Vamorolone for treatment of Duchenne muscular dystrophy
Authors:
M. Rohlenová
Authors‘ workplace:
Klinika dětské neurologie 2. LF UK a FNMH – Motol, Praha
Published in:
Cesk Slov Neurol N 2026; 89(2): 87-92
Category:
Review Article
doi:
https://doi.org/10.48095/cccsnn202687
Overview
Corticosteroid therapy is currently the only therapeutic option for the treatment of Duchenne muscular dystrophy. However, long-term corticosteroid therapy is associated with numerous and serious side effects. At the end of 2023, the European Medicines Agency approved vamorolone, a partial agonist of the glucocorticoid receptor, which promises to maintain an anti-inflammatory effect while reducing the side effects of glucocorticoids. The article provides an overview of preclinical and clinical studies. The results show that vamorolone, especially at higher doses (6 mg/kg/day), has comparable efficacy to prednisone in maintaining muscle strength, has a demonstrably more favorable profile in maintaining growth rate, and potentially a lower incidence of undesirable psychological, bone, immunosuppressive, and cardiological effects, while body mass index values are comparable to prednisone, they do not increase over time.
Keywords:
Duchenne muscular dystrophy – vamorolone – corticotherapy
Sources
1. Matthews E, Brassington R, Kuntzer T et al. Corticosteroids for the treatment of Duchenne muscular dystrophy. Cochrane Database Syst Rev 2016; 6: CD003725. doi: 10.1002/14651858.CD003725.pub4.
2. Moxley RT, Pandya S, Ciafaloni E et al. Change in natural history of Duchenne muscular dystrophy with long--term corticosteroid treatment: implications for management. J Child Neurol 2010; 25 (9): 1116–1129. doi: 10.1177/0883073810371004.
3. Griggs RC, Miller JP, Greenberg CR et al. Corticosteroids in Duchenne muscular dystrophy: major variations in practice. Muscle Nerve 2013; 48 (1): 27–31. doi: 10.1002/mus.23831.
4. Ramamoorthy S, Cidlowski JA. Corticosteroids. Rheum Dis Clin North Am 2016; 42 (1): 15–31. doi: 10.1016/j.rdc.2015.08.002.
5. Gensler LS. Glucocorticoids: complications to anticipate and prevent. Neurohospitalist 2013; 3 (2): 92–97. doi: 10.1177/1941874412458678.
6. Liu G, Liu Y, Zhang X et al. Comparison of pharmaceutical properties and biological activities of prednisolone, deflazacort, and vamorolone in DMD disease models. Hum Mol Genet 2024; 33 (3): 211–223. doi: 10.1093/hmg/ddad173.
7. Akkad H, Wilding BR, Hunt LC et al. Vamorolone treatment improves skeletal muscle outcome in a critical illness myopathy rat model. Acta Physiol 2019; 225 (2): e13172. doi: 10.1111/apha.13172.
8. Heier CR, Damsker JM, Yu Q et al. VBP15, a novel anti-inflammatory and membrane stabilizer, improves muscular dystrophy without side effects. EMBO Mol Med 2013; 5 (10): 1569–1585. doi: 10.1002/emmm.201302621.
9. Quattrocelli M, Zelikovich AS, Salamone IM et al. Mechanisms and clinical applications of glucocorticoid steroids in muscular dystrophy. J Neuromuscul Dis 2021; 8 (1): 39–52. doi: 10.3233/JND-200556.
10. Reeves EKM, Hoffman EP, Nagaraju K et al. VBP15: preclinical characterization of a novel anti-inflammatory D9,11 steroid. Bioorg Med Chem 2013; 21 (8): 2241–2249. doi: 10.1016/j.bmc.2013.02.009.
11. Liu X, Wang Y, Gutierrez JS et al. Disruption of a key ligand–H-bond network drives dissociative properties in vamorolone. Proc Natl Acad Sci USA 2020; 117 (39): 24285–24293. doi: 10.1073/pnas.2006890117.
12. Ziemba M, Ge Y, Fox J et al. Biomarker-focused multi--drug combination therapy and repurposing trial in mdx mice. PLoS One 2021; 16 (2): e0246507. doi: 10.1371/journal.pone.0246507.
13. Fiorillo AA, Tully CB, Damsker JM et al. Muscle miRNAome shows suppression of chronic inflammatory miRNAs with prednisone and vamorolone. Physiol Genomics 2018; 50 (9): 735–745. doi: 10.1152/physiolgenomics. 00134.2017.
14. Crastin A, Smith L, Brown K et al. Vamorolone: a novel metabolism-resistant steroid with reduced systemic side effects. Rheumatology 2025; 64 (7): 4371–4381. doi: 10.1093/rheumatology/keaf129.
15. Damsker JM, Dillingham BC, Rose S et al. Vamorolone reduces joint damage and inflammation in arthritis model. Inflamm Res 2019; 68 (11): 969–980. doi: 10.1007/s00011-019-01279-z.
16. Mnuskina S, Hamar D, Szentesi P et al. Effects of vamorolone in ventilator-induced diaphragm dysfunction. Front Physiol 2023; 14 : 1207802. doi: 10.3389/fphys.2023.1207802.
17. Wells E, Koppaka V, Huang W et al. Vamorolone reduces inflammation and improves survival in glioma model. Oncotarget 2017; 8 (6): 9366–9374. doi: 10.18632/oncotarget.14070.
18. Dillingham BC, Knoblach SM, Damsker JM et al. VBP15 reduces severity of autoimmune encephalomyelitis. Cell Mol Neurobiol 2015; 35 (3): 377–387. doi: 10.1007/s10 571-014-0133-y.
19. Damsker JM, Dillingham BC, Rose S et al. VBP15 reduces allergic lung inflammation in mice. PLoS One 2013; 8 (5): e63871. doi: 10.1371/journal.pone.0063871.
20. McCormack NM, Nguyen NY, Tully CB et al. Vamorolone improves Becker muscular dystrophy in mouse model. iScience 2023; 26 (7): 107161. doi: 10.1016/j.isci.2023.107161.
21. Baudy AR, Damsker JM, Heier CR et al. D9,11 glucocorticoid modification dissociates efficacy from side effects. J Pharmacol Exp Ther 2012; 343 (1): 225–232. doi: 10.1124/jpet.112.194340.
22. Heier CR, Yu Q, Fiorillo AA et al. Vamorolone targets dual nuclear receptors. Life Sci Alliance 2019; 2 (1): e201800186. doi: 10.26508/lsa.201800186.
23. De Vera A, Smith EC, McDonald CM et al. Mineralocorticoid receptor antagonism of vamorolone: clinical trial evidence. Steroids 2025; 223 : 109689. doi: 10.1016/j.steroids.2025.109689.
24. Mavroudis PD, DuBois DC, Almon RR et al. Population pharmacokinetics of vamorolone. J Clin Pharmacol 2019; 59 (7): 979–988. doi: 10.1002/jcph.1388.
25. Conklin LS, Damsker JM, Hoffman EP et al. Phase IIa trial of vamorolone in DMD. Pharmacol Res 2018; 136 : 140–150. doi: 10.1016/j.phrs.2018.09.007.
26. Hoffman EP, Schwartz BD, Mengle-Gaw LJ et al. Phase 1 trial of vamorolone. Steroids 2018; 134 : 43–52. doi: 10.1016/j.steroids.2018.02.010.
27. Hoffman EP, Schwartz BD, Mengle-Gaw LJ et al.Vamorolone trial shows dose-related improvement. Neurology 2019; 93 (13): e1312–e1323. doi: 10.1212/WNL.00000 00000008168.
28. Smith EC, Conklin LS, Hoffman EP et al. Efficacy and safety of vamorolone: 18-month analysis. PLoS Med 2020; 17 (9): e1003222. doi: 10.1371/journal.pmed.1003222.
29. Mah JK, Clemens PR, Guglieri M et al. Vamorolone in DMD: 30-month extension study. JAMA Netw Open 2022; 5 (1): e2144178. doi: 10.1001/jamanetworkopen.2021.44178.
30. Guglieri M, Clemens PR, Perlman SJ et al. Vamorolone vs placebo and prednisone in DMD. JAMA Neurol 2022; 79 (10): 1005–1014. doi: 10.1001/jamaneurol.2022.2480.
31. Dang UJ, Clemens PR, Guglieri M et al. Vamorolone over 48 weeks in boys with DMD. Neurology 2024; 102 (5): e208112. doi: 10.1212/WNL.0000000000208112.
32. Henricson E, Abresch RT, Han JJ et al. Evaluation of behavioural problems in VISION-DMD study. [online]. Available from: https: //www.mdaconference.org/abstract-library/evaluation-of-behavioral-problems-in-the-vision-dmd-study-of-vamorolone-vs-prednisone-in-duchenne-muscular-dystrophy/.
33. Denger B, Kinnett K, Martin A et al. Patient and caregiver perspectives on guideline adherence in DMD. Orphanet J Rare Dis 2019; 14 (1): 205. doi: 10.1186/s13023-019-1173-7.
34. Wood CL, Page J, Foggin J et al. Testosterone therapy and quality of life in DMD. Neuromuscul Disord 2021; 31 (12): 1259–1265. doi: 10.1016/j.nmd.2021.09.007.
35. Weber DR, Hadjiyannakis S, McMillan HJ et al. Obesity and endocrine management in DMD. Pediatrics 2018; 142 (Suppl 2): S43–S52. doi: 10.1542/peds.2018-0333F.
36. Joseph S, Wang C, Bushby K et al. Fractures and growth in boys with DMD. JAMA Neurol 2019; 76 (6): 701–709. doi: 10.1001/jamaneurol.2019.0242.
37. Santhera Pharmaceuticals. Five-year data of AGAMREE (vamorolone) in DMD. Pratteln: Santhera Pharmaceuticals 2025.
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Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
2026 Issue 2
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