Introduction: In Duchenne muscular dystrophy (DMD), glucocorticoids (GCs) can play a crucial role in preserving pulmonary function by slowing the progression of respiratory muscle weakness. Here, we examined whether long-term GC use was related to a reduced risk of respiratory complications, particularly during adolescence and early adulthood.
Methods: A retrospective cohort study used 2017–2022 Medicaid claims to assess respiratory outcomes among male DMD patients aged ≤30 years. Long-term GC users (≥90 days of use with ≤60-day gaps) were compared to non-users (no GC use during the study period and in the 12 months prior). Adjusted odds ratios (aOR) were estimated for discrete age groups [10, 15, 20, 25, 30 years] to examine the impact of long-term GC use for pneumonia, upper respiratory infections (URIs), and respiratory failure, adjusting for race/ethnicity, comorbidity burden, and follow-up duration.
Results: Among 2,273 male DMD patients (1,365 GC users; 908 non-GC), GC users had significantly lower odds of pneumonia at ages 10 and 15 (aOR = 0.64 and 0.70, respectively). Although a protective effect was suggested at age 20 (aOR = 0.76), it was not statistically significant. GC users also had reduced odds of respiratory failure at ages 15 and 20 (aOR = 0.78 and 0.75, respectively). All p-values were <0.05 for significant comparisons. No significant differences in URIs were observed between groups at any age. Conclusion: GC use was associated with lower odds of pneumonia and respiratory failure through mid-adolescence, with possible continued benefit into early adulthood. These age-stratified findings suggest that GCs delay respiratory progression in DMD.