From the Guidelines
Dexamethasone is the more effective corticosteroid for improving fatigue in patients with cancer-related fatigue.
Key Points
- A double-blind, placebo-controlled study showed that dexamethasone 4 mg twice a day for 14 days resulted in a significant improvement in fatigue scores compared to placebo 1.
- In contrast, methylprednisolone 16 mg twice a day for 7 days showed an improvement in quality of life, but the study was not specifically designed to evaluate fatigue as the primary endpoint 1.
- The study on dexamethasone had a longer treatment duration and a larger sample size, making it a more robust comparison 1.
- Both studies highlight the importance of avoiding long-term steroid use due to potential side effects 1.
- The dose and duration of dexamethasone in the study were 4 mg twice a day for 14 days, which can be considered for patients with cancer-related fatigue.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Dexamethasone sodium phosphate injection has a rapid onset but short duration of action when compared with less soluble preparations. DESCRIPTION Methylprednisolone tablets are glucocorticoids.
The FDA drug label does not answer the question.
From the Research
Comparison of Solumedrol (Methylprednisolone) and Dexamethasone
- The effectiveness of Solumedrol (methylprednisolone) and dexamethasone has been compared in several studies 2, 3, 4, 5, 6.
- A study comparing oral dexamethasone and oral prednisolone for acute exacerbation of asthma found that dexamethasone had a faster action and minimal side effects compared to prednisolone 2.
- Another study found that parenteral methylprednisolone was associated with better improvement in the severity of moderate and severe COVID-19 compared to dexamethasone 4.
- A systematic review and meta-analysis of glucocorticoids treatment in severe COVID-19 found that methylprednisolone could reduce the systemic inflammatory response in severe COVID-19, and its effect was equivalent to that of dexamethasone on other clinical outcomes 5.
- However, a quasi-experimental study found that dexamethasone and methylprednisolone were equally effective in treating moderate to severe COVID-19 disease 6.
Potency and Efficacy
- Dexamethasone is a long-acting, systemic corticosteroid with a potency about 25 times greater than short-acting products like hydrocortisone 3.
- Methylprednisolone is an intermediate-acting product, four to five times more potent than hydrocortisone 3.
- The efficacy of methylprednisolone and dexamethasone may depend on the specific condition being treated, with some studies suggesting that methylprednisolone may be more effective in certain situations 4, 5.
Side Effects and Safety
- Both methylprednisolone and dexamethasone can cause an increase in blood glucose levels, indicating a risk of hyperglycemia and its potential complications 4, 5.
- Dexamethasone was found to have less incidence of vomiting/gastritis compared to prednisolone in one study 2.
- The safety and side effect profile of methylprednisolone and dexamethasone should be carefully considered when selecting a treatment option 4, 5, 6.