dexmedetomedine IV (IV Dex) / BioXcel - LARVOL DELTA

Mezigdomide (MEZI) Plus Dexamethasone (DEX) and Daratumumab (DARA) or Elotuzumab (ELO) in Patients (pts) with Relapsed/Refractory Multiple Myeloma (RRMM): Results from the CC-92480-MM-002 Trial (ASH 2023) - P1/2 | "Intravenous (IV; 16 mg/kg) or subcutaneous (1800 mg) DARA was given weekly (C1–2), then biweekly (C3–6), and monthly (≥ C7) for subcohorts B1 and B3, and weekly (C1–3) then on D1 of each 21-D (C4–8) or 28-D (≥ C9) cycle for subcohort B2; with weekly oral/IV DEX (40 mg; 20 mg > 75 y or body mass index < 18.5 kg/m2). MeziDd showed promising efficacy and a manageable safety profile in pts with RRMM and 2–4 prior lines of therapy, as did MeziEd in pts with prior anti-CD38 mAb therapy. The immune activity of MEZI was consistent with previous preclinical reports. Improved safety and efficacy may be achieved by schedule and dose adjustments."

Clinical • Cardiovascular • Hematological Malignancies • Infectious Disease • Multiple Myeloma • Neutropenia • Plasmacytoma • Pulmonary Embolism • Respiratory Diseases • Targeted Protein Degradation • Thrombocytopenia • CRBN

Dexamethasone is Associated with a Lower Incidence and Severity of Cytokine Release Syndrome Compared with Other Corticosteroid Regimens When Given as Premedication for Glofitamab Monotherapy in Patients with Relapsed/Refractory (R/R) Large B-Cell Lymphoma (LBCL) (ASH 2023) - P1/2 | " Pts with R/R LBCL (diffuse LBCL not otherwise specified [DLBCL NOS], high-grade B-cell lymphoma [HGBCL], primary mediastinal LBCL [PMBCL], or LBCL arising from follicular lymphoma [trFL]) and ≥2 prior therapies received 1000mg obinutuzumab pretreatment (Gpt) 7 days prior to the first glofitamab dose...Steroid premedication (80mg IV methylprednisolone, or equivalent dose of prednisone [100mg] or prednisolone [100mg], or 20mg IV Dex) was given at least 60 minutes prior to Gpt and each glofitamab dose... The incidence, severity, and seriousness of CRS after glofitamab administration in pts with R/R LBCL were numerically lower with Dex premedication versus premedication with other steroid regimens. Response rates in the Dex only cohort were similar to those reported in the non-Dex cohort. We therefore propose Dex as the steroid of choice for premedication to prevent or mitigate CRS in pts with LBCL treated with glofitamab monotherapy, considering its half-life and..."

Clinical • Cytokine release syndrome • Monotherapy • B Cell Lymphoma • Diffuse Large B Cell Lymphoma • Follicular Lymphoma • Hematological Malignancies • High-grade B-cell lymphoma • Large B Cell Lymphoma • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology • Primary Mediastinal Large B-Cell Lymphoma • CD20

Phase 3, two-stage, randomized trials of mezigdomide-based regimens versus standard regimens in relapsed/refractory multiple myeloma (RRMM): SUCCESSOR-1 (MeziVd vs PVd) and SUCCESSOR-2 (MeziKd vs Kd) (DGHO 2025) - P3 | "In preclinical studies, MEZI synergizes with dexamethasone (DEX) and bortezomib (BORT) (MeziVd) or carfilzomib (CFZ) (MeziKd)...The phase 3 trials SUCCESSOR-1 (S-1) (NCT05519085) and SUCCESSOR-2 (S-2) (NCT05552976) will compare the efficacy and safety of MeziVd vs pomalidomide (POM), BORT, and DEX (PVd), and MeziKd vs CFZ and DEX (Kd) in RRMM, respectively...Key eligibility criteria for S-1 include 1–3 prior lines of tx including lenalidomide (LEN), no prior tx with POM; and for S-2 include ≥1 prior line including LEN and an anti-CD38 monoclonal antibody, and no prior tx with CFZ...Kd consists of IV CFZ at 56mg/m2 biw or 70mg/m2 qwk, based on investigator's choice, plus PO/IV DEX...Enrollment began in September 2022 for S-1 and February 2023 for S-2 and is ongoing. Stage 1 resulted in the selection of 1mg in both trials."

Clinical • P3 data • Hematological Malignancies • Multiple Myeloma

Remimazolam vs Dexmedetomidine for Sedation in Orthopedic Surgery:A Meta-Analysis and Trial Sequential Analysis (ASA 2025) - " Pubmed, Embase and Cochrane were searched for randomized controlled trials (RCTs) comparing intraoperative (IO) intravenous (IV) RMMZ and IV DEX in hemodynamic fluctuations and postoperative complications. Remimazolam had a lower incidence of intraoperative bradycardia when compared to dexmedetomidine in sedation for orthopedic procedures, while the remaining hemodynamic parameters showed no differences. TSA confirmed firm evidence for IO bradycardia, though further studies are warranted to clarify the remaining outcomes."

Retrospective data • Surgery • Anesthesia • Cardiovascular • Hypertension • Hypotension • Orthopedics • Psychiatry

Comparative evaluation of intravenous versus intranasal dexmedetomidine on emergence delirium and hemodynamics in pediatric patients undergoing adenotonsillectomy: a randomized controlled trial. (PubMed, Front Pharmacol) - "A total of 139 children, aged 3-10 years, who were scheduled for elective adenotonsillectomy were randomly assigned to receive intravenous dexmedetomidine (IV DEX group) or intranasal dexmedetomidine (IN DEX group), or saline (control group) after anesthesia induction. Intranasal administration of dexmedetomidine provided more stable hemodynamics and more prolonged analgesia and sedation than intravenous infusion of dexmedetomidine. https://www.chictr.org.cn/showproj.html?proj=180658."

Journal • Anesthesia • CNS Disorders • Pain • Pediatrics

Safety and efficacy of supraciliary dexamethasone implantation for macular oedema: a preliminary comparative study. (PubMed, Eye (Lond)) - "SC-DEX shows promise as an alternative for managing ME, offering similar effectiveness to IV-DEX with safe profile. Further studies are needed to confirm its long-term safety and efficacy."

Journal • Macular Edema • Ocular Infections • Ocular Inflammation • Ophthalmology

Reduced incidence and severity of cytokine release syndrome with dexamethasone compared with other corticosteroid treatments as premedication for glofitamab monotherapy in patients with relapsed/refractory (R/R) large B-cell lymphoma (LBCL) (DGHO 2024) - P1/2 | " Pts with R/R LBCL and ≥2 prior therapies received 1000mg obinutuzumab pretreatment (Gpt) 7days prior to the first Glofitamab dose...Steroid premedication (80mg IV methylprednisolone/100mg prednisone/100mg prednisolone or 20mg IV Dex) was given at least 1h prior to Gpt and each Glofitamab dose... Incidence, severity and seriousness of CRS after Glofitamab in pts with R/R LBCL were numerically lower with Dex vs other steroid premedication. Response rates were similar in both cohorts. We recommend Dex as premedication to prevent/mitigate CRS in Glofitamab-treated pts with LBCL."

Clinical • Cytokine release syndrome • Monotherapy • B Cell Lymphoma • Diffuse Large B Cell Lymphoma • Hematological Malignancies • Inflammation • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology

Phase 3, two-stage, randomized trials of mezigdomide-based regimens versus standard regimens in relapsed/refractory multiple myeloma (RRMM): SUCCESSOR-1 (MeziVd vs PVd) and SUCCESSOR-2 (MeziKd vs Kd) (IMW 2024) - P3 | "In preclinical studies, MEZI synergizes effectively with dexamethasone (DEX) and bortezomib (BORT) (MeziVd) or carfilzomib (CFZ) (MeziKd)...The phase 3 trials SUCCESSOR-1 (NCT05519085) and SUCCESSOR-2 (NCT05552976) will compare the efficacy and safety of MeziVd vs pomalidomide (POM), BORT, and DEX (PVd), and MeziKd vs CFZ and DEX (Kd) in RRMM, respectively...Key eligibility criteria for both trials include age ≥18 years; for SUCCESSOR-1 include 1–3 prior lines of tx including lenalidomide (LEN), and no prior tx with POM; and for SUCCESSOR-2 include ≥1 prior line including LEN and an anti-CD38 monoclonal antibody, and no prior tx with CFZ...Kd consists of IV CFZ at 56mg/m2 biw or 70mg/m2 qwk, based on investigator's choice, plus PO/IV DEX... n/a"

Clinical • P3 data • Hematological Malignancies • Multiple Myeloma • Oncology

Efficacy of Switching From Oral to Intravenous Administration for Dexamethasone-Induced Hiccups in CyberKnife Radiotherapy: A Case Report. (PubMed, Cureus) - "Our case suggests the significance of recognizing DIH during radiotherapy. Switching the administration from oral to IV DEX may be an option for dealing with DIH."

Journal • Brain Cancer • Genetic Disorders • Neurofibromatosis • Oncology • Solid Tumor

Final results of a phase II study of lenalidomide-elotuzumab as maintenance therapy post-autologous stem cell transplant (AuSCT) in patients (Pts) with multiple myeloma (MM). (ASCO 2024) - P2 | "For the 1 st 8 weeks, pts <75 yrs received 28 mg of dexamethasone (DEX) 3-24 hours pre-infusion and pts ≥75yrs received 8 mg; pts received 4-10 mg iv DEX pre-infusion for all cycles. ELO-LEN is a well-tolerated maintenance therapy on which 53% of patients had improved quality of response. Median PFS and 5-year OS compare favorably with results from CALGB 100104 and IFM 2005-02 trials of lenalidomide alone. SPM incidence is similar to rates reported in these trials."

Clinical • P2 data • Anemia • Bone Marrow Transplantation • Cardiovascular • Fatigue • Hematological Malignancies • Herpes Zoster • Infectious Disease • Multiple Myeloma • Musculoskeletal Pain • Neutropenia • Oncology • Pain • Renal Disease • Respiratory Diseases • Solid Tumor • Thrombocytopenia • Transplantation

A Case Series of Unexplained Resolution of Neuropsychiatric Symptoms following Administration of Dexmedetomidine (APA 2024) - "Patient was transferred to MICU for management of severe agitation not responding to standard agents due to concerns for LBD and delirium; and placed on IV DEX drip for ~ 44 hours. The neuropsychiatric benefits of DEX should continue to be investigated. It could become a valuable pharmacologic agent for multiple psychiatric conditions including delirium, agitation, insomnia, and anxiety. The growing body of research is promising that this medication may become a first line agent due to its safety profile, anti-inflammatory and cellular protective properties, and anticipated efficacy, but this is yet to be determined."

Clinical • Alzheimer's Disease • Anesthesia • Cardiovascular • CNS Disorders • Dementia • Depression • Human Immunodeficiency Virus • Infectious Disease • Inflammation • Insomnia • Lewy Body Disease • Mood Disorders • Pain • Pneumonia • Psychiatry • Renal Cell Carcinoma • Respiratory Diseases • Septic Shock • Sleep Disorder

"On RT feed, Sir. IV Dex being given, severely drowsy." (@Doc_Amarendra)

Long-duration upper extremity surgery under brachial plexus block combined with intravenous dexmedetomidine sedation without an anesthesiologist. (PubMed, J Plast Reconstr Aesthet Surg) - "Long-duration upper extremity surgery, even longer than 2 h, was feasible under brachial plexus block combined with IV DEX sedation without an anesthesiologist. For patients with low blood pressure and/or low heart rate, it is recommended to adjust the continuous infusion of IV DEX to less than 0.4 µg/kg/h. To ensure that the patients are able to promptly leave the operating room fully awake, IV DEX infusion should be stopped at least 30 min before finishing the operation."

Journal • Surgery • Anesthesia • Cardiovascular • CNS Disorders • Depression • Hypotension • Pain • Psychiatry

A phase 3, two-stage, randomized study of mezigdomide, carfilzomib, and dexamethasone (MeziKd) versus carfilzomib and dexamethasone (Kd) in relapsed/refractory multiple myeloma (RRMM): SUCCESSOR-2. (ASCO 2023) - P3 | "MeziKd has shown potent synergistic antiproliferative activity in MM cell lines resistant to lenalidomide (LEN), and in a phase 1/2 study showed promising preliminary efficacy and safety in RRMM...Tx in the Kd arm consists of 28-D cycles with 20 mg/m2 IV CFZ on D1 and 2 of C1, then 56 mg/m2 on D8, 9, 15, and 16 of C1, and on D1, 2, 8, 9, 15, and 16 of ≥ C2; and 20 mg oral/IV DEX (10 mg optional in certain pt groups) on D1, 2, 8, 9, 15, 16, 22, and 23...Enrollment began in October 2022 and is ongoing. Clinical trial information: NCT05552976."

Clinical • P3 data • Hematological Malignancies • Multiple Myeloma • Oncology • Targeted Protein Degradation • CRBN • IKZF1

Intravenous versus perineural dexmedetomidine as adjuvant in adductor canal block for total knee arthroplasty. (PubMed, Korean J Anesthesiol) - "First, the Intravenous dexmedetomidine group (IV dex) who were given 0.5 µg /kg dexmedetomidine diluted in 20 mL saline by intravenous (IV) infusion while, 20 mL of 0.25% levobupivacaine plus 1 mL saline was used for adductor canal block (ACB), and second, the adductor canal block dexmedetomidine group (ACB dex) who were given 20 mL saline by IV infusion while, 20 mL 0.25% levobupivacaine plus 1 mL of 0.5 µg /kg dexmedetomidine was used for ACB. Sedation scores were significantly higher in the ACB dex group in the preoperative, intraoperative, and immediate postoperative recordings. Perineural dexmedetomidine in ACB had a similar sedative and intraoperative anti-shivering effects compared to IV dexmedetomidine but, postoperatively it had lesser shivering control and superior analgesia after TKA under spinal anesthesia."

Journal • Anesthesia • Orthopedics • Pain

Comparison of the effects of perineural or intravenous dexamethasone on thoracic paravertebral block in Ivor-Lewis esophagectomy: A double-blind randomized trial. (PubMed, Clin Transl Sci) - "Ninety-five patients scheduled for Ivor-Lewis esophagectomy were randomized to receive TPVB (0.5% ropivacaine 15 ml), perineural or intravenous dexamethasone 8 mg. Perineural dexamethasone improved the magnitude and duration of analgesia compared to that of the IV-Dex group in TPVB in Ivor-Lewis esophagectomy. However, there were no clinically significant differences between the two groups in the incidence of chronic pain."

Journal • Anesthesia • Neuralgia • Pain

"So no iv dex on day of pembro /carbo?" (@NicoleJacobi4)

Safety and Efficacy of IV Dexmedetomidine as an Adjunct to Propofol to Sedate Anxious and Uncooperative Pediatric Dental Patients: A Randomized Controlled Trial. (PubMed, J Clin Pediatr Dent) - "Dexmedetomidine is a safe and effective adjunct to propofol."

Clinical • Journal • Anesthesia • Pain • Pediatrics

[VIRTUAL] Update of a Phase II Study of Lenalidomide-Elotuzumab As Maintenance Therapy Post-Autologous Stem Cell Transplant (AuSCT) in Patients (Pts) with Multiple Myeloma (MM) (ASH 2020) - "Elotuzumab (ELO), a humanized IgG1 immunostimulatory monoclonal antibody against signaling lymphocytic activation molecule F7 (SLAM F7), is FDA approved in combination with LEN and dexamethasone (DEX) for treatment of MM pts who have received 1-3 prior therapies...For the 1st 8 weeks, pts <75 yrs receive 28 mg of DEX 3-24 hours pre-infusion, while pts ≥75yrs receive 8 mg; pts receive 4-10 mg iv DEX pre-infusion for all cycles...SPM rates seem consistent with those observed in CALGB 100104 and IFM 2005-02 trials of lenalidomide alone. Longer follow up is required to determine how median PFS and OS will compare with those from lenalidomide monotherapy trials, and how SPM rates will continue to evolve."

Clinical • P2 data • Appendix Cancer • Cardiovascular • CNS Disorders • Epilepsy • Fatigue • Genito-urinary Cancer • Hematological Malignancies • Herpes Zoster • Infectious Disease • Multiple Myeloma • Multiple Sclerosis • Musculoskeletal Pain • Neutropenia • Oncology • Osteosarcoma • Pain • Pneumonia • Prostate Cancer • Renal Cell Carcinoma • Renal Disease • Respiratory Diseases • Sarcoma • Solid Tumor • Squamous Cell Carcinoma • Thrombocytopenia • Transplantation

Evaluation of retinal inflammatory biomarkers after intravitreal steroid implant and Ranibizumab injection in diabetic macular edema. (PubMed, Eur J Ophthalmol) - "To compare the efficacy of intravitreal (IV) ranibizumab (IVR) injection with IV dexamethasone implant (IVDEX) in treatment naive diabetic macular edema (DME) patients with inflammatory component. HRSs tended to migrate from inner retina to the outer retina in DME eyes by treatment. Dexamethasone seemed to be more effective option in such cases with inflammatory component."

Biomarker • Journal • Diabetic Macular Edema • Immunology • Inflammation • Ocular Inflammation • Ophthalmology

Difference in the efficacy of intravitreal dexamethasone implant before and after silicone oil removal: A case report. (PubMed, Medicine (Baltimore)) - "IV-DEX implant may be less efficacious in the treatment of macular edema in an SO-filled eye than that in a normal vitreous cavity."

Clinical • Journal • Diabetic Retinopathy • Macular Edema • Ophthalmology • Retinal Disorders

"Updates on TKA... Prospect guidelines .... NO ❌#RegionalAnesthesia by Regional experts anymore 🤔🤔🤔 IV dex ✅ and LIA ✅ @ASRA_Society @ESRA_Society @RegionalAnaesUK @NarouzeMD @EMARIANOMD @amit_pawa @jeffgadsden @claralexlobo @Ropivacaine @mokaeleni @drchadb @dr_rajgupta" (@KalagaraHari)

"They get IV dex as well. Epinephrine primarily to reduce absorption." (@glauncel)

"Not used Ropi or Mep. IV Dex might be better than Epinephrine??" (@DrRobbieErskine)

"Glad more evidence is emerging for IV dex. Certainly seen in my practice. 🙏 for sharing #ivdexamethasone" (@ashwani_doc)