[kemscm]

Study: Dexamethasone timing affects Velcade neuropathy

by kemscm on Thu Jun 29, 2017 10:26 pm

Here's the abstract for the study, but the upshot is that the authors conclude that dexamethasone works to reduce Velcade-induced peripheral neuropathy (PN) because the neuropathy is a kind of inflammatory response. Their study showed the dex worked best when taken on the same days as the Velcade ("concomitant", or "partnered", dosing).

Abstract:

Peripheral neuropathy (PN) is the most troublesome adverse event associated with the proteasome inhibitor bortezomib. Studies suggest an inflammatory aetiology for bortezomib-induced PN (BiPN) and it has been hypothesized that reducing inflammation with concomitant dexamethasone may reduce BiPN incidence and/or severity. We retrospectively analysed PN rates from 32 studies (2697 patients with previously untreated multiple myeloma) incorporating bortezomib and differing dexamethasone schedules: partnered dosing (days of and after bortezomib), weekly dosing, and other dosing schedules (e.g. days 1-4, 8-11). Pooled overall PN rates were 45·5%, 63·9%, and 47·5%, respectively, with 5·3%, 11·0%, and 9·6% grade ≥3. Adjusting for potential confounders (age, gender, presence of thalidomide, bortezomib treatment duration), PN rates in patients on partnered dosing schedules appeared lower than in patients on weekly or other dosing schedules. Analyses conducted using patient-level data suggest that cumulative dexamethasone dose, a potential confounding factor, is unlikely to have influenced the analyses. Findings were similar in a separate pooled analysis excluding data from regimens incorporating thalidomide, when pooled overall PN rates were 50·1%, 63·9%, and 48·3%, respectively, with 4·2%, 11·0%, and 8·6% grade ≥3. These findings suggest that partnered dexamethasone dosing may result in less severe BiPN compared with alternative dexamethasone dosing schedules.

Reference:

Kumar, SK, et al, "Impact of concomitant dexamethasone dosing schedule on bortezomib-induced peripheral neuropathy in multiple myeloma," British Journal of Haematology, June 2017 (abstract)

[lrankin]

Re: Study: Dexamethasone timing affects Velcade neuropathy

by lrankin on Sat Oct 14, 2017 5:06 pm

My husband is a year past needing this info , but I do thank you for sharing it. He had such bad leg pain and peripheral neuropathy from Velcade, although the pain did go away. He still has nerve damage (has little reflexes).