Network meta‐analysis of first‐line treatments in transplant‐ineligible multiple myeloma patients

Abstract

Objectives Multiple myeloma (MM) is a complex disease. Lack of direct comparisons among treatments and incorporation of new alternatives make it necessary to perform studies that allow for clinical decision‐making. A network meta‐analysis (NMA) was developed to evaluate the comparative efficacy among different therapeutic alternatives in newly diagnosed transplant‐ineligible MM patients. Methods MEDLINE® and EMBASE® were systematically searched up for these drugs: lenalidomide, thalidomide, bortezomib, and daratumumab. Comparative phase II‐III randomized clinical trials (RCTs) were included. Progression‐free survival (PFS) was selected as efficacy outcome. The NMA was developed using Bayesian methods. Fixed‐ and random‐effects models were assessed using deviance information criteria. Results The systematic search yielded 593 results. Ten RCTs were included. No differences were observed between fixed‐ and random‐effects models. The combination of daratumumab, bortezomib, melphalan, and prednisone showed the best HR in PFS (reference treatment). Along with this scheme, the best PFS results were obtained by combination of daratumumab, lenalidomide, and dexamethasone (HR 1.2, 95% CrI 0.64‐2.4) and bortezomib with lenalidomide and dexamethasone (HR 1.6, 95% CrI 0.81‐3.0). Conclusions Schemes with the best PFS results were daratumumab treatments and combination of bortezomib, lenalidomide, and dexamethasone, although the latter scheme has been analyzed in heterogeneous populations.

Clinical Outcomes of Autologous Hematopoietic Stem Cell Transplant in Multiple Myeloma Patients: A 5-year Experience from a Single Centre in North India

“…17 Our PFS data also corroborate with PFS achieved in large trials. 7,17,18 The survival data in our study, shown in ►Table 1, are comparable to other published reports from India and demonstrate beyond doubt that autologous HSCT is a safe and feasible treatment modality for MM in resource-restricted countries such as India. The non-relapse mortality of the transplant procedure was nil.…”

Treatment Regimens for Transplant-Ineligible Patients With Newly Diagnosed Multiple Myeloma: A Systematic Literature Review and Network Meta-analysis

“…Previous NMAs performed in this setting since 2019 have identified VRd, daratumumab in combination with VMP (D-VMP), and daratumumab in combination with Rd (D-Rd) as the most effective regimens in terms of progressionfree survival (PFS) and/or overall survival (OS) [8][9][10][11][12][13][14][15]. The results from these analyses also emphasize the benefits obtained from the use of triplet or quadruplet regimens.…”

Network meta‐analysis of randomized trials in multiple myeloma: Efficacy and safety in frontline therapy for patients not eligible for transplant

“…In the last 10 years several NMA in this field have been published, 46 , 47 , 58 , 59 , 60 , 61 , 62 each of them with its own limitations which reflect the fact that this method could not completely replace a randomized clinical trial. Anyway, the most recent ones are in line with the results of our NMA, where the addition of Daratumumab to the previous standard‐of‐care RD and VMP should be considered as the preferred regimen in NEMM, a result further supported by the achievement of similar results in term of MRD negativity.…”