Dexamethasone is a key component of induction therapy for newly diagnosed multiple myeloma (NDMM), but its use is often associated with toxicities such as hyperglycemia and insomnia. In a secondary pooled analysis of two clinical trials, SWOG 0777 and SWOG 1211, researchers examined the effects of dexamethasone dose reductions on progression-free survival (PFS) and overall survival (OS). Among the 541 evaluated patients, 69% underwent dexamethasone dose reductions due to grade 3+ toxicities. The study found no significant differences in PFS or OS between patients who maintained full-dose dexamethasone and those who received lowered-dose dexamethasone. These groups were balanced in terms of key clinical factors, including age, stage, and performance status.

The findings suggest that dexamethasone dose reductions are common in NDMM, even within the controlled environment of clinical trials, and do not adversely affect survival outcomes. This challenges the necessity of maintaining high dexamethasone doses in modern treatment regimens, where combination therapies are more effective and less reliant on corticosteroids. Given the toxicities and limited demonstrated benefits of dexamethasone, further prospective studies are needed to explore the role of dose reductions and optimize its use during NDMM induction therapy.

Reference: Banerjee R, Sexton R, Cowan AJ, et al. Dexamethasone dose intensity does not impact outcomes in newly diagnosed multiple myeloma: a secondary SWOG analysis. Blood. 2025;145(1):75-84. doi: 10.1182/blood.2024025939.