Does anyone know the pros and cons of using dexamethasone versus prednisone for treating myeloma?
It seems that dexamethasone is much more widely used and it appears that most clinical trials use dexamethasone if a steroid is used. But I also see that some trials are using prednisone. Why one over the to other?
I have only used dexamethasone and, like most, I find it difficult to stay on it for long term use. Is prednisone any better?
Given that most clinical trials use dexamethasone, it seems that the efficacy of dexamethasone against myeloma is better understood. Is prednisone known to be just as effective as dexamethasone, or is not much known about the effectiveness of prednisone against myeloma or how it compares with dexamethasone?
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Re: Dexamethasone vs prednisone for multiple myeloma
I cannot provide a definitive answer with studies to back it up, but my doctor has suggested that prednisone is equally – or close to equally – effective. I was on it for several months, albeit at low dosage, and found it to be far easier to tolerate than dex.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Dexamethasone vs prednisone for multiple myeloma
According to my oncologist / hematologist, one is not necessarily better than the other, though, as mentioned, dex seems to be the standard. Do bear in mind that the dosing equivalencies are very different.
I have actually continued taking low dose methylprednisolone (this is the form the liver has to break prednisone down into for the body to actually utilize it) to help with energy and inflammation.
Also, on the chance that this might be helpful, when I was on dex we ended up cutting the normal dosage by 25% and taking it over 2 days instead of all at once. This made a huge difference, as the full dose on 1 day made me a raving lunatic!
Best wishes,
Daniel
I have actually continued taking low dose methylprednisolone (this is the form the liver has to break prednisone down into for the body to actually utilize it) to help with energy and inflammation.
Also, on the chance that this might be helpful, when I was on dex we ended up cutting the normal dosage by 25% and taking it over 2 days instead of all at once. This made a huge difference, as the full dose on 1 day made me a raving lunatic!
Best wishes,
Daniel
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DanielR - Name: Daniel Riebow
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: 12/2012
- Age at diagnosis: 59
Re: Dexamethasone vs prednisone for multiple myeloma
Dexamethasone is a more potent steroid and that is why the doses are distinctly different. For instance, 20 mg of dexamethasone is equivalent to 125 mg of prednisone. As such, the toxicity profile may be more intense with dexamethasone. But, dosed once (or even twice) weekly, it is tolerable. On the other hand, prednisone (at lower doses) has been given continuously.
Hope that helps!
Hope that helps!
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Dr. Heather Landau - Name: Heather Landau, M.D.
Beacon Medical Advisor
Re: Dexamethasone vs prednisone for multiple myeloma
Does prednisone have the same side effects as dexamethasone?
My daughter is experiencing muscle weakness in her thighs. She is having difficulty lifting her legs to go up steps. She also has had to start taking insulin because it raised her blood sugars. She was not diabetic before, although I have been diabetic since I was 14 for 46 years.
Will these side effects go away after she stops dex?
My daughter is experiencing muscle weakness in her thighs. She is having difficulty lifting her legs to go up steps. She also has had to start taking insulin because it raised her blood sugars. She was not diabetic before, although I have been diabetic since I was 14 for 46 years.
Will these side effects go away after she stops dex?
Re: Dexamethasone vs prednisone for multiple myeloma
Thank you, Dr. Landau, that helps some.
But would 125 mg of prednisone be expected to be just as effective against myeloma as 20 mg of dexamethasone given once weekly? Or is that something that is not known yet?
I have seen the steroid converters that relate the prednisone equivalency to dexamethasone on the Internet, but I have found nothing that says that 125 mg of prednisone would be as effective as 20 mg of dexamethasone on myeloma. I am not sure what equivalent means in that these steroids are used to treat a lot of different ailments and would they be equivalent on all of them? Or is "equivalent" meant to mean the side effects felt that would be experienced?
What I am really asking is: If I substituted 125 mg of prednisone for 20 mg dexamethasone, would I get the same result against myeloma with possibly more tolerable side effects, or possibly worse side effects? Or is this something that has not been learned yet through the trial process, and the tolerance to dexamethasone and prednisone is unique to each individual, so you could not make a generalized comparison between them?
In general, if someone is on long term dexamethasone and is having trouble tolerating it, would it make sense to switch to the equivalent prednisone dose and hope for better results? Dr. Landau's reply suggests that prednisone may be more tolerable given continuously so, if used for treating myeloma, the dosing could be done differently than a large single weekly dose as with dexamethasone. But would that still work?
Seems there is not much known about this, or at least I could not find anything.
But would 125 mg of prednisone be expected to be just as effective against myeloma as 20 mg of dexamethasone given once weekly? Or is that something that is not known yet?
I have seen the steroid converters that relate the prednisone equivalency to dexamethasone on the Internet, but I have found nothing that says that 125 mg of prednisone would be as effective as 20 mg of dexamethasone on myeloma. I am not sure what equivalent means in that these steroids are used to treat a lot of different ailments and would they be equivalent on all of them? Or is "equivalent" meant to mean the side effects felt that would be experienced?
What I am really asking is: If I substituted 125 mg of prednisone for 20 mg dexamethasone, would I get the same result against myeloma with possibly more tolerable side effects, or possibly worse side effects? Or is this something that has not been learned yet through the trial process, and the tolerance to dexamethasone and prednisone is unique to each individual, so you could not make a generalized comparison between them?
In general, if someone is on long term dexamethasone and is having trouble tolerating it, would it make sense to switch to the equivalent prednisone dose and hope for better results? Dr. Landau's reply suggests that prednisone may be more tolerable given continuously so, if used for treating myeloma, the dosing could be done differently than a large single weekly dose as with dexamethasone. But would that still work?
Seems there is not much known about this, or at least I could not find anything.
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Eric Hofacket - Name: Eric H
- When were you/they diagnosed?: 01 April 2011
- Age at diagnosis: 44
Re: Dexamethasone vs prednisone for multiple myeloma
Hi Eric,
Indeed it is complex and not entirely understood. The issue is that each steroid's potency has to do with its half life (the length of time it sticks around) not only in blood but also in tissues, which is difficult to quantify. As a gross generalization, dexamethasone can be thought of as more potent in terms of binding to its receptor and sticking around. Thus, small doses of dexamethasone can cause patients to become Cushingoid sooner than would be expected with prednisone - if used continuously like prednisone is often used for a variety of disorders.
However, I believe your question is really aimed at determining the potency of the steroid (dex versus prednisone) against your myeloma, which is perhaps even more complicated. Prior to having IMIDs (thalidomide, Revlimid, and Pomalyst) and proteasome inhibitors (Velcade and Kyprolis), myeloma patients were treated with high dose dexamethasone alone -- 40 mg x 4 days on and then 4 days off, with each patient receiving 40 mg of dex for 12 days every month. YIKES!
I tell you this just to make the point that you have to think of it as a drug against myeloma cells. Like other drugs, i.e., Revlimid or Velcade, your myeloma cells may be more or less sensitive to dexamethasone and / or prednisone. And among all your myeloma cells, each can have differential sensitivity to drugs, i.e., one cell can be sensitive to Revlimid while another may not, including the steroids.
So, while a good rule of thumb is to use the calculators to define "equivalent" doses of steroids, each patient's disease may respond to a different dose and each patient's body may suffer more or less side effects with one or the other steroid at higher or lower doses.
I too wish it was more predictable!!
Indeed it is complex and not entirely understood. The issue is that each steroid's potency has to do with its half life (the length of time it sticks around) not only in blood but also in tissues, which is difficult to quantify. As a gross generalization, dexamethasone can be thought of as more potent in terms of binding to its receptor and sticking around. Thus, small doses of dexamethasone can cause patients to become Cushingoid sooner than would be expected with prednisone - if used continuously like prednisone is often used for a variety of disorders.
However, I believe your question is really aimed at determining the potency of the steroid (dex versus prednisone) against your myeloma, which is perhaps even more complicated. Prior to having IMIDs (thalidomide, Revlimid, and Pomalyst) and proteasome inhibitors (Velcade and Kyprolis), myeloma patients were treated with high dose dexamethasone alone -- 40 mg x 4 days on and then 4 days off, with each patient receiving 40 mg of dex for 12 days every month. YIKES!
I tell you this just to make the point that you have to think of it as a drug against myeloma cells. Like other drugs, i.e., Revlimid or Velcade, your myeloma cells may be more or less sensitive to dexamethasone and / or prednisone. And among all your myeloma cells, each can have differential sensitivity to drugs, i.e., one cell can be sensitive to Revlimid while another may not, including the steroids.
So, while a good rule of thumb is to use the calculators to define "equivalent" doses of steroids, each patient's disease may respond to a different dose and each patient's body may suffer more or less side effects with one or the other steroid at higher or lower doses.
I too wish it was more predictable!!
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Dr. Heather Landau - Name: Heather Landau, M.D.
Beacon Medical Advisor
Re: Dexamethasone vs prednisone for multiple myeloma
Thanks for the follow-up, Dr. Landau. If understand you correctly, without knowing the specific subclone types for a given individual, and without knowing how each subclone type responds to prednisone or dex, we are all a bit in the wild, wild west regarding knowing which steroid might be the most efficacious for a given patient? Correct?
I'm therefore thinking that each patient should probably have the prednisone versus dex discussion with their doc when first starting treatment, both from a side-effect and an efficacy perspective. And patients should also consider a switch if one of these steroids is really causing them side-effect issues, or is not producing the results they hoped for.
Have there ever been any studies done that have compared dex versus prednisone in multiple myeloma patients, keeping everything else equal? All the studies I have come across so far also change one of the other major drugs in the overall cocktail (i.e., dex versus melphalan + prednisone).
I'm therefore thinking that each patient should probably have the prednisone versus dex discussion with their doc when first starting treatment, both from a side-effect and an efficacy perspective. And patients should also consider a switch if one of these steroids is really causing them side-effect issues, or is not producing the results they hoped for.
Have there ever been any studies done that have compared dex versus prednisone in multiple myeloma patients, keeping everything else equal? All the studies I have come across so far also change one of the other major drugs in the overall cocktail (i.e., dex versus melphalan + prednisone).
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Dexamethasone vs prednisone for multiple myeloma
Yes Multibilly; that is the real question. We know that dex, with all it's negative side effects, does help in this battle against multiple myeloma in most cases. But I haven't seen any studies involving prednisone in this battle. I know they are both steroids, but I don't know if that means all steroids help (I don't think so).
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coachhoke - Name: coachhoke
- When were you/they diagnosed?: Apri 2012
- Age at diagnosis: 71
Re: Dexamethasone vs prednisone for multiple myeloma
My husband was recently changed from dex to prednisone at 50 mg twice weekly. He experienced very worrisome shortness of breath. Has anyone had this experience? Is anyone else on 5 mg Revlimid with prednisone and, if so, at what dosage of prednisone.
Thank you.
Thank you.
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Linda D
12 posts
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