Real-World Treatment Patterns, Healthcare Use and Costs in Triple-Class Exposed Relapsed and Refractory Multiple Myeloma Patients in the USA

Abstract

Aim: To estimate treatment patterns and healthcare costs among triple-class exposed relapsed and refractory multiple myeloma (RRMM) patients. Materials & methods: Eligible patients had ≥1 line of therapy (LOT) each of proteasome inhibitors, immunomodulatory drugs and daratumumab in December 2015–September 2018 and received a new LOT. Results: A total of 154 patients were included with a median follow-up of 6.2 months. Median time from diagnosis to new LOT was 41.0 months. Kaplan–Meier estimate of median time to therapy discontinuation was 4.2 months. Mean per-patient, per-month MM-related costs were 35,657 US dollars. Most frequently observed regimens were lenalidomide or pomalidomide + daratumumab (18.2%), lenalidomide or pomalidomide + proteasome inhibitors (15.6%) and lenalidomide or pomalidomide monotherapy (11.0%). Conclusion: Triple-class exposed RRMM patients receive heterogeneous treatments for a short duration with high healthcare resource utilization and costs.

Treatment patterns and effectiveness of patients with multiple myeloma initiating Daratumumab across different lines of therapy: a real-world chart review study

“…In this study, daratumumab was used both in monotherapy and in combination with a variety of different agents. This is consistent with other reports of how daratumumab is used in the real world [ 23 ]. While a majority of patients initiated daratumumab in third line or after, the proportion of patients initiating daratumumab in earlier lines increased in the subset of patients initiating in 2018 or later.…”

Healthcare Costs Incurred by Patients with Multiple Myeloma Following Triple Class Exposure (TCE) in the US

“…Our study findings reflect more recent cost estimates (through February 2021) and are generally consistent with those reported in the study by Madduri et al in which patients were also identified from the MarketScan CCAE and MDCR databases. In that study, 154 MM patients were selected who had TCE and initiated at least one subsequent LOT between December 1, 2015 and September 30, 2018 [ 8 ]. Total all-cause healthcare costs were estimated at $37,033 PPPM in the 6 months (median follow-up) after initiation of another LOT post-TCE; MM-related healthcare costs represented 96% of total all-cause healthcare costs [ 8 ].…”

Treatment Patterns and Outcomes in Triple-Class Exposed Patients With Relapsed and Refractory Multiple Myeloma: Findings From the Multinational ITEMISE Study

“…20 The treatment regimens selected by hematologists in our survey across Europe and Canada are consistent with regimens from the published US studies. Madduri et al 15 found that an immunomodulatory drug alone (11.0%) or in combination with daratumumab (18.2%) or a PI (15.6%) were the most used regimens in the first line of therapy after TCE. 15 Mehra et al 13 similarly reported elotuzumab-, pomalidomide-, and carfilzomib-based regimens to be used most frequently.…”

“…Madduri et al 15 found that an immunomodulatory drug alone (11.0%) or in combination with daratumumab (18.2%) or a PI (15.6%) were the most used regimens in the first line of therapy after TCE. 15 Mehra et al 13 similarly reported elotuzumab-, pomalidomide-, and carfilzomib-based regimens to be used most frequently. The global KarMMa-RW study 14 likewise reported a variety of treatments, with 94 unique regimens used for the next-line treatment of 190 TCE patients; common combination regimens consisted of carfil-zomib, pomalidomide, daratumumab, lenalidomide, or elotuzumab.…”

“…10 Poor outcomes for patients with RRMM after TCE were also reported by 3 recent real-world studies from the United States. [12][13][14][15] A retrospective IBM Mar-ketScan study by Madduri et al 15 observed a median time to treatment discontinuation of 4.2 months (95% CI, 3.1-5.2) and a median time to the next treatment of 6.2 months (95% CI, 5.4-8.0) for patients receiving first treatment after TCE. The KarMMA-RW study 14 reported results describing the treatment pattern of heavily pretreated patients with RRMM with TCE refractory to their last regimen received.…”