Do Steroids Like Dexamethasone Increase Myeloma Treatment Efficacy?

Dr. Brian Durie discusses if steroids like dexamethasone are required when treating multiple myeloma and why steroids are used as part of treatment.

The BOTTOM LINE: 

The use of steroids improves the effectiveness of myeloma therapies. Consider reducing the steroid dose or stopping the use of steroids once a desirable outcome has been achieved. Discuss the use of steroids carefully with your doctor.

If you have a question that you’d like to suggest for a future episode of Ask Dr. Durie, please submit it to [email protected] (mailto:[email protected]). Please note that Ask Dr. Durie is designed to address myeloma questions of the broadest possible audience interest. If you have a question of a personal nature, please contact our InfoLine Coordinators at 800.452.2873 or [email protected] (mailto:[email protected]). 

Transcript:

This week’s “Ask Dr. Durie” is from a patient anxious about the use of steroids, such as dexamethasone or prednisone, as part of the myeloma therapy. This is a question that has come up for many years about myeloma therapy but continues to be an important question. 

The first point to be made is that myeloma therapy is always improved when steroids are added. So, if you take a medicine plus dexamethasone frequently the response is somewhat better.  

Common combinations that we use are things like Revlimid® plus dexamethasone, or Velcade®, Revlimid, and dex. Many combinations of the most active therapies used for myeloma treatment include that dexamethasone. 

However, we know that dexamethasone has a lot of side effects. In some cases, for older patients or frail patients, the side effects could be so threatening that we decide that it’s not worth adding in the risks of steroid therapy to get some added benefit eventually.

These side effects include things like increased risk of infection, some thinning of the bone, some development of cataracts in the eyes, an increased risk of developing sugar diabetes. All of these are some serious things that you need to be aware of. 

For all patients who are taking, for example, dexamethasone as part of their therapy, it is important to assess what is the ongoing need or benefit from that dexamethasone? And what are the potential ongoing risks?   

What this means is that dexamethasone is frequently very, very helpful initially for the first number of months to get that best response. But in the coming months, after six months or between six months and twelve months, it may be that there are potential side effects that outweigh the risks of additional value with the dexamethasone. 

In the long term, that thinning of the bones, the risk of possible infection, and the development of cataracts, for example, are things that can be, obviously, quite serious. Whenever there is a chance, and if it’s feasible, steroid dosage should be reduced. If feasible, even stopped, if an excellent response has been achieved. 

The BOTTOM LINE, in this case, is that you can see clearly that the use of steroids is something to discuss very carefully with your doctor. Do you need them? Are there side effects in your case that could be of particular concern? Can you go ahead and taper them down and stop them as you move forward into a maintenance-type phase, where, for example, Revlimid could be used without the dexamethasone? Steroids, we love them. We hate them. Use them with great caution and talk to your doctor whenever you’re taking steroids. If there is ongoing use in a maintenance-type situation, please raise the question with your doctor.

Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.