Steroids are anti-inflammatory drugs often used to treat conditions like hay fever and arthritis, which cause pain and swelling. They are also an important part of multiple myeloma (MM) treatment. Steroids such as prednisone and dexamethasone are used to treat MM, as they are effective in killing off myeloma cells.
“Steroids are hormones that bind to specific receptors inside the lymphocyte and alter its synthesis of RNA and proteins,” said Charles Farber, MD, PhD, oncologist and medical director of Cancer Research with Atlantic Health System.
According to Dr. Farber, the alteration results in “the inhibition of the lymphocyte function and, in high doses, causes healthy and cancerous cells to die.”
Steroids used to treat MM are not the same as anabolic steroids, which athletes and bodybuilders use to improve performance and increase muscle growth. Steroids for MM are human-made versions of adrenal gland hormones, whereas anabolic steroids are medications that share a similar chemical structure as the male sex hormone, testosterone.
Steroids have different mechanisms of action. They help treat MM by:
Lowering the body’s immune system activity
Stopping white blood cells from migrating to areas of inflammation
Reducing swelling, pain, and other inflammatory signs
Helping to kill off myeloma cells
Reducing symptoms caused by chemotherapy like nausea and vomiting
However, because they can cause complications, steroids may not be the best treatment approach for everyone with MM. Your healthcare team may recommend treating you with steroids, if the benefits outweigh the risks.
What Are Corticosteroids?
Synthetic corticosteroids, which generally refers to glucocorticoids, are medications that mimic the action of hormones produced by the outer part of the adrenal gland in humans.
Corticosteroids are strong medications used to treat a range of medical conditions, from allergies to life-threatening conditions, such as:
Eczema and rashes
These drugs can be given in different ways, like as pills, injections into the muscle, through the vein, inhalers, or creams that go on the skin.
The Role of Corticosteroids
Corticosteroids secreted by the adrenal gland are involved with various physiological processes, including:
Regulating other hormones of the endocrine system
Suppressing inflammatory reactions
Modifying immune system response
Increasing hemoglobin and red blood cell
Helping maintain normal electrolyte levels
Doctors typically prescribe synthetic corticosteroid medications to reduce inflammation and swelling, suppress the immune system, and relieve pain and pressure.
Which Steroids Are Used to Treat MM?
One of the most prescribed steroids for MM is dexamethasone. However, healthcare professionals also prescribe other medications in the same class, such as:
Because body systems differ from person to person, tolerance for these medications is not the same even though they belong to the same class of corticosteroids.
When To Use Steroids With MM
Steroids can be used at various points in MM treatment and management.
“They are used at all stages and lines of therapy for this disease,” said Dr. Farber. “In addition to directly killing cancer cells, these drugs decrease inflammation, relieve pain and pressure (e.g., spinal cord compression), and provide a sense of well-being.”
Along with therapies like targeted medications or chemotherapy, steroids can be used as part of the initial treatment for MM, also known as induction therapy. The treatment during this period often includes reducing the number of malignant plasma cells that cause MM and the proteins they make.
Oncologists also use steroids for treating refractory or relapsed MM. Refractory MM refers to when the first treatment did not work well, whereas relapsed MM refers to when the signs and symptoms come back after a period of improvement. Steroids work well with other treatments, such as chemotherapy, proteasome inhibitors, or immunomodulators, to treat MM at such points.
Common Side Effects of Steroids
Steroids usually don’t cause significant side effects when taken in low doses or for a short time.
However, when taken in high doses, they can cause adverse effects that can impact a person’s quality of life. Some common side effects of steroids include:
High blood pressure
Higher blood sugar
Missed or late periods
Long-term Risks of Steroids
“It is okay but not desirable to use steroids for a long time,” Dr. Farber noted. Prolonged use of steroids can increase the risk of complications, such as:
Weakened bones (osteoporosis)
Stunted growth, especially in children
Clouding of the lens of the eyes (cataracts)
Loss of muscle mass with weakness
Dr. Farber also mentioned other long-term risks of steroids, like having a rounded face and a weakened immune system. “These effects usually resolve after the patients stop taking these drugs,” he said.
It helps to speak with your healthcare team about the risks and benefits of using corticosteroid medications. You should also inform them if you experience severe symptoms while on the medication. They may suggest you stop the medication immediately or reduce your dosage slowly over time.