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Duvyzat (givinostat oral suspension)Medica

Duchenne muscular dystrophy

Initial criteria

  • Patient is age ≥ 6 years
  • Diagnosis of Duchenne muscular dystrophy is confirmed by genetic testing with a confirmed pathogenic variant in the dystrophin gene [documentation required]
  • Patient is ambulatory
  • Patient is on a stable systemic corticosteroid therapy for at least 6 months
  • Medication is prescribed by or in consultation with a physician who specializes in the treatment of Duchenne muscular dystrophy and/or neuromuscular disorders

Reauthorization criteria

  • Patient is age ≥ 6 years
  • Patient is ambulatory
  • Patient is continuing to receive stable systemic corticosteroid therapy
  • According to the prescriber, the patient continues to benefit from therapy, as demonstrated by a stabilization or slowed decline on timed function tests (e.g., 4-stair climb, 6-minute walk test, time-to-rise) or in the North Star Ambulatory Assessment (NSAA) score
  • Medication is prescribed by or in consultation with a physician who specializes in the treatment of Duchenne muscular dystrophy and/or neuromuscular disorders

Approval duration

1 year