A randomized, double-blind trial of lisinopril and losartan for the treatment of cardiomyopathy in duchenne muscular dystrophy.
OBJECTIVE
This study sought to compare the effectiveness and safety of an angiotensin converting enzyme inhibitor (ACE-I) (lisinopril) vs. an angiotensin receptor blocker (ARB) (losartan) for the treatment of cardiomyopathy (CM) in boys with Duchenne muscular dystrophy (DMD).


BACKGROUND
Development of CM is universal in boys with DMD. ACE-I and ARB have both been suggested as effective treatment options. ARBs have been associated with skeletal muscle regeneration in a mouse model of DMD. The question of which, if either, is more effective for CM treatment in DMD remains. The purpose of this multicenter double-blind prospective study was to compare efficacy and safety of lisinopril versus losartan in the treatment of newly diagnosed CM in boys with DMD.


METHODS
Echocardiographic technician inter- and intraobserver variability were tested on 2 separate days on 2 different boys with DMD CM. Results were compared with paired t-testing. Twenty-two boys with newly diagnosed DMD CM (echocardiographic ejection fraction (EF) 10% EF drop. Three boys in the aCE-I group had 3 visits, due to study funding termination. Two were withdrawn because of low EF. All their data are included in the analysis for as long as they remained in the study. Mean EF's were similar at baseline (47.5%- ACE-I, 48.4%- ARB). After 1 year each group significantly improved to 54.6% and 55.2% respectively (p=.02). There was no difference between the 2 treatment groups at 1 year.


CONCLUSIONS
Inter-observer and intra-observer reliability studies showed no differences between echocardiographers on serial examinations. EF improved equally in the two groups. There is no therapeutic difference in EF improvement between lisinopril and losartan over the one-year duration for treatment of boys with DMD-related CM.


BACKGROUND
ClinicalTrials.gov NCT01982695.
Center for Gene Therapy, Heart Center, and Wellstone Cooperative Muscular Dystrophy Research Center, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Hugh D
HD
Allen
Departments of Neurology and Pediatrics, The Ohio State University, Columbus, Ohio, United States; Center for Gene Therapy, Nationwide Children's Hospital, Columbus, Ohio, United States.
Kevin M
KM
Flanigan
Center for Gene Therapy, Heart Centre, and Wellstone Cooperative Muscular Dystrophy Research Center, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.
Philip T
PT
Thrush
Center for Mathematical Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.
Igor
I
Dvorchik
Center for Mathematical Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.
Han
H
Yin
St. Louis Children's Hospital, Washington University College of Medicine, St. Louis, Missouri, USA.
Charles
C
Canter
St. Louis Children's Hospital, Washington University College of Medicine, St. Louis, Missouri, USA.
Anne M
AM
Connolly
University of California Davis, Davis, California, USA.
Mark
M
Parrish
University of California Davis, Davis, California, USA.
Craig M
CM
McDonald
The University of Minnesota College of Medicine, Minneapolis, Minnesota, USA.
Elizabeth
E
Braunlin
Boston Children's Hospital, Harvard Medical School, Boston, USA.
Steven D
SD
Colan
The University of Minnesota College of Medicine, Minneapolis, Minnesota, USA.
John
J
Day
Boston Children's Hospital, Harvard College of Medicine, Boston, Massachusetts, USA.
Basil
B
Darras
Departments of Neurology and Pediatrics, The Ohio State University, Columbus, Ohio, USA; Center for Gene Therapy, Nationwide Children's Hospital, Columbus, Ohio, USA.
Jerry R
JR
Mendell