Dexamethasone Use in Multiple Myeloma and COVID-19 Isn’t the Same

Taking dex as part of myeloma treatment doesn’t protect against the virus

• Practice guidelines recommend the use of corticosteroids such as dexamethasone in COVID-19 patients receiving mechanical ventilation
• Dexamethasone settles the overactive immune response, but it doesn’t treat the virus
• The dex dosage and frequency used in multiple myeloma treatment is not protective against COVID

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Corticosteroids such as hydrocortisone and dexamethasone have emerged as a valuable intervention to improve outcomes in critically ill patients with COVID-19. Randomized trials have indicated that these drugs reduce mortality in seriously ill patients receiving mechanical ventilation and supplemental oxygen.

Dexamethasone isn’t a treatment for COVID, but rather, a way to manage its effects. “It doesn’t do anything at all to eliminate or eradicate the virus,” Dr. Sagar Lonial, chief medical officer at Winship Cancer Institute, tells SurvivorNet. “All it does is settle down the overvigorous immune response that occurs late in the disease.”

Dexamethasone is also an integral part of multiple myeloma treatment, although the two applications of this steroid are not the same. “I’ve had patients who’ve said, ‘I’m on dexamethasone, so I shouldn’t have to worry about COVID, should I?’ Which I think is absolutely the wrong interpretation,” says Dr. Natalie Callander, hematologist-oncologist at UW Health. She points out that myeloma patients may be even more vulnerable to COVID than the general population, due to their treatment.

“The amount of dex that we give is actually immunosuppressive, and it’s supposed to be, because myeloma cells are immune cells,” Dr. Nina Shah, hematologist-oncologist at UCSF Medical Center, tells SurvivorNet. “They’re two different ways of using the same drug.”