Are other corticosteroids used in the treatment of myeloma? In addition to dexamethasone, other corticosteroids are used to treat patients with myeloma. Because these drugs all belong to the glucocorticosteroids class of drugs, they act very similarly and can be used to treat many of the same medical conditions. They behave the same way chemically in the body to treat diseases. Because they are so similar in their mechanisms of action, many of the side effects and associated precautions are the same. Results of clinical trials have shown these agents all to be equally effective in the treatment of myeloma. Some of the steroids may be better tolerated than others, depending on the patient and the drug. An Italian study presented at the 2015 ASH meeting demonstrated that in post-autologous transplant maintenance therapy, the use of prednisone in combination with Revlimid added no benefit and was not well tolerated. The 2016 guidelines of the National Comprehensive Cancer Network (NCCN) list thalidomide and Revlimid without steroids as the preferred regimens for maintenance therapy. The uses, side effects, precautions, and considerations described previously for dexamethasone are relevant for the entire class of corticosteroids and thus pertain to prednisone, prednisolone, and methylprednisolone. Prednisolone is a metabolite of prednisone. Methylprednisolone, although structurally similar, may be less toxic and appears to be associated with less sodium and fluid retention than prednisolone. Thus, it is worth discussing with the healthcare team if any particular type of steroid (e.g., methylprednisolone versus dexamethasone) might be more useful or appropriate in your care. As with dexamethasone, the smallest dose necessary of the corticosteroids that can produce the desired response should be used in order to avoid or minimize unwanted side effects.
In closing This booklet is not meant to replace the advice of your doctors and nurses who are best able to answer questions about your specific healthcare management plan. The IMF intends only to provide you with information that will guide you in discussions with your healthcare team. To help ensure effective treatment with good quality of life, you must play an active role in your own medical care. We encourage you to visit myeloma.org for more information about myeloma and to contact the IMF InfoLine with your myeloma-related questions and concerns. The IMF InfoLine consistently provides callers 14
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