Efficacy and safety of dexamethasone and prednisone for therapy in childhood acute lymphoblastic leukemia: A systematic review and meta-analysis

BACKGROUND: This meta-analysis examined the efficacy and safety of dexamethasone compared with prednisone in the treatment of acute lymphoblastic leukemia (ALL). METHODS: A search was conducted in PubMed, EMBASE, and the Cochrane Library databases for randomized controlled trials (RCTs) or observational studies involving children diagnosed with ALL who received dexamethasone or prednisone as pharmacotherapy. Studies without access to primary data were excluded. RCTs were assessed using the Cochrane Risk of Bias 2.0 tool, while observational studies were evaluated with ROBINS-I. However, the pooled results, which showed significant heterogeneity, indicated a potentially higher incidence of toxicity associated with dexamethasone (OR 1.92 [95% CI 1.32 to 2.81]), a finding that warrants cautious interpretation. Qualitative synthesis further clarified that this increased risk was particularly evident for infectious, neuropsychiatric, and musculoskeletal adverse events. No significant differences were found in remission rates, relapse rates, or mortality between the two glucocorticoids. The GRADE assessment indicated high certainty regarding the evidence for event-free survival. CONCLUSIONS: In children with ALL, dexamethasone improves event-free survival compared to prednisone but may have a higher risk of adverse effects. This highlights the need for a careful benefit-risk assessment. Future research should explore hybrid glucocorticoid strategies to maximize survival outcomes while reducing adverse effects.