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Dexamethasone and overall survival and progression free survival in patients with newly diagnosed glioblastoma: a meta-analysis

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Abstract

Purpose

Glioblastomas, the most common primary malignant brain tumors in adults, still hold poor prognosis. Corticosteroids, such as dexamethasone, are usually prescribed to reduce peritumoral edema and limit neurological symptoms, although potential detrimental effects of these drugs have been described. The present meta-analysis aimed to explore the association of dexamethasone with overall survival (OS) and progression free survival (PFS) in patients with newly diagnosed glioblastoma.

Methods

PubMed, Cochrane Library, Embase, and ClinicalTrials.gov were searched for pertinent studies following the Preferred Reporting Items of Systematic Review and Meta-Analysis checklist. Pooled multivariable-adjusted hazard ratios (HR) for OS and PFS and their associated 95% confidence intervals (CIs) were calculated using the random-effects model and the heterogeneity among studies was assessed using I2. The quality of evidence was assessed using the GRADE criteria.

Results

Seven studies were included, pooling data of 1,257 patients, with age varying from 11 to 81 years. Glioblastoma patients on pre- or peri-operative dexamethasone were associated with a significantly poorer overall survival (HR: 1.33, 95% CI: 1.15, 1.55; 7 studies; I2: 59.9%) and progression free survival (HR: 1.77, 95% CI: 1.05, 2.97; 3 studies; I2: 71.1%) compared to patients not on dexamethasone. The quality of evidence was moderate for overall survival and low for progression free survival.

Conclusion

Dexamethasone appeared to be associated with poor survival outcomes of glioblastoma patients.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials; additional information can be requested from the corresponding author, R.M.

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  1. Harshit Arora and Marco Mammi are co-first authors.

  2. Timothy R. Smith and Rania A. Mekary are co-senior authors.

Authors and Affiliations

  1. Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Harshit Arora, Timothy R. Smith & Rania A. Mekary

  2. Neurosurgery Division, “M. Bufalini” Hospital, Cesena, Italy

    Marco Mammi

  3. School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA

    Naisargi Manishkumar Patel, Dea Zyfi, Hema Reddy Dasari, Ismael Yunusa, Thomas Simjian & Rania A. Mekary

  4. College of Pharmacy, University of South Carolina, Columbia, SC, USA

    Ismael Yunusa

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Contributions

H.A. and M.M. wrote the main manuscript text; N.P., D.Z., and H.D. were responsible of investigation and formal analysis; I.Y. and T.S. provided edits to the analysis and to the manuscript; T.S. conceptualized and designed the study; R.M. assisted in all stages of the study, from conceptualization and definition of methodology, to data analysis and manuscript editing. All authors reviewed the manuscript.

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Correspondence to Rania A. Mekary.

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Arora, H., Mammi, M., Patel, N.M. et al. Dexamethasone and overall survival and progression free survival in patients with newly diagnosed glioblastoma: a meta-analysis. J Neurooncol 166, 17–26 (2024). https://doi.org/10.1007/s11060-023-04549-3

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