Relative efficacy of treatment options in transplant-ineligible newly diagnosed multiple myeloma: results from a systematic literature review and network meta-analysis

Abstract

Established treatments for transplant-ineligible (TNE) patients with newly diagnosed multiple myeloma (NDMM) include melphalan and prednisone (MP) combined with either bortezomib (VMP) or thalidomide (MPT), or lenalidomide plus low-dose dexamethasone (Rd). New treatments for TNE NDMM include Rd plus bortezomib (RVd) and daratumumab plus VMP (VMP + D), daratumumab plus lenalidomide and dexamethasone (D + Rd). Relative efficacy of these treatments was compared using a network meta-analysis. Eight trials identified by a systematic literature review were included in the primary analysis; hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) were used. Rd was superior to other MP-based regimens for OS and PFS. There was strong evidence that, compared with Rd, both D + Rd and RVd improved PFS (HR 0.57; 95% credible interval (CrI) 0.43, 0.73 and HR 0.72; 95% CrI 0.56, 0.91, respectively). However, there was strong evidence only for RVd in respect to OS (HR 0.72; 95% CrI 0.52, 0.96).

Keywords:

• Multiple myeloma
• network meta-analysis
• systematic literature review
• treatment-naive

Acknowledgments

Medical writing and editorial support were provided by Mauro Locati, PhD (Excerpta Medica) and Joanna Todd, PhD (Stellar Medical Communications Limited) and were funded by Celgene Corporation. The authors are fully responsible for all content and editorial decisions for this manuscript.

Disclosure statement

K. R. has received honoraria from AbbVie, Amgen, Celgene Corporation, Janssen, Oncopeptides, Sanofi, and Takeda; and grants from Amgen, Celgene Corporation, Janssen, and Takeda. H. T. has received honoraria from Bayern AG, Celgene Corporation, Hoffman-La Roche, Janssen, Novartis, and Pfizer. V. K. D. and V. B. have received a grant and consultancy fees from Celgene Corporation. S. R. and S.D. are employees of Celgene Corporation and hold shares in Celgene Corporation. K. W. is an advisory board member for Amgen, Adaptive Biotechnologies, Bristol-Myers Squibb, Janssen, Juno, Sanofi, and Takeda; and has received honoraria from Amgen, Bristol-Myers Squibb, Celgene Corporation, Janssen, Novartis, Takeda; and grants from Amgen, Celgene Corporation, Janssen, and Sanofi.

Additional information

Funding

This research is sponsored by Celgene Corporation.