Deflazacort: Mechanism, Uses, Side Effects, Contraindications, and Dosage

Deflazacort is a synthetic glucocorticoid with immunosuppressive and anti-inflammatory properties. It is widely used in the treatment of various autoimmune, inflammatory, and allergic conditions. This article provides an in-depth look at its mechanism of action, clinical applications, potential side effects, contraindications, and dosage recommendations.

Mechanism of Action

Deflazacort exerts its effects by binding to intracellular glucocorticoid receptors, leading to the modulation of gene expression. This results in the suppression of inflammatory mediators such as prostaglandins and leukotrienes. Additionally, it reduces the migration of inflammatory cells to the affected sites, thereby decreasing inflammation and immune system activity. Compared to other corticosteroids like prednisone, deflazacort has a relatively lower risk of metabolic side effects, making it a preferred option in certain clinical scenarios.

Uses of Deflazacort

Deflazacort is indicated in the treatment of various medical conditions, including:

Duchenne Muscular Dystrophy (DMD): One of the primary approved uses, deflazacort helps improve muscle strength and slow disease progression in DMD patients.
Autoimmune Disorders: Used in conditions such as rheumatoid arthritis, systemic lupus erythematosus (SLE), and multiple sclerosis to reduce inflammation.
Inflammatory and Allergic Conditions: Effective in managing asthma, chronic obstructive pulmonary disease (COPD), and allergic rhinitis.
Organ Transplantation: Helps in preventing organ rejection by suppressing the immune system.
Nephrotic Syndrome: Used to control proteinuria and manage relapse episodes in children and adults.

Side Effects

Like other corticosteroids, deflazacort may cause a range of side effects, including:

Weight gain and increased appetite
Hyperglycemia and diabetes mellitus
Osteoporosis and increased fracture risk
Hypertension
Mood changes, including anxiety and depression
Cataracts and glaucoma
Increased susceptibility to infections
Gastrointestinal disturbances like nausea and gastric ulcers

Contraindications

Deflazacort is contraindicated in certain conditions, including:

Systemic fungal infections: As it suppresses immune function, increasing the risk of worsening infections.
Untreated bacterial or viral infections: May exacerbate the condition.
Hypersensitivity: Patients with a known allergy to deflazacort should avoid it.
Live Vaccinations: Immunosuppression can interfere with vaccine efficacy and increase infection risks.

Dosage and Administration

The dosage of deflazacort varies depending on the condition being treated:

Duchenne Muscular Dystrophy: Recommended dose is 0.9 mg/kg/day orally.
Autoimmune and Inflammatory Conditions: Typically, the dose ranges from 6 mg to 90 mg per day, depending on disease severity.
Nephrotic Syndrome: Dosage is individualized, often starting at high doses and gradually tapering down.
Organ Transplantation: Higher doses may be used initially, followed by maintenance therapy.

Dose adjustments are required in elderly patients, those with hepatic impairment, and patients on concurrent medications that affect steroid metabolism.

Benefits Over Other Steroids

Lower Risk of Osteoporosis: Compared to other corticosteroids, deflazacort has a lesser impact on bone mineral density.
Reduced Weight Gain: Studies suggest that deflazacort may have a lower tendency to cause significant weight gain compared to prednisone.
Better Tolerability in Long-term Use: Due to its favorable metabolic profile, it is preferred in chronic conditions requiring prolonged corticosteroid therapy.

Conclusion

Deflazacort is an effective corticosteroid with a broad range of applications in inflammatory, autoimmune, and neuromuscular conditions. While it offers advantages over traditional steroids like prednisone, careful monitoring is essential to minimize adverse effects. Always consult a healthcare professional before starting or adjusting deflazacort therapy to ensure safe and effective treatment.