Comparison of serum pharmacodynamic biomarkers in prednisone-versus deflazacort-treated duchenne muscular dystrophy boys

Prednisone (Pred) and Deflazacort (Dfz) are commonly used glucocorticoids (GCs) for Duchenne muscular dystrophy (DMD) treatment and management. While GCs are known to delay the loss of ambulation and motor abilities, chronic use can result in onerous side effects, e.g., weight gain, growth stunting, loss of bone density, etc. Here, we use the CINRG Duchenne natural history study to gain insight into comparative safety of Pred versus Dfz treatment through GC-responsive pharmacodynamic (PD) biomarkers. Longitudinal trajectories of SOMAscan^® protein data obtained on serum of DMD boys aged 4 to 10 (Pred: N = 7; Dfz: N = 8) were analyzed after accounting for age and time on treatment. Out of the pre-specified biomarkers, seventeen candidate proteins were differentially altered between the two drugs (p < 0.05). These include IGFBP-2 and AGER associated with diabetes complications, and MMP-3 associated with extracellular remodeling. As a follow-up, IGFBP-2, MMP-3, and IGF-I were quantified with an ELISA using a larger sample size of DMD biosamples (Dfz: N = 17, Pred: N = 12; up to 76 sera samples) over a longer treatment duration. MMP- 3 and IGFBP-2 validated the SOMAscan^® signal, however, IGF-I did not. This study identified GCresponsive biomarkers, some associated with safety, that highlight differential PD response between Dfz and Pred.