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

Impact of bone events on survival in solitary bone plasmacytoma

BACKGROUND

Although much studied in multiple myeloma, bone events (BE) can also cause important morbidity in bone plasmacytoma patients. To our knowledge, the effect of BE on overall survival (OS) and progression to multiple myeloma free-survival (MPFS) also has never been studied.

PATIENTS AND METHODS

Fifty-nine patients treated from 2008 to 2017 were retrospectively assessed. All patients had histological proof of disease and were treated with radical radiotherapy (RT). Available clinical information for at least 6 months follow-up or until death had to be available. BE were described as one of the following events in the index bone: fractures, osteomyelitis, chronic pain, surgery or loss of limb function after RT.

RESULTS

Mean age at diagnosis was 57.3 years (18-80); most male (67.8%). Mean OS, bone event free-survival (BEFS), local progression-free survival (LPFS) and MPFS were 41, 36, 37 and 19 months, respectively. There were 15 deaths. BEFS (p = 0.008) and age>55y (p = 0.044) were associated with MPFS. Only BEFS correlated with OS (p = 0.029). BE was independently associated with both MPFS and OS in multivariate analysis.

CONCLUSION

BE and survival end-points were correlated. BE should be investigated in prospective trials.

Bone complications in patients with multiple myeloma in five European countries: a retrospective patient chart review

BACKGROUND

Bone complications (pathologic fracture, spinal cord compression, surgery to bone and radiation to bone) are a common problem in patients with multiple myeloma (MM). We set out to provide insights into the real-world burden of bone complications in patients with newly diagnosed MM (NDMM).

METHODS

We conducted a retrospective review of medical charts of patients with NDMM whose disease had progressed following first-line treatment in the 3 months before data collection in 2016 in five European countries (France, Germany, Italy, Spain and the United Kingdom).

RESULTS

The aggregated study population included 813 patients. Bone pain commonly led to MM diagnosis (63%) and 74% of all patients had two or more bone lesions at initiation of first-line treatment. Furthermore, 26% of patients experienced a new bone complication between MM diagnosis and disease progression following first-line treatment, despite 75% of individuals receiving bisphosphonates. Most bone complications (52%) occurred in the period before initiation of first-line treatment (mean duration: 2.3 months) and more than half of patients (56%) who experienced a new bone complication were hospitalised. Analgesics were used more frequently in patients with bone complications than in those without them (76% vs 50%, respectively). Furthermore, 51% of patients had renal impairment by the time first-line treatment was started. Overall, 25% of patients did not receive bisphosphonates for prevention of bone complications and one in four of those with renal impairment at initiation of first-line treatment did not receive bisphosphonates.

CONCLUSIONS

Bone complications are common in patients with NDMM. They are frequently associated with hospitalization and analgesic use. Data from this study, conducted in the era of novel anti-myeloma therapies and before the approval of denosumab for use in patients with MM, suggest that although most patients (75%) received bisphosphonates, use of anti-resorptive therapy for prevention of bone complications may be suboptimal in patients with NDMM, irrespective of renal function.

Initiation and interruption in intravenous bisphosphonate therapy among patients with multiple myeloma in the United States

BACKGROUND

Prior to 2018, intravenous bisphosphonates (IV BPs) were the only therapies recommended to prevent skeletal-related events for patients diagnosed with multiple myeloma (MM). We examined patterns of IV BP initiation and interruption among patients with newly diagnosed MM (NDMM) in the United States.

METHODS

Electronic health records linked to administrative health insurance claims were used to identify adults with NDMM between 1 January 2011 and 30 April 2016. Patients were excluded for recent IV BP use or concurrent cancer. The incidences of IV BP initiation and interruption were estimated using competing risk regression. A generalized linear model was used to estimate risk factors for treatment initiation and interruption.

RESULTS

Among the 547 patients with NDMM, 64% initiated MM therapy within 30 days of diagnosis. By one year, 65% (95% CI: 59, 70) of patients with appropriately timed anti-MM therapy had initiated an IV BP. Zoledronic acid was the most commonly initiated IV BP. Patients with Stage III MM were more likely to initiate an IV BP (adjusted risk difference (RD): 6.3; 95% CI: 2.7, 10.1), while those with eGFR <30 mL/min were less likely to initiate (RD: -9.7; 95% CI: -13.8, -5.8). Of the 264 patients who initiated an IV BP, 77% (95% CI: 71, 82) experienced an interruption within one year. Patients on concurrent anti-MM therapy were less likely to experience an interruption in IV BP therapy.

CONCLUSIONS

Many patients with NDMM do not initiate IV BPs, particularly those with renal complications. Interruptions of IV BPs were common.