Advertisement

Supportive Care in Cancer

, Volume 26, Issue 3, pp 807–812 | Cite as

Utilization of agents to prevent skeletal-related events among patients with multiple myeloma: analysis of real-world data

  • Yi QianEmail author
  • Debajyoti Bhowmik
  • Nandita Kachru
  • Rohini K Hernandez
  • Paul Cheng
  • Alexander Liede
Original Article

Abstract

Purpose

This study examined real-world utilization patterns of bone-targeted agents (BTA) in patients with multiple myeloma (MM).

Methods

In this retrospective cohort study, adults with an MM diagnosis recorded in 2012–2014 were identified from electronic health records in the Oncology Services Comprehensive Electronic Records (OSCER) database. Patients received zoledronic acid (ZA) or pamidronate (PA) on/after first MM diagnosis recorded in the study period, had no BTA use in prior 6 months, and were followed through earliest of May 31, 2015 or last clinic visit. Patients with any solid tumor diagnosis were excluded. Time to BTA initiation, compliance (≥ 12 administrations in a year), switching, and non-persistence (switch or ≥ 90-day gap in therapy) were described by agent and follow-up period.

Results

Among 9,617 patients with MM, 3,735 (38.8%) received a BTA. Most patients (90.9%) received ZA, with first BTA use generally seen within 3 months of first observed MM diagnosis (ZA 76.1%, PA 75.1%). A minority of ZA (27.4%) and PA (23.0%) patients were compliant in Year 1, with lower compliance in Year 2 (19.8% and 15.6%, respectively). The median time to non-persistence was 16.2 (95% confidence interval [CI] 15.4–17.4) months for ZA and 13.8 (95% CI 11.5–15.4) months for PA. Persistence was 86% at 6 months and 34% at 24 months for ZA, and 77% and 30% for PA, respectively.

Conclusions

These results highlight the possibility of suboptimal prevention of skeletal-related events due to non-compliant dosing and non-persistence after patients initiate BTA therapy.

Keywords

Bone metastasis Multiple myeloma Bone-targeted agents Persistence Compliance 

Notes

Acknowledgements

This study was funded by Amgen Inc., Thousand Oaks, CA. YQ, DB, RKH, and AL are employees and stockholders of Amgen Inc. and have access to the primary study data. PC and NK were employed by Amgen Inc. at the time of the study. Writing assistance was provided by Sally Wade, Wade Outcomes Research and Consulting, Salt Lake City, UT.

Compliance with ethical standards

Conflicts of interest

This study was funded by Amgen Inc., Thousand Oaks, CA. YQ, DB, RKH and AL are employees and stockholders of Amgen Inc. and have access to the primary study data. NK and PC were employed by Amgen Inc. at the time of the study. Writing assistance was provided by Sally Wade, Wade Outcomes Research and Consulting, Salt Lake City, UT.

References

  1. 1.
    Siegel RL, Miller KD, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65:5–29CrossRefPubMedGoogle Scholar
  2. 2.
    American Cancer Society Cancer facts and figures 2016. American Cancer Society, Atlanta, GAGoogle Scholar
  3. 3.
    Gay F, Palumbo A (2010) Management of disease- and treatment-related complications in patients with multiple myeloma. Med Oncol 27(Suppl 1):S43–S52CrossRefPubMedGoogle Scholar
  4. 4.
    Wirk B (2011) Renal failure in multiple myeloma: a medical emergency. Bone Marrow Transplant 46:771–783CrossRefPubMedGoogle Scholar
  5. 5.
    Kyle RA (2004) Plasma cell disorders. In: Goldman L (ed) Cecil textbook of medicine. W. B. Saunders, Philadelphia, pp 1184–1195Google Scholar
  6. 6.
    Raje N, Roodman GD (2011) Advances in the biology and treatment of bone disease in multiple myeloma. Clin Cancer Res 17:1278–1286CrossRefPubMedGoogle Scholar
  7. 7.
    Terpos E, Morgan G, Dimopoulos MA, Drake MT, Lentzsch S, Raje N, Sezer O, Garcia-Sanz R, Shimizu K, Turesson I, Reiman T, Jurczyszyn A, Merlini G, Spencer A, Leleu X, Cavo M, Munshi N, Rajkumar SV, Durie BG, Roodman GD (2013) International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease. J Clin Oncol 31:2347–2357CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR (2003) Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 78:21–33CrossRefPubMedGoogle Scholar
  9. 9.
    Terpos E, Szydlo R, Apperley JF, Hatjiharissi E, Politou M, Meletis J, Viniou N, Yataganas X, Goldman JM, Rahemtulla A (2003) Soluble receptor activator of nuclear factor kappaB ligand-osteoprotegerin ratio predicts survival in multiple myeloma: proposal for a novel prognostic index. Blood 102:1064–1069CrossRefPubMedGoogle Scholar
  10. 10.
    Coleman RE (1997) Skeletal complications of malignancy. Cancer 80:1588–1594CrossRefPubMedGoogle Scholar
  11. 11.
    Roodman GD (2008) Novel targets for myeloma bone disease. Expert Opin Ther Targets 12:1377–1387CrossRefPubMedGoogle Scholar
  12. 12.
    Chow E, Hoskin P, van der Linden Y, Bottomley A (2006) Velikova G. Quality of life and symptom end points in palliative bone metastases trials Clin Oncol (R Coll Radiol) 18:67–69Google Scholar
  13. 13.
    Coleman RE (2006) Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 12:6243s–6249sCrossRefPubMedGoogle Scholar
  14. 14.
    Terpos E, Kleber M, Engelhardt M, Zweegman S, Gay F, Kastritis E, van de Donk NW, Bruno B, Sezer O, Broijl A, Bringhen S, Beksac M, Larocca A, Hajek R, Musto P, Johnsen HE, Morabito F, Ludwig H, Cavo M, Einsele H, Sonneveld P, Dimopoulos MA, Palumbo A, European Myeloma N (2015) European Myeloma Network guidelines for the management of multiple myeloma-related complications. Haematologica 100:1254–1266CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Costa LJ, Brill IK, Brown EE (2016) Impact of marital status, insurance status, income, and race/ethnicity on the survival of younger patients diagnosed with multiple myeloma in the United States. Cancer 122:3183–3190CrossRefPubMedGoogle Scholar
  16. 16.
    Mateos MV, San Miguel JF (2013) How should we treat newly diagnosed multiple myeloma patients? Hematology Am Soc Hematol Educ Program 2013:488–495PubMedGoogle Scholar
  17. 17.
    Kristinsson SY, Landgren O, Dickman PW, Derolf AR, Bjorkholm M (2007) Patterns of survival in multiple myeloma: a population-based study of patients diagnosed in Sweden from 1973 to 2003. J Clin Oncol 25:1993–1999CrossRefPubMedGoogle Scholar
  18. 18.
    Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S, Kapoor P, Dingli D, Hayman SR, Leung N, Lust J, McCurdy A, Russell SJ, Zeldenrust SR, Kyle RA, Rajkumar SV (2014) Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia 28:1122–1128CrossRefPubMedGoogle Scholar
  19. 19.
    Pulte D, Jansen L, Castro FA, Emrich K, Katalinic A, Holleczek B, Brenner H, Group GCSW (2015) Trends in survival of multiple myeloma patients in Germany and the United States in the first decade of the 21st century. Br J Haematol 171:189–196CrossRefPubMedGoogle Scholar
  20. 20.
    Schaapveld M, Visser O, Siesling S, Schaar CG, Zweegman S, Vellenga E (2010) Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. Eur J Cancer 46:160–169CrossRefPubMedGoogle Scholar
  21. 21.
    Hernandez RK, Adhia A, Wade SW, O’Connor E, Arellano J, Francis K, Alvrtsyan H, Million RP, Liede A (2015) Prevalence of bone metastases and bone-targeting agent use among solid tumor patients in the United States. Clin Epidemiol 7:335–345PubMedPubMedCentralGoogle Scholar
  22. 22.
    Qian Y, Bhowmik D, Kachru N, Hernandez RK (2016) Longitudinal patterns of bone-targeted agent use among patients with solid tumors and bone metastases in the United States. Support Care Cancer 25:1845–1851CrossRefGoogle Scholar
  23. 23.
    Kyle RA, Yee GC, Somerfield MR, Flynn PJ, Halabi S, Jagannath S, Orlowski RZ, Roodman DG, Twilde P, Anderson K, American Society of Clinical O (2007) American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. J Clin Oncol 25:2464–2472CrossRefPubMedGoogle Scholar
  24. 24.
    National Comprehensive Cancer Network (2016) NCCN clinical practice guidelines in oncology: multiple myelomaGoogle Scholar
  25. 25.
    Group IMW (2013) International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease. In: Editor (ed)^(eds) Book International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease, CityGoogle Scholar
  26. 26.
    Wu EQ, Bensimon AG, Marynchenko M, Namjoshi M, Guo A, Yu AP, Ericson SG, Raje N (2011) Comparison of skeletal complications and treatment patterns associated with early vs. delayed zoledronic acid therapy in multiple myeloma. Clin Lymphoma Myeloma Leuk 11:326–335CrossRefPubMedGoogle Scholar
  27. 27.
    Henk HJ, Teitelbaum A, Perez JR, Kaura S (2012) Persistency with zoledronic acid is associated with clinical benefit in patients with multiple myeloma. Am J Hematol 87:490–495CrossRefPubMedGoogle Scholar
  28. 28.
    Highlights of prescribing information: Zometa (zoledronic acid) infusion. In: Editor (ed)^(eds) Book Highlights of prescribing information: Zometa (zoledronic acid) infusion, CityGoogle Scholar
  29. 29.
    Aredia (pamidronate disodium) prescribing information. In: Editor (ed)^(eds) Book Aredia (pamidronate disodium) prescribing information, CityGoogle Scholar
  30. 30.
    El-Amm J, Tabbara IA (2015) Emerging therapies in multiple myeloma. Am J Clin Oncol 38:315–321CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Yi Qian
    • 1
    Email author
  • Debajyoti Bhowmik
    • 1
  • Nandita Kachru
    • 2
  • Rohini K Hernandez
    • 1
  • Paul Cheng
    • 1
  • Alexander Liede
    • 3
  1. 1.Amgen Inc.Thousand OaksUSA
  2. 2.Department of Pharmaceutical Health Outcomes and Policy, College of PharmacyUniversity of HoustonHoustonUSA
  3. 3.Amgen Inc.South San FranciscoUSA

Personalised recommendations