Report of the multistakeholder drug development round table meeting of the World Duchenne Organization focusing on challenges for clinical development of therapies.

Duchenne muscular dystrophy (DMD) is a muscle wasting disease where patients lose muscle tissue and function. The disease is caused by pathogenic variants that abolish the production of functional dystrophin protein. There are many therapeutic approaches in clinical development for DMD patients, but so far showing clinical benefit in trials has proven challenging. On May 6, 2025, the World Duchenne Organization convened a multistakeholder drug development round table meeting to discuss pertinent aspects of drug development in the DMD field: trial design, the impact of variable doses and regimen of glucocorticoids on disease trajectory, gene therapy and the use of real world evidence. Herein the most important discussion points, realizations and recommendations are summarized. As current therapeutic approaches for DMD patients aim to slow down disease progression, measuring benefit will likely be challenging. The trial design should consider the mechanism of action of the therapeutic approach, the expected therapeutic effect, and the exposure to glucocorticoids could be considered as a stratification factor (regimen and when glucocorticoids were initiated). For gene therapy there are many uncertainties yet, and in hindsight trials were not all properly designed. Looking forward, additional data needs to be collected to assess the therapeutic effect and its longevity. Finally, real world data can only be used if it has sufficient quantity and quality. This will require global alignment and collaboration.