This systematic review and cumulative meta-analysis evaluated temporal trends in life expectancy for patients with Duchenne muscular dystrophy (DMD) and assessed the impact of home mechanical ventilation (HMV) on survival. The analysis was registered on PROSPERO (CRD420251163011) and used PubMed searches spanning from 1977 to 13 October 2025. The authors synthesized study-level data to generate pooled median survival estimates and to explore predefined subgroups and associations with treatments.
The review included 53 studies with a combined sample of more than 13,000 patients and a median study-level follow-up of 8 years. The investigators performed cumulative meta-analyses, random-effects meta-analyses with prespecified subgroups for ventilation status and study period, and meta-regressions to evaluate associations between treatments and survival. Risk of bias across included studies was assessed using the Newcastle-Ottawa Scale. The source text reports these core methods; further granular methodological details (for example, inclusion/exclusion criteria, search terms, and heterogeneity statistics) were not included in the provided abstract.
Pooled median survival differed substantially by ventilation status. Patients who received home mechanical ventilation had a pooled median survival of 29 years (95% CI 27 to 31), whereas non-ventilated patients had a pooled median survival of 19 years (95% CI 18 to 20). These pooled estimates indicate a pronounced survival advantage associated with ventilatory support at a population level across included studies.
The meta-analysis demonstrated progressive improvement in survival over time in both ventilated and non-ventilated groups. The findings suggest that care advances implemented across successive eras have contributed to increased life expectancy for people with DMD. The cumulative meta-analytic approach used by the authors allowed visualization of how median survival estimates changed as newer studies and more contemporary patient cohorts were added.
In the analyses reported, glucocorticoid therapy was not associated with an improvement in survival (p = 0.45). In contrast, cardiovascular treatments were associated with longer survival: use of renin-angiotensin system inhibitors showed a statistically significant association with increased survival (p = 0.002), and β-blocker therapy was also associated with longer survival (p = 0.02). These results highlight the measurable contribution of cardiac management to outcomes in DMD cohorts included in the review.
Historically, respiratory failure accounted for the majority of deaths in DMD. The analysis found a shift in the predominant causes of mortality from respiratory to cardiac causes as respiratory care—particularly HMV—became more widespread. Improved cardiac management, reflected by the association of cardiac medications with survival, corresponded with a growing contribution of other non-respiratory causes of death. Clinically, these trends underscore the importance of sustained multidisciplinary care that includes early and proactive cardioprotective strategies alongside respiratory support.
Risk of bias for included studies was assessed using the Newcastle-Ottawa Scale. The meta-analysis and systematic review were registered on PROSPERO under CRD420251163011. The abstract does not provide detailed results of the bias assessment, heterogeneity metrics, or full sensitivity analyses; these details were not reported in the provided source text and would require consultation of the full article for clarification.
The authors conclude that survival in DMD has increased substantially over time, with the pooled median survival in ventilated patients now approaching the third decade of life. The findings attribute major survival gains to respiratory interventions such as home mechanical ventilation and to improved cardiac care, particularly use of renin-angiotensin system inhibitors and β-blockers. The observed shift from respiratory to cardiac and other causes of death highlights the need for long-term, multidisciplinary management and early cardioprotective intervention in DMD care pathways. Specific operational recommendations, implementation strategies, and detailed subgroup guidance were not included in the abstract and are not reported in the source text provided.