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Association of adverse events and associated cost with efficacy for approved relapsed and/or refractory multiple

Binod Dhakal1, Ravi K Narra1, Smith Giri2

  • 1Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.

Cancer
|March 11, 2020
PubMed
Abstract

Insights

New treatments for relapsed and/or refractory multiple myeloma (RRMM) were compared. Carfilzomib and dexamethasone offered the best balance of efficacy, safety, and cost, guiding treatment decisions.

Area of Science:

  • Hematology
  • Oncology
  • Pharmacoeconomics

Background:

  • Relapsed and/or refractory multiple myeloma (RRMM) has several new treatment options.
  • Comparing efficacy, adverse events (AEs), and costs is crucial for optimal patient care.

Purpose of the Study:

  • To systematically compare the efficacy, safety, and cost of approved regimens for RRMM.
  • To provide guidance for selecting the most appropriate treatment regimen.

Main Methods:

  • A Bayesian network meta-analysis (NMA) of 15 phase 3 randomized controlled trials (RCTs) was conducted.
  • Efficacy (progression-free survival), safety (grade 3-4 AEs), and total cost per cycle were primary outcomes.
  • Surface under the cumulative ranking (SUCRA) probabilities were used to rank agents.

Main Results:

  • Daratumumab, lenalidomide, and dexamethasone showed highest efficacy but highest cost.
  • Panobinostat, bortezomib, and dexamethasone were least effective and safe.
  • Carfilzomib and dexamethasone demonstrated a favorable balance of efficacy, safety, and cost (SUCRA 0.61 and 0.60).

Conclusions:

  • The NMA provides valuable data for clinicians choosing RRMM regimens.
  • Carfilzomib and dexamethasone represent a strong option considering multiple factors.
  • Informed decision-making can improve outcomes for patients with RRMM.
Keywords:
adverse eventsrelapsed and/or refractory multiple myelomatotal cost per cycle

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