Survival and treatment patterns of patients with relapsed or refractory multiple myeloma in France — a cohort study using the French National Healthcare database (SNDS)

Abstract

Over the past decade, several drugs have been approved for the treatment of relapsed or refractory multiple myeloma (RRMM). This retrospective study, using the French National Healthcare database (SNDS), describes the treatment patterns and outcomes of patients with RRMM treated in real-world clinical practice in France. Patients were adults, with a diagnosis of multiple myeloma, who initiated second-line (2L) treatment approved for use in France between 2014 and 2018; this included bortezomib, carfilzomib, daratumumab, ixazomib, lenalidomide, or pomalidomide. Data were analyzed overall, by first-line (1L) autologous stem cell transplant (ASCT) status and by lenalidomide treatment status at 2L. In total, 12987 patients with RRMM were included in the study (mean age 69.5 years); 27% received an ASCT at 1L, and 30% received a lenalidomide-sparing regimen at 2L. Overall, and among the ASCT and non-ASCT subgroups, most patients received a bortezomib-based regimen at 1L, whereas lenalidomide-based regimens were most common at 2L. Among patients who received a lenalidomide-sparing regimen at 2L, this was most often a proteasome inhibitor-based regimen. Mortality rate was 26.1/100 person-years, and median (95% confidence interval) survival from 2L initiation was 32.4 (31.2–33.6) months. Survival differed by various factors, shorter survival was reported in the non-ASCT group, those receiving a lenalidomide-sparing regimen at 2L, older patients (≥ 70 years), and those with multiple comorbidities. This analysis provides insight into the real-world use of approved novel MM treatments and highlights an ongoing unmet need to improve outcomes, particularly for selected patient groups.

Assessing the treatment pattern, health care resource utilisation, and economic burden of multiple myeloma in France using the Système National des Données de Santé (SNDS) database: a retrospective cohort study

“…In France, as in the broader global context [ 31 ], no regimen is currently recommended as a standard of care for heavily pretreated and relapsed MM. Consistent with previous findings [ 29 ], LOT1 treatment was quite uniform during the study period (with 97% of patients receiving bortezomib-based regimens). However, published global data showed lower use of bortezomib based regimens in non-SCT population than in this study (54% vs 96%, respectively) [ 30 ].…”

“…Furthermore, the greater hospitalisation costs in the current analysis were found to be higher in the first year of follow-up, which likely is due to a difference between an incident population vs a prevalent population [ 13 ]. Approximately 30% of patients underwent SCT, consistent with recently published data [ 29 , 30 ]; these patients accounted for greater financial impact, particularly in the first year after diagnosis, than the average for the total population. They were generally younger, in line with published data [ 30 ], and experienced fewer hospitalisations during follow-up than the total population in a manner that was constant over time.…”

“…Fewer patients who received later LOTs than those who received LOT1 were captured in the study, consistent with previous findings [ 29 ]. Thus the relatively short period of the study may have not fully captured the economic impact of SCT as patients who undergo the SCT are younger, live longer, and are more likely to need multiple LOT.…”

Real-world study of the efficacy and safety of belantamab mafodotin (GSK2857916) in relapsed or refractory multiple myeloma based on data from the nominative ATU in France: the IFM 2020-04 study

“…Non-immunologic agents, although still necessary, are usually associated with toxicities such as selinexor 16,17 or melflufen 18 , whose development has been put on hold, and therefore immune-based treatment such as BM offer innovative strategies. To contextualize median OS of 9.3 months, we found a median OS of about 3-4 months for MAMMOTH-like MM patients in a French national healthcare database OS study 6,19 . Belantamab mafodotin represents a promising alternative option for these patients with its unique mechanism of action for the delivery of the cytotoxic agent directly into MM cells after binding BCMA.…”

Survival outcomes for patients with multiple myeloma in France: A retrospective cohort study using the Système National des Données de Santé national healthcare database

“…A retrospective study in France revealed that patients with relapsing/refractory MM (RRMM) who received a lenalidomide‐sparing regimen at second LOT had shorter median survival time than those who received a lenalidomide‐based regimen 12 . Although this real‐world study provided valuable insights into MM treatments, patient outcomes with later LOTs were not fully investigated 12 .…”