HealthTree Study: Dexamethasone's Impact on Eye Health in Myeloma | Rahul Banerjee, MD | IMS 2024

Hi everyone, my name is Rahul Banerjee. I'm an assistant professor of medicine at the Fred Hutchinson Cancer Center in Seattle, Washington. And today I'm going to talk about our work that was done in collaboration with HealthTree about eye health in patients living with multiple myeloma. So I'll start by thanking all the patients who, you know, I think 500 plus patients who actually filled out the survey through the Cure Hub on HealthTree. This is an example of where this research I think is hopefully going towards a good cause where essentially what we wanted to look at is what is happening with our patients' eyes. Patients with myeloma often are older, patients like in their 60s and 70s, patients with myeloma live for years, awfully decades with this disease, which is wonderful to see. As people get older, the risk of cataracts goes up, the risk of glaucoma goes up. My angle for going into this line of research was that, as some of you may know from my other videos and my other work with HealthTree, you know, I'm all about tailoring how dexamethasone, dex is used in multiple myeloma. We've had dex for years and decades that are on myeloma treatment paradigms as newer treatments have evolved like CD30 monoclonal antibodies like daratumumab or esotuxumab. We really need the dexamethasone 40 milligrams weekly for forever the way that it was dosed before. And so we actually went into this research looking specifically at the link between dexamethasone and cataracts. And last year at Ash we've reported that the more time that someone spent on dexamethasone, the more higher the risk became of visually significant cataracts. The issue was that, well, as you get older, you end up accumulating more dexamethasone and your risk of cataracts goes up because of age. And so here we actually went a step deeper and we asked patients, over 500 patients from several countries through the HealthTree Cure Hub, so thank you, looking at that risk of basically, looking at their eye health, how long they've been on treatment for, what treatments they've received like dexamethasone and so forth. We did find that independently of age, more dexamethasone was increased with a higher rate of cataracts. So that, I think, is now crystal clear that link is here and that's something that I will bring forward to my research. All of you listening should talk with your physicians about this. There are many reasons to de-escalate dexamethasone to a lower dose or stop it entirely. If you had a good response not having any issues with the other medications, this may be one of them because our risk of cataracts is real. We didn't see a link between dexamethasone and glaucoma, possibly because the sample sizes were small for glaucoma. Well, from what I know, it was interesting. We asked patients, how often have you had an annual eye exam versus do you remember your myeloma doctor or your transplant doctor telling you to have an eye exam? The discrepancy was vast. Eighty percent of patients that had an eye exam in the last year, many of you probably have just for glaucoma, even with the optometrist to get your glasses adjusted, probably only 20 or 30 percent of them had their doctor tell them that, hey, you should get an eye exam. So that was a wake-up call for me to start bringing this up more important because I think we always talk about the importance of primary care followed from all of our patients. But again, in the U.S. healthcare system, eye health is over here, primary health care is over here. As patients get older and with any dexamethasone, their risk of cataracts goes up. I'm not saying you can't get any dexamethasone for myeloma, but I think we can try to de-escalate the dexamethasone. But in the interim, I would say that talk to your doctor about what you can do to lower dexamethasone dosing and see if it's right for you. And two, I would say absolutely, whether your doctor says so or not, I would absolutely recommend an annual eye exam or at least an eye exam every two years just by virtue of getting older. But again, because of dexamethasone, because of the bortezomib, because of the belanthamab and mafidoid, many of these medications can have ocular side effects, I think it's important to take our eyes seriously.