Neurol, 2019, 32(5):722-727.
[2] Fernández-Ruiz I.New developments in gene editing for Duchenne muscular dystrophy[J].Nat Rev Cardiol, 2020, 17(4):200-201.
[3] Moxley R T 3rd, Ashwal S, Pandya S, et al. Practice parameter: corticosteroid treatment of Duchenne dystrophy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society[J]. Neurology, 2005, 64(1):13-20.
[4] Bushby K, Muntoni F, Urtizberea A, et al.Report on the 124th ENMC International Workshop. Treatment of Duchenne muscular dystrophy; defining the gold standards of management in the use of corticosteroids. 2-4 April 2004, Naarden, The Netherlands[J]. Neuromuscul Disord, 2004, 14(8-9): 526-534.
[5] Griggs R C, Miller J P, Greenberg C R, et al. Efficacy and safety of deflazacort vs prednisone and placebo for Duchenne muscular dystrophy[J]. Neurology, 2016, 87(20): 2123-2131.
[6] Bushby K, Finkel R, Birnkrant D J, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and pharmacological and psychosocial management[J]. Lancet Neurol, 2010, 9(1):77-93.
[7] Drachman D B, Toyka K V,Myer E. Prednisone in Duchenne muscular dystrophy[J]. Lancet, 1974,2(7894):1409-1412.
[8] Fel A, Aslangul E,Le Jeunne C. Eye and corticosteroid's use[J]. Presse Med, 2012, 41(4):414-421.
[9] Ernst P, Baltzan M, Deschênes J, et al. Low-dose inhaled and nasal corticosteroid use and the risk of cataracts[J]. Eur Respir J, 2006, 27(6): 1168-1174.
[10] van Staa T P, Leufkens H G,Cooper C.The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis[J]. Osteoporos Int, 2002, 13(10): 777-787.
[11] Jones R 3rd,Rhee D J.Corticosteroid-induced ocular hypertension and glaucoma: a brief review and update of the literature[J].Curr Opin Ophthalmol, 2006, 17(2): 163-167.
[12] Fini M E, Schwartz S G, Gao X, et al.Steroid-induced ocular hypertension/glaucoma: focus on pharmacogenomics and implications for precision medicine[J].Prog Retin Eye Res, 2017, 56:58-83.
[13] Liesenborghs I, Eijssen L M T, Kutmon M, et al. The molecular processes in the trabecular meshwork after exposure to corticosteroids and in corticosteroid-induced ocular hypertension[J]. Invest Ophthalmol Vis Sci, 2020, 61(4):24.
[14] Chan W, Wiggs J L,Sobrin L.The genetic influence on corticosteroid-induced ocular hypertension: a field positioned for discovery[J]. Am J Ophthalmol, 2019, 202:1-5.
[15] James E R.The etiology of steroid cataract[J].J Ocul Pharmacol Ther, 2007, 23(5): 403-420.
[16] Behbehani A H, Owayed A F, Hijazi Z M, et al.Cataract and ocular hypertension in children on inhaled corticosteroid therapy[J]. J Pediatr Ophthalmol Strabismus, 2005, 42(1):23-27.
[17] Rice M L, Wong B, Horn P S, et al.Cataract development associated with long-term glucocorticoid therapy in Duchenne muscular dystrophy patients[J]. J AAPOS, 2018, 22(3): 192-196.
[18] Hayasaka Y, Hayasaka S,Matsukura H. Ocular findings in Japanese children with nephrotic syndrome receiving prolonged corticosteroid therapy[J]. Ophthalmologica, 2006, 220(3):181-185.
[19] Lee S W, Jin K H, Lee S C, et al. Cataract and glaucoma in Korean children with chronic glomerulonephritis receiving systemic corticosteroid treatment[J].Acta Ophthalmol, 2010, 88(8): e344-e345.
[20] Matthews E, Brassington R, Kuntzer T, et al.Corticosteroids for the treatment of Duchenne muscular dystrophy[J]. Cochrane Database Syst Rev, 2016(5): CD003725.
[21] Ward L M,Weber D R. Growth, pubertal development, and skeletal health in boys with Duchenne Muscular Dystrophy[J].Curr Opin Endocrinol Diabetes Obes, 2019, 26(1):39-48.
[22] Kim S, Zhu Y, Romitti P A, et al. Associations between timing of corticosteroid treatment initiation and clinical outcomes in Duchenne muscular dystrophy[J]. Neuromuscul Disord, 2017, 27(8):730-737.
[23] Bylo M, Farewell R, Coppenrath V A, et al. A review of deflazacort for patients with Duchenne muscular dystrophy[J].Ann Pharmacother,2020,54(8):788-794.
[24] McDonald C M, Sajeev G, Yao Z, et al.Deflazacort vs prednisone treatment for Duchenne muscular dystrophy: a meta-analysis of disease progression rates in recent multicenter clinical trials[J]. Muscle & Nerve, 2020,61(1):26-35.
[25] Joseph S, Wang C, Bushby K, et al. Fractures and linear growth in a nationwide cohort of boys with Duchenne muscular dystrophy with and without glucocorticoid treatment: results from the UK NorthStar Database[J].JAMA Neurol,2019,76(6):701-709.
[26] Hoffman E P, Schwartz B D, Mengle-Gaw L J, et al.Vamorolone trial in Duchenne muscular dystrophy shows dose-related improvement of muscle function[J].Neurology,2019,93(13):e1312-e1323.
[27] Pillers D A, Fitzgerald K M, Duncan N M, et al.Duchenne/Becker muscular dystrophy: correlation of phenotype by electroretinography with sites of dystrophin mutations[J].Hum Genet,1999,105(1-2):2-9.
[28] Costa M F, Oliveira A G, Feitosa-Santana C, et al.Red-green color vision impairment in Duchenne muscular dystrophy[J].Am J Hum Genet,2007,80(6):1064-1075.
[29] Barboni M T S, Vaillend C, Joachimsthaler A, et al. Rescue of defective electroretinographic responses in Dp71-Null mice with AAV-Mediated reexpression of Dp71[J].Invest Ophthalmol Vis Sci,2020,61(2):11.
[30] Fort P E, Darche M, Sahel J A, et al.Lack of dystrophin protein Dp71 results in progressive cataract formation due to loss of fiber cell organization[J].Mol Vis,2014,20:1480-1490.
[31] Kurihara T, Kishi M, Saito N, et al.Electrical myotonia and cataract in X-linked muscular dystrophy (mdx) mouse[J].J Neurol Sci,1990, 99(1):83-92.