ASH 2023: Down with Dex! New Research Reveals Dexamethasone Dosing Can Be Reduced

Sleepless nights, paralyzing anxiety, wicked irritability…the list goes on. Ask any myeloma patient or those in their inner circle, and most have “colorful” stories about life with high dose (40mg) dexamethasone (dex), a common element of most myeloma treatment plans. 

Despite this drama, many patients and doctors are reluctant to reduce the dose of dexamethasone because, until now, there has been limited research on the impact of lower doses on survival outcomes. 

For those struggling with high-dose dex, new research presented at ASH 2023 may be useful in reaching a shared decision with your doctors regarding your personalized, optimal treatment plan.

Watch the video and read the article below for more information on this important topic.

Research Highlights

On December 11th, at the ASH 2023 Annual Meeting, Dr. Rahul Banerjee from Fred Hutchinson Cancer Center in Seattle presented abstract 1066, which features a secondary analysis of 2 recent trials in newly diagnosed multiple myeloma (NDMM) patients. 

This important research sought to answer a common question: is survival impacted by lowering the dexamethasone (dex) dose in NDMM patients? The co-authors of this important research include distinguished myeloma experts from the Mayo Clinic, Emory, University of Arkansas, Memorial Sloan Kettering, MD Anderson, and the International Myeloma Foundation.

To the investigators’ knowledge, this is the first analysis of dex dosing strength and outcomes in NDMM since the E4A03 trial in 2010, which was the basis for selecting 40 milligrams as the standard dose for many patients.

A comparison of progression-free survival (PFS) and overall survival (OS) was conducted on the “DEX full dose”, “DEX lowered dose” and “DEX very low dose” subsets described below:

Despite the fact that these patients were in a clinical trial, the dose of dexamethasone was reduced during the induction therapy of 76% of the 541 evaluable patients. 

An important finding is reflected in Tables B, C, D, and E below, which led to the conclusion that “dex dose reductions had no impact on post-induction PFS and OS, even in the subset of patients who required significant dose reductions.” 

During the oral presentation, however, there was a reference to an exploratory analysis of a subset of 40 patients, many that were frail, that had a >50% dose reduction and experienced a decrease in progression-free survival.

The authors make a powerful conclusion, “We could not discern specifically why dex[amethasone] was lowered, and it is possible that dex might have been lowered disproportionately commonly in patients who had achieved early responses and thus independently did better. Regardless, these results strongly suggest that maintaining dex 40 mg weekly for the entirety of NDMM [newly diagnosed myeloma] induction may be unnecessary in the modern era.”

In easier-to-understand terms, in 76% of patients, the dose of dexamethasone was lowered. Overall, dex dose reductions during induction therapy were not associated with lower survival.

Although the focus of this research was the impact of dex dosing during initial therapy, many patients remain on dexamethasone for years.

Based on recent research and recognition of the real-world struggles associated with dex, many myeloma doctors and patients are having conversations about decreasing the dose if and when it is appropriate at any stage of treatment. In fact, a trending hashtag among physicians at ASH was “#down with dex”.

If you are currently struggling with significant side effects from dex and don’t want to endure more sleepless nights, you don’t need to suffer in silence. You should not decrease the dose or discontinue dex without talking to your doctor, but you can speak up and demonstrate that you are an educated, empowered patient and discuss this important topic during your next clinical visit. You can share this article and learn more at the links below. 

I wish you long survival, restful nights, and an excellent quality of life along the way!

Resources

• HealthTree Medication Information Pages: Dexamethasone 
• HealthTree University (Free Myeloma Education): All About Dexamethasone and other Corticosteroids 
• Recently Published Dexamethasone Research: Seniors Enjoy Life with Less Dex (ASH 2022) Article 
• Steroids 101: Darn that Dex Webinar with Myeloma Specialist Dr. Banerjee
• Myeloma 101: Dexamethasone and Blood Sugar Levels

ASH 2023 Resources

Would you like to watch ASH 2023 myeloma research interviews from the investigators themselves? Click "ASH 2023" here: HealthTree University Conference Coverage

To read other ASH 2023 articles, click here: HealthTree 2023 ASH Articles