Utilization of agents to prevent skeletal-related events among patients with multiple myeloma: analysis of real-world data
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This study examined real-world utilization patterns of bone-targeted agents (BTA) in patients with multiple myeloma (MM).
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.
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.
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.
KeywordsBone metastasis Multiple myeloma Bone-targeted agents Persistence Compliance
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.
- 2.American Cancer Society Cancer facts and figures 2016. American Cancer Society, Atlanta, GAGoogle Scholar
- 5.Kyle RA (2004) Plasma cell disorders. In: Goldman L (ed) Cecil textbook of medicine. W. B. Saunders, Philadelphia, pp 1184–1195Google Scholar
- 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
- 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
- 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
- 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
- 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
- 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.National Comprehensive Cancer Network (2016) NCCN clinical practice guidelines in oncology: multiple myelomaGoogle Scholar
- 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
- 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.Aredia (pamidronate disodium) prescribing information. In: Editor (ed)^(eds) Book Aredia (pamidronate disodium) prescribing information, CityGoogle Scholar