Safety, efficacy and total costs of multiple myeloma regimens

Abstract

When safety, efficacy and total costs of treatment and management of adverse events (AEs) are considered, carfilzomib plus dexamethasone appears to be the superior regimen for relapsed or refractory multiple myeloma (RRMM), according to findings of a Bayesian network meta-analysis (NMA) published in Cancer.Scopus, Cochrane, PubMed Publisher and Web of Science databases were searched from 1999 to July 2018 for phase III randomised controlled trials (RCTs) of antineoplastic regimens approved by the US FDA for the treatment of RRMM. Progression-free survival (PFS), grade 3-4 AEs and the total cost per course (drug costs plus costs for management of AEs) were assessed for each regimen. Fifteen studies which evaluated 14 regimens in a total of 7718 patients with RRMM met the inclusion criteria for meta-analysis. Regimens were ranked based on surface under the cumulative ranking (SUCRA) probabilities.Daratumumab plus lenalidomide and dexamethasone had the highest ranking in terms of PFS (hazard ratio [HR] 0.13; 95% credible interval 0.09, 0.19; SUCRA 1), and total cost per course ($41 420; SUCRA 0.02). Daratumumab plus bortezomib and dexamethasone also ranked high in terms of total cost ($40 553, SUCRA 0.08). Panobinostat plus bortezomib and dexamethasone was ranked as the least effective regimen with the lowest safety (SUCRA 0.24). Bortezomib plus thalidomide and dexamethasone was ranked as the least effective regimen with the highest total cost per course (SUCRA 0.33). Carfilzomib plus dexamethasone had the highest ranking in terms of efficacy and safety (SUCRA 0.61) as well as efficacy and total cost (SUCRA 0.60)."To our knowledge, this is the first NMA that has indirectly evaluated the efficacy, safety, and total treatment cost of a myriad of approved RRMM regimens using phase 3 RCTs," commented the authors. "Overall, the results of our analysis should provide guidance in choosing the right regimen tailored to an individual patient's needs," they said.Dhakal B, et al. Association of adverse events and associated cost with efficacy for approved relapsed and/or refractory multiple myeloma regimens: A Bayesian network meta-analysis of phase 3 randomized controlled trials. Cancer : 10 Mar 2020.