Life Expectancy With DMD: New Treatments and Improved Survival Rates

Medically reviewed by Chiara Rocchi, M.D.
Written by Emily Wagner, M.S.
Updated on August 19, 2024

  • Over the past few decades, the overall survival rate of Duchenne muscular dystrophy (DMD) has significantly improved.
  • New treatments have helped increase the life expectancy of people living with DMD by nearly 10 years.
  • The most common factors affecting life expectancy with DMD are heart and respiratory (breathing) problems.

Life expectancy for people living with Duchenne muscular dystrophy has significantly increased in recent years as new treatment options emerge. Among them are gene therapies and exon-skipping therapies that help address the gene mutations (changes) that cause this muscle-weakening disease.

In this article, we’ll discuss life expectancy with DMD and how different therapies are improving prognosis (outlook). We’ll also cover common complications that affect the outlook of those living with DMD.

What Is Duchenne Muscular Dystrophy?

DMD is a rare neuromuscular disorder diagnosed in early childhood that causes muscle weakness and degeneration that gets worse over time. DMD is caused by genetic changes in the dystrophin gene, which gives instructions to make dystrophin proteins. This protein is responsible for holding muscle cells together and helping them function properly. People with DMD don’t make enough dystrophin, which causes muscle symptoms.

DMD is the most common type of muscular dystrophy, affecting 4.8 per 100,000 people globally.

DMD is the most common type of muscular dystrophy, affecting 4.8 per 100,000 people globally. The condition accounts for around half of all cases of muscular dystrophy. A milder form of muscular dystrophy known as Becker muscular dystrophy (BMD) — which affects 1.6 in 100,000 people globally — tends to develop in teenagers and young adults.

Most symptoms of DMD develop in early childhood. Over time, people with DMD can develop other complications that affect their disease outlook, including lung and heart problems.

Common signs and symptoms of DMD include:

  • Large calf muscles
  • Toe-walking
  • Learning difficulties
  • Scoliosis (changes in spine curvature)
  • Breathing difficulties
  • Difficulty walking, running, or climbing up stairs, leading to falls
  • Waddling gait (waddling when walking)
  • Gowers’ sign — Standing up by crawling one’s hands up one’s legs

Survival Rates With Duchenne Muscular Dystrophy

To better understand the disease outlook with DMD, it’s important to first learn about how researchers talk about survival and life expectancy. Many DMD studies talk about survival rates in terms of median overall survival (OS). Here, we use this term to mean how long 50 percent of people with DMD remain alive.

How Long Does Someone With Duchenne Muscular Dystrophy Live?

As doctors and researchers have learned more about DMD and how to treat it, survival rates have significantly improved. Researchers from Sweden and Great Britain performed a meta-analysis of 14 different studies from around the world looking at people with DMD. This study, published in 2021, found that the median OS was 22 years.

It's becoming more common for people with DMD to live into their 30s, according to the Muscular Dystrophy Association.

The median OS could be divided further into different age groups:

  • People born before 1970 had a median OS of just over 18 years.
  • People born between 1970 and 1990 had a median OS of 24 years.
  • People born after 1990 had a median OS of just over 28 years.

A smaller, but more recent study, was conducted on 129 people in Sweden with DMD and published in 2024. It found that the median lifespan among those with DMD was 24.3 years. The study was focused on respiratory complications and their impact on survival. The Muscular Dystrophy Association notes that with improvement in cardiac and respiratory care, people with DMD are more commonly living into their 30s.

Treatments for Duchenne Muscular Dystrophy Extend Life Expectancy

There’s currently no cure for DMD, but mainstay and new treatments continue to improve the quality of life for those living with DMD and extend their life expectancy. The therapies used to treat DMD today focus on managing symptoms and slowing disease progression.

Gene Therapies

Gene therapies are medications that give individuals with DMD the ability to produce dystrophin. Because Duchenne muscular dystrophy is caused by underproduction of dystrophin, gene therapy helps control disease progression by supplying the body with a way to make this protein.

One of the best ways to slow the progression of DMD is to start treatment with corticosteroids shortly after receiving a diagnosis.

In 2023, the U.S. Food and Drug Administration (FDA) approved the gene therapy delandistrogene moxeparvovec-rokl (Elevidys) for a small subset of people with DMD. In June 2024, the FDA extended approval of this gene therapy to people with DMD who are at least 4 years old and have a mutation in their DMD gene. The medication is delivered through an intravenous infusion, and it’s approved for both those who can and cannot walk.

Researchers studied 20 children with DMD, aged 4 to 8, who received this gene therapy. After a year, study participants’ motor function was found to be either better or stable compared to the start of the trial. Because gene therapy is a newer treatment for DMD, it’s unclear what its effect will be on longevity.

Corticosteroids

One of the best ways to slow the progression of DMD is to start treatment with corticosteroids shortly after receiving a diagnosis. Corticosteroids are synthetic (laboratory-made) hormones that help control inflammation. In people with DMD, these drugs may help the body repair damaged or weakened muscle cells.

Studies show that corticosteroids help strengthen muscles in people with DMD. Long-term corticosteroid treatment can help reduce a person’s risk of losing their mobility and their risk of death by more than 50 percent.

One study of 86 people with DMD found that the OS rates improved significantly for participants treated with corticosteroids compared to those who weren’t. For example, the OS rate at 15 years for the corticosteroid group was 78.6 percent compared to 27.9 percent for those not treated with corticosteroids. This means that after 15 years, 78.6 percent of people treated with corticosteroids were alive, whereas 27.9 percent of people who weren’t treated with corticosteroids were alive.

Another study followed 440 people with DMD for up to 10 years. The researchers found that those who took a steroid medication called glucocorticoids for at least a year experienced slower disease progression than those who didn’t take it or who only took it for a month or less. The study’s lead researcher also noted that study participants who took the glucocorticoids had a 50 percent lower risk of death than those who didn’t take them.

The most commonly prescribed corticosteroids for treating DMD include prednisone and deflazacort (Emflaza). Corticosteroids work well to treat DMD, but they’re associated with some unwanted side effects. Overall, the benefits outweigh the risks, but side effects can include:

  • Weight gain
  • Delays in growth
  • Osteoporosis (decline in bone density)
  • Behavioral changes

Exon-Skipping Therapies

In recent years, scientists have developed new therapies for treating DMD that help address different mutations in the dystrophin gene. Many people living with this disease are missing a specific part of DNA known as an exon — this means that their cells don’t have all of the instructions needed to make dystrophin proteins.

New treatments known as exon-skipping therapies help correct this problem so that muscle cells can make more dystrophin. The FDA has approved several different exon-skipping therapies, including:

  • Casimersen (Amondys 45)
  • Eteplirsen (Exondys 51)
  • Givinostat (Duvyzat)
  • Golodirsen (Vyondys 53)
  • Viltolarsen (Viltepso)

Exon-skipping therapies were developed through a technology called “clustered regularly interspaced short palindromic repeats (CRISPR)-directed gene editing.” CRISPR is a simplified method of modifying genes to allow them to perform new functions.

One study found that treatment with eteplirsen improved median OS rates by 5.4 years. Researchers found that 50 percent of people who were treated with eteplirsen lived for nearly 33 years, compared to 27.4 years for those who weren’t treated with eteplirsen.

It’s important to note that many of these treatments are new and haven’t been studied long term, so we don’t know their effects on life expectancy yet.

Complicating Factors in Survival With Duchenne Muscular Dystrophy

Dystrophin helps the lungs and heart work properly — without it, there’s a higher risk of health complications. People with DMD often have weakened lung and heart muscles, which makes it hard to breathe. The most common complications and causes of death in people with DMD are:

  • Heart failure — A condition that prevents your heart from pumping blood around the body
  • Respiratory failure — A condition that prevents your lungs from taking in enough oxygen on their own
  • Pneumonia — An infection that affects the lungs
  • Aspiration — Breathing in food or another foreign object into the lungs that may lead to infection

Fortunately, there are treatments available to help prevent these complications. Your child’s or loved one’s doctor will likely prescribe medications or respiratory care as needed. Beta-blockers or ACE inhibitors are medications used to help take stress off of the heart and help it pump blood better. Studies show that these medications can help people with DMD live longer when they’re prescribed early.

Medical devices can also help people with DMD breathe better during the day and at night, depending on their needs. There are many types of ventilation to help bring air into the lungs — other devices help them cough and clear out mucus to keep the lungs clear. Studies show that using ventilation while sleeping has improved life expectancy.

Finally, it's essential to have a team approach to provide the best care, including a physiotherapist, who helps with movement and exercises, and a neurorehabilitation specialist, who focuses on recovery from nervous system injuries.

Find Your Team

At myDMDcenter, the site for people with Duchenne muscular dystrophy and their loved ones, people come together to gain a new understanding of DMD and share their stories with others who understand life with DMD.

Have you talked to your or your loved one’s doctor about life expectancy with DMD? Share your experiences in the comments below.

References
  1. Duchenne Muscular Dystrophy (DMD) — Muscular Dystrophy Association
  2. What Are the Types and Symptoms of Muscular Dystrophy (MD)? — Eunice Kennedy Shriver National Institute of Child Health and Human Development
  3. Duchenne Muscular Dystrophy (DMD) — Cleveland Clinic
  4. Life Expectancy in Duchenne Muscular Dystrophy — Neurology
  5. Respiratory Comorbidities and Treatments in Duchenne Muscular Dystrophy: Impact on Life Expectancy and Causes of Death — Journal of Neurology
  6. Gene Therapy for Duchenne Muscular Dystrophy — Children’s Hospital of Philadelphia
  7. FDA Expands Approval of Gene Therapy for Patients With Duchenne Muscular Dystrophy — U.S. Food and Drug Administration
  8. New Gene Therapy for Duchenne Muscular Dystrophy a ‘Monumental Advance’ — University of Rochester Medical Center
  9. Delandistrogene Moxeparvovec Gene Therapy in Ambulatory Patients (Aged ≥4 to <8 Years) With Duchenne Muscular Dystrophy: 1-Year Interim Results From Study SRP-9001-103 (Endeavor) — Annals of Neurology
  10. Optimizing Steroid Treatment for Duchenne Muscular Dystrophy — National Institute of Arthritis and Musculoskeletal and Skin Diseases
  11. Corticosteroids — Cleveland Clinic
  12. All-Cause Mortality and Cardiovascular Outcomes With Prophylactic Steroid Therapy in Duchenne Muscular Dystrophy — Journal of the American College of Cardiology
  13. Long-Term Effects of Glucocorticoids on Function, Quality of Life, and Survival in Patients With Duchenne Muscular Dystrophy: A Prospective Cohort Study — The Lancet
  14. Optimizing Steroid Treatment for Duchenne Muscular Dystrophy — National Institute of Arthritis and Musculoskeletal or Skin Diseases
  15. Exon-Skipping in Duchenne Muscular Dystrophy — Journal of Neuromuscular Diseases
  16. Exon Skipping Induced by CRISPR-Directed Gene Editing Regulates the Response to Chemotherapy in Non-Small Cell Lung Carcinoma Cells — Gene Therapy
  17. Gene Editing — Digital Media Kit — National Institutes of Health
  18. Survival in Eteplirsen-Treated vs. Duchenne Muscular Dystrophy Natural History Patients: An Indirect Treatment Comparison Using Real-World Data — Muscular Dystrophy Association
  19. One in Five Patients With Duchenne Muscular Dystrophy Dies From Other Causes Than Cardiac or Respiratory Failure — European Journal of Epidemiology
  20. What Is Heart Failure? — National Heart, Lung, and Blood Institute
  21. What Is Respiratory Failure? — National Heart, Lung, and Blood Institute
  22. Muscular Dystrophy — Mayo Clinic
  23. Beneficial Effects of Beta-Blockers and Angiotensin-Converting Enzyme Inhibitors in Duchenne Muscular Dystrophy — Journal of Cardiology
  24. Survival in Duchenne Muscular Dystrophy: Improvements in Life Expectancy Since 1967 and the Impact of Home Nocturnal Ventilation — Neuromuscular Disorders
  25. Global Prevalence of Duchenne and Becker Muscular Dystrophy: A Systematic Review and Meta-Analysis — Journal of Orthopaedic Surgery and Research
Updated on August 19, 2024

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Chiara Rocchi, M.D. completed medical school and neurology residency at Polytechnic Marche University in Italy. Learn more about her here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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