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Dexamethasone in brain tumor patients: a real-world pharmacovigilance audit

2025-01-01Artigo de investigação Acesso aberto
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dc.contributor.authorPrasad, Vindhya
dc.contributor.authorElhag, Ali
dc.contributor.authorOnyiriuka, Louis
dc.contributor.authorMthunzi, Engelbert
dc.contributor.authorHatch, Sarah
dc.contributor.authorNaeem, Awais
dc.contributor.authorNoureldin, Fatmahelzahraa
dc.contributor.authorMarchi, Francesco
dc.contributor.authorRaslan, Ahmed
dc.contributor.authorChowdhury, Yasir A.
dc.contributor.authorShapey, Jonathan
dc.contributor.authorGullan, Richard
dc.contributor.authorBhangoo, Ranjeev
dc.contributor.authorVergani, Francesco
dc.contributor.authorAshkan, Keyoumars
dc.contributor.authorLavrador, José Pedro
dc.date.accessioned2026-07-02T16:35:17Z
dc.date.available2026-07-02T16:35:17Z
dc.date.issued2025-01-01
dc.description.abstractIntroduction: Dexamethasone is routinely prescribed for the management of peritumoral edema in brain tumor patients. Despite available orientations for its management in neuro-oncology patients, the individual needs according to the natural history of the disease and treatment options allied to a hierarchical system with multiple teams involved poses significant challenges in its real-world application. Methods: We conducted a retrospective single-centre observational study of 316 brain tumor referrals to a tertiary neurosurgical center over a 3-month period. Data was extracted from referral notes, multidisciplinary team (MDT) documentation and clinical records. Steroid-related variables such as indication, dose, duration, weaning plan, complications, and follow-up practices were collected alongside demographic and clinical data. Results: Of 316 referrals, 210 patients (66.5%) were started on steroids at baseline, yet only 6% had a documented weaning plan at that point. MDT referral occurred in 252 patients (79.7%), where steroid initiation was significantly associated with surgical management (χ2 = 13.1, p < 0.001). However, only 28.8% of MDT-referred patients had a documented steroid plan, with higher rates in surgical patients (41.3%) than those managed conservatively or with best supportive care (BSC) (16.5%, p < 0.001). Steroid-related complications occurred in 11.4% (24/210) of patients, most commonly wound infections. Prolonged steroid use (>2 weeks) (OR = 3.5, [95% CI: 1.1–11.0], p = 0.04), and absence of an MDT steroid plan (OR = 4.2, [95% CI: 1.2–15.0], p = 0.03) were significant predictors of complications, particularly of Common Terminology Criteria for Adverse Events (CTCAE) Grade 2–3 severity. Nurse-led clinic follow-up was more common in surgical patients (91%) than BSC patients (24.6%, p < 0.001) and supported steroid monitoring. Discussion: Prolonged steroid use and incomplete documentation of steroid plan were associated with increased steroid-related complications highlighting the need for more robust prescribing protocols and improved multidisciplinary follow-up.eng
dc.identifier.doi10.3389/fneur.2025.1632231
dc.identifier.eid105014887159
dc.identifier.otherc6fdcf35-82a0-44a2-85ea-05751ba7215a
dc.identifier.pmcPMC12406498
dc.identifier.pmid40909003
dc.identifier.urihttp://hdl.handle.net/10400.14/58456
dc.language.isoeng
dc.peerreviewedyes
dc.publisherFrontiers Media S.A.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectBrain tumorseng
dc.subjectDexamethasoneeng
dc.subjectNeuro-oncologyeng
dc.subjectPharmacovigilanceeng
dc.subjectSteroid complicationseng
dc.titleDexamethasone in brain tumor patients: a real-world pharmacovigilance audit
dc.typeresearch article
dspace.entity.typePublication
oaire.citation.volume16
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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