Eight RCTs were included in the review (13,568 participants; range 359 to 3,655). Four were only available as conference abstracts. One trial reported generation of allocation sequence; two reported concealment of allocation, withdrawal was reported by four trials and intention-to-treat analysis for three trials. Blinding was not reported by any of the trials. Median follow-up ranged from 4.3 to 10 years.
Dexamethasone was associated with a significantly reduced event rate compared with prednisone (RR 0.80, 95% CI 0.68 to 0.94; five RCTs), although this was associated with substantial heterogeneity (Ι²=60%). Dexamethasone was also associated with decreased risk of CNS relapse (RR 0.53, 95% CI 0.44 to 0.65; six RCTs) compared with prednisone. There was no significant difference between drugs for the outcomes risk of bone marrow relapse (six RCTs), testicular relapse (two RCTs) and overall mortality (three RCTs).
Dexamethasone was associated with significantly greater risk of death during induction (RR 2.31, 95% CI 1.46 to 3.66; four RCTs), neuro-psychiatric adverse events (RR 4.55, 95% CI 2.45 to 8.46; three RCTs), myopathy (RR 7.05, 95% CI 3.00 to 16.58; two RCTs) and a significantly higher risk of withdrawal due to adverse events (RR 121.70, 95% CI 16.34 to 906.64; two RCTs). There was no significant difference between drugs in rates of osteonecrosis, sepsis, fungal infection, diabetes and pancreatitis.
The results of sensitivity and subgroup analyses were also reported.