AI Article Synopsis
- The study reviews literature on the dosage and schedule of dexamethasone (DXM) and its impact on clinical outcomes for patients with malignant brain tumors, highlighting the need for evidence-based practices.
- A systematic search revealed 15 relevant studies, indicating that a common dose of 16 mg (4 mg four times a day) is used, but differences among studies prevented a comprehensive analysis.
- Findings indicate that higher DXM doses may lead to more adverse effects without improving patient outcomes, suggesting that lower doses might be just as effective, though further research is urgently needed, particularly with the rise of immunotherapy treatments.
Article Abstract
Purpose: The present study aims to conduct a systematic review of literature reporting on the dose and dosing schedule of dexamethasone (DXM) in relation to clinical outcomes in malignant brain tumor patients, with particular attention to evidence-based practice.
Methods: A systematic search was performed in PubMed, Embase, Web of Science, Cochrane, Academic Search Premier, and PsycINFO to identify studies that reported edema volume reduction, symptomatic relief, adverse events and survival in relation to dexamethasone dose in glioma or brain metastasis (BM) patients.
Results: After screening 1812 studies, fifteen articles were included for qualitative review. Most studies reported a dose of 16 mg, mostly in a schedule of 4 mg four times a day. Due to heterogeneity of studies, it was not possible to perform quantitative meta-analysis. For BMs, best available evidence suggests that higher doses of DXM may give more adverse events, but may not necessarily result in better clinical condition. Some studies suggest that higher DXM doses are associated with shorter survival in the palliative setting. For glioma, DXM may lead to symptomatic improvement, yet no studies directly compare different doses. Results regarding edema reduction and survival in glioma patients are conflicting.
Conclusions: Evidence on the safety and efficacy of different DXM doses in malignant brain tumor patients is scarce and conflicting. Best available evidence suggests that low DXM doses may be noninferior to higher doses in certain circumstances, but more comparative research in this area is direly needed, especially in light of the increasing importance of immunotherapy for brain tumors.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6700052 | PMC |
| http://dx.doi.org/10.1007/s11060-019-03238-4 | DOI Listing |
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