Pulsed Dexamethasone Administration

Definition and Administration

Pulsed dexamethasone refers to the intermittent administration of high doses of corticosteroids, typically given on consecutive days followed by a treatment-free period, as recommended by the British Association of Dermatologists 1, 2
When given orally, dexamethasone tablets can be used instead of intravenous administration, maintaining the same pulsed dosing schedule, according to the British Journal of Dermatology 1

The British Association of Dermatologists' guidelines for pemphigus vulgaris explicitly state that "Generally, pulsed corticosteroids are given intravenously but they can be delivered orally" 1, 2
Monthly oral dexamethasone pulses have been studied in pemphigus vulgaris treatment protocols, with the British Association of Dermatologists recommending this approach 1

Equivalent doses to intravenous methylprednisolone (250-1000 mg) can be calculated for oral dexamethasone, as suggested by the British Journal of Dermatology 1, 3

The theoretical aims of pulsed therapy include more rapid and effective disease control compared to conventional daily dosing, reduction in long-term maintenance corticosteroid doses, and fewer corticosteroid side effects due to intermittent dosing, as proposed by the British Association of Dermatologists 1, 2
A well-designed double-blind RCT found that monthly oral dexamethasone pulses provided no additional benefit over conventional oral corticosteroids with azathioprine in pemphigus vulgaris, according to the British Journal of Dermatology 1

Pulsed oral dexamethasone has been successfully used in pemphigus vulgaris and other autoimmune bullous diseases, as recommended by the British Association of Dermatologists 1, 2
Pulsed oral dexamethasone has also been used in multiple myeloma treatment regimens, as reported in the Annals of Oncology 4