Background: Historical trials of adjunctive dexamethasone for management of neurologic symptoms in malignant spinal cord compression (MSCC) utilized high doses of dexamethasone for 3 days then tapered over an additional 12 days. There is limited evidence on the current practice of adjunctive dexamethasone. Objective: The purpose of this study was to evaluate various dosing strategies of dexamethasone in MSCC. Methods: This was a retrospective, single-site, analysis of hospitalized patients presenting with MSCC and received dexamethasone. Patients were grouped into 2 cohorts; an acute course (AC, ≤3 days) and a prolonged course (PC, >3 days), based on length of high-dose dexamethasone therapy (16 mg/day). Primary outcome was cumulative dexamethasone dose between groups. Other additional outcomes evaluated safety and efficacy. Results: A total of 26 patients were included, with 14 patients in the AC group and 12 in the PC group. The median cumulative dexamethasone dose was significantly lower in the AC group compared to the PC group (117 mg vs 165 mg, P < 0.001). Time to IV-to-PO conversion was significantly delayed in the PC group (6 days vs 1 day, P < 0.001). There were no significant differences in additional outcomes. Conclusion: The findings of this study provide insights into consideration of early tapering strategies to decrease dexamethasone exposure and lessen the risk of adverse effects. Despite the retrospective nature of this small study, the findings of this study highlight the need for more standardized guidance to optimal dose, duration, and tapering strategy for dexamethasone use in patients with MSCC.
Wells et al. (Sun,) studied this question.