Dexamethasone, a steroid commonly used in the treatment of myeloma, a blood cancer, could be given to patients at a lower dose than in historic treatments with no loss of effect, according to a new study and an editorial by HonorHealth Research Institute investigators published this month in the journal “Blood.”

In the past, effective doses of dexamethasone were as high as 40 mg, four days a week, and contemporary treatment regimens have shown that 40 mg just once a week is just as effective, and with less toxicity, a press release stated.

In a national study of 541 patients titled “Dexamethasone dose intensity does not impact outcomes in newly diagnosed multiple myeloma: a secondary SWOG analysis,” researchers concluded that “there were no differences” in outcome between patients who received 40 mg to 60 mg weekly versus those who required dose reductions and even discontinuation of dexamethasone.

This evidence suggests that dosing below 40 mg weekly does not decrease efficacy, but does produce major benefits for quality of life.

The paper concluded that “given the many toxicities and unclear benefits of dexamethasone in the era of modern treatment regimens, dexamethasone dose reduction during (newly diagnosed multiple myeloma) NDMM induction warrants further prospective studies.”

Importantly, the paper stated patients receiving lower doses were “associated with lower mortality than higher doses.”

In an accompanying editorial in “Blood,” investigators at HonorHealth Research Institute concluded, “dexamethasone-sparing strategies can reduce steroid-induced toxicity and allow for patients to continue long-term myeloma treatment with improved quality of life.”

Susan Harding, a nurse practitioner at HonorHealth Research Institute who specializes in hematology and oncology — and one of the authors of the editorial, “Down with Dex!” — said in the release, “Although the exact dosing and role of dexamethasone in contemporary treatment of multiple myeloma needs clearer definition, this study suggests that further reduction of this agent and its toxicity are possible. It is time to go down with dex!”

Steroids, used alone and in combination with other drugs, have played an important role in the treatment of myeloma, and dexamethasone is the most commonly prescribed corticosteroid for this cancer.

However, steroids cause a wide range of side effects, affecting nearly every system of the body, including insomnia, sexual dysfunction, personality changes and mood swings, hyperactivity, dizziness, headaches, difficulty concentrating, weakened muscles and bones and more.

Dr. Joseph Mikhael, director of Myeloma Research and Consultant Hematologist at HonorHealth Research Institute, is the other author of the editorial and chief medical officer for the International Myeloma Foundation.

“Minimizing these side effects and managing them quickly can help contribute to the successful treatment of myeloma,” Mikhael said in the release.