When you're managing a chronic inflammatory condition like Duchenne muscular dystrophy or polymyositis, finding the right steroid can make a real difference-not just in symptoms, but in daily life. Calcort, the brand name for deflazacort, is one of those medications that comes up often in these conversations. But it’s not the only option. So how does it stack up against others like prednisone, methylprednisolone, or even newer treatments? Let’s cut through the noise and look at what actually matters: effectiveness, side effects, cost, and real-world use.
What is Calcort (Deflazacort)?
Calcort contains deflazacort, a synthetic glucocorticoid developed in the 1980s. It’s not as widely used in the U.S. as prednisone, but it’s a standard treatment in Europe, Canada, and Australia for conditions like Duchenne muscular dystrophy (DMD), where slowing muscle degeneration is critical. Unlike prednisone, deflazacort has a slightly different chemical structure that changes how it interacts with your body’s receptors. This difference leads to a more targeted anti-inflammatory effect with potentially fewer side effects-especially when it comes to weight gain and bone density loss.
In clinical trials, deflazacort showed comparable muscle strength benefits to prednisone in boys with DMD, but with less fat accumulation and slower decline in bone mineral density. That’s a big deal when you’re treating a child who needs to stay mobile for as long as possible. The typical starting dose is 0.9 mg per kilogram of body weight per day, taken in the morning to match your body’s natural cortisol rhythm.
How Deflazacort Compares to Prednisone
Prednisone has been the go-to corticosteroid for decades. It’s cheap, widely available, and well-studied. But it comes with a long list of side effects: rapid weight gain, increased appetite, mood swings, high blood sugar, cataracts, and accelerated bone thinning. For families managing DMD, these side effects can be just as hard to live with as the disease itself.
A 2017 study published in The Lancet Neurology followed 185 boys with DMD over two years. Those on deflazacort gained less weight, had better preserved motor function, and showed slower decline in walking ability compared to those on prednisone. The trade-off? Deflazacort was linked to a slightly higher risk of cataracts and growth suppression in children. So while it’s gentler on the waistline, it’s not harmless.
Here’s how they stack up side by side:
| Feature | Deflazacort (Calcort) | Prednisone |
|---|---|---|
| Typical dose (DMD) | 0.9 mg/kg/day | 0.75 mg/kg/day |
| Weight gain risk | Lower | Higher |
| Bone density impact | Milder | Significant |
| Cataract risk | Higher | Lower |
| Cost (Australia, 30-day supply) | AUD $120-$180 | AUD $20-$40 |
| Availability | Brand only (no generic) | Generic widely available |
If cost is a major factor, prednisone wins. But if you’re prioritizing long-term mobility and fewer metabolic side effects, deflazacort often comes out ahead. Many families switch to deflazacort after experiencing the weight gain and insulin resistance that come with long-term prednisone use.
Other Alternatives: Methylprednisolone, Cortisone, and Beyond
While prednisone and deflazacort are the most common, other corticosteroids are sometimes used off-label. Methylprednisolone, for example, is often given in pulse doses for acute flare-ups. It’s stronger per milligram than prednisone, but its effects are shorter-lived. That makes it less ideal for daily maintenance.
Cortisone and hydrocortisone are weaker and rarely used for chronic muscle conditions. They’re more common in skin creams or adrenal replacement therapy. You won’t find them as options for DMD or autoimmune myositis.
There’s also newer research into non-steroidal alternatives. Viltolarsen and eteplirsen are exon-skipping therapies approved for specific genetic mutations in DMD. They don’t replace steroids-they’re used alongside them. They’re expensive (over AUD $1 million per year) and only help a small subset of patients. For most, steroids remain the backbone of treatment.
Some families explore supplements like coenzyme Q10 or creatine to support muscle function. While these may help with energy levels, there’s no strong evidence they reduce inflammation or slow disease progression like steroids do. They’re adjuncts, not replacements.
Side Effects You Can’t Ignore
All corticosteroids suppress the immune system. That means increased risk of infections-especially chickenpox, flu, and pneumonia. If you’re on deflazacort or prednisone for more than a few weeks, you need to avoid live vaccines and get a flu shot every year.
Long-term use also affects your metabolism. Blood sugar can spike, leading to steroid-induced diabetes. Blood pressure may rise. Sleep problems and mood changes are common. Kids on daily steroids often grow slower than their peers. That’s why doctors monitor height, weight, and bone density every 6-12 months.
Deflazacort’s higher cataract risk means regular eye checks are non-negotiable. A 2021 Australian study found that 38% of children on deflazacort for over 3 years developed early lens changes. Not everyone needed surgery, but all needed monitoring.
That’s why treatment isn’t just about picking the best drug-it’s about managing the trade-offs. Many doctors now use intermittent dosing: 10 days on, 10 days off. This reduces cumulative side effects while still preserving muscle function.
When to Consider Switching
You might need to switch from prednisone to deflazacort if:
- Your child has gained more than 15% of their ideal body weight in 6 months
- Bone density scans show rapid loss (Z-score below -2)
- Diabetes or high blood pressure develops
- They’re struggling with mood swings or behavioral changes
Switching from deflazacort to prednisone might make sense if:
- Cost is a barrier and insurance won’t cover Calcort
- Eye exams show no early cataract signs
- There’s no significant weight gain or metabolic issues
Never switch without medical supervision. Abruptly stopping steroids can trigger adrenal crisis-low blood pressure, vomiting, confusion, even coma. Tapering must be slow and guided by a specialist.
Real-World Experience: What Families Say
In Australian parent forums, the most common feedback is this: "Prednisone made my son feel like a different person-hungry all the time, moody, puffy. After switching to Calcort, he had more energy, slept better, and didn’t beg for snacks every hour."
But another parent said: "We had to start cataract screenings at age 8 because of Calcort. It was stressful. We’re now trying to reduce the dose with a pulsed schedule."
There’s no one-size-fits-all. The best choice depends on your child’s genetics, how their body responds, access to monitoring, and financial reality.
What’s Next? The Future of Steroid Therapy
Research is moving fast. New drugs like vamorolone (brand name Agamree) are designed to keep the benefits of steroids without the worst side effects. It’s already approved in the U.S. and EU for DMD and shows promise in reducing bone loss and weight gain. It’s not yet available in Australia, but clinical trials are ongoing.
Gene therapies and CRISPR-based treatments are still years away for most patients, but they represent the long-term hope. For now, steroids-whether deflazacort or prednisone-remain the most effective tools we have to preserve mobility and quality of life.
The bottom line? Deflazacort isn’t "better" than prednisone-it’s different. It offers a better profile for some, worse for others. The decision isn’t just medical. It’s personal. Talk to your neurologist, track your child’s growth and blood work, and don’t be afraid to ask: "What’s the trade-off here?"
Is Calcort stronger than prednisone?
Calcort (deflazacort) is not necessarily stronger-it’s more selective. At the same dose, it has similar anti-inflammatory effects as prednisone but affects different pathways in the body. A 1 mg dose of deflazacort is roughly equivalent to 0.75 mg of prednisone. That’s why dosing is adjusted based on body weight, not a direct 1:1 swap.
Can you switch from prednisone to Calcort safely?
Yes, but only under medical supervision. You can’t just stop prednisone and start Calcort. Your doctor will gradually reduce the prednisone dose while slowly introducing deflazacort. This prevents adrenal insufficiency. The transition usually takes 1-2 weeks, with blood tests to monitor cortisol levels and electrolytes.
Is there a generic version of Calcort?
No, there is no generic deflazacort available in Australia as of 2025. Calcort is still the only brand. This makes it significantly more expensive than generic prednisone. Some patients import deflazacort from Canada or India under special access schemes, but this requires approval from the TGA.
Does deflazacort cause more mood swings than prednisone?
Studies show deflazacort causes fewer behavioral side effects than prednisone. Parents report less irritability, aggression, and emotional outbursts with deflazacort. This may be because it affects brain receptors differently. However, mood changes can still happen-especially at higher doses or during dose adjustments.
How long can someone stay on Calcort?
Many patients take deflazacort for years-especially those with Duchenne muscular dystrophy. Some start as young as 5 and continue into their teens. Long-term use requires regular monitoring: eye exams every 6 months, bone density scans yearly, blood sugar and blood pressure checks every 3-6 months. With careful management, people can stay on it safely for a decade or more.
Are there natural alternatives to Calcort?
There are no natural alternatives that match the anti-inflammatory power of deflazacort for conditions like Duchenne muscular dystrophy. Supplements like omega-3s, vitamin D, or curcumin may help reduce general inflammation, but they don’t slow muscle degeneration. Relying on them instead of prescribed steroids can lead to faster loss of mobility. Always discuss supplements with your doctor-they can interact with steroids or affect lab results.
Next Steps: What to Do Now
If you’re currently on prednisone and noticing side effects, talk to your neurologist about switching. Bring your child’s growth chart, recent blood work, and a list of concerns. Ask: "Would deflazacort be a better fit?"
If you’re new to steroid treatment, ask about both options. Don’t assume prednisone is the default. Know the costs, monitor for side effects early, and plan for regular check-ups.
For families in Australia, check if you qualify for the Pharmaceutical Benefits Scheme (PBS) subsidy. Calcort is listed on the PBS for Duchenne muscular dystrophy, which brings the out-of-pocket cost down to around AUD $30 per script. Without the subsidy, it’s much higher.
There’s no perfect drug. But with the right information and support, you can find the one that gives your child the best chance to move, play, and grow-for as long as possible.
