Real-world treatment patterns, comorbidities, and disease-related complications in patients with multiple myeloma in the United States

Abstract

Objectives:

To describe multiple myeloma (MM) treatment patterns and comorbidities over time in the US.

Research design and methods:

Study patients were newly diagnosed with MM (ICD-9-CM 203.0x) between 1 July 2006 and 31 March 2014 and had ≥6 months of data prior to the initial MM diagnosis in MarketScan Research Databases. Patients were followed until inpatient death or the end of data. First-line, second-line, and third-line treatment regimens were identified following diagnosis and were described over time based upon the start date of the first line of therapy (2006–2007, 2008–2014, 2013–2014). Comorbid conditions and disease-related complications were examined during the 6 months prior to the line of therapy start dates.

Results:

A total of 24,507 MM patients were examined (mean age: 65.2 years, 54.1% male, mean follow-up: 23 months, 16.2% transplant). Across all lines of therapy, the proportion of patients on thalidomide-based regimens decreased over time. In the first line, bortezomib-based regimens became more common from 2006–2007 to 2008–2014 (2006–2007: 17.0%, 2008–2014: 44.3%, 2013–2014: 49.4%). In the second line, lenalidomide- and bortezomib-based regimens were the most common (2013–2014: lenalidomide: 28.9%, bortezomib: 26.2%). The combination regimen of lenalidomide + bortezomib became more common in the first and second lines. In the third line, carfilzomib- and/or pomalidomide-based regimens were 37.0% in 2013–2014. Skeletal-related events, hypertension, anemia, and chronic kidney disease were the most prevalent comorbidities and disease-related complications. During the 6 months prior to each line of therapy, the prevalence of the majority of the comorbidities and complications increased as patients progressed to higher lines of therapy.

Conclusions:

MM treatment patterns have been dynamic over time. Comorbid conditions and myeloma-related complications increase as patients progress and may worsen MM patients’ prognoses over time. Combination regimens such as lenalidomide + bortezomib are more widely used as first- and second-line therapy. Newly approved agents (carfilzomib, pomalidomide) are the prevailing treatments in the third line and are under further investigation for earlier lines of therapy.

Keywords: :

• Claims data
• Comorbidity
• Multiple myeloma
• Treatment pattern

Transparency

Declaration of funding

This study was supported by Onyx Pharmaceuticals Inc., an Amgen subsidiary.

Author contributions: All authors made significant contributions to this manuscript and met all of the conditions as previously stated by the ICMJE. All authors have read and approved the manuscript for submission.

Declaration of financial/other relationships

Z.C. has disclosed that he is an employee of Onyx Pharmaceuticals Inc. and is a stockholder in Amgen. X.S. and K.W. have disclosed that they are employees of Truven Health Analytics. Truven Health Analytics was compensated to perform this work on behalf of Onyx Pharmaceuticals Inc.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work. CMRO peer reviewer 1 has disclosed that he has received honoraria from Celgene and Janssen Cilag. CMRO peer reviewers 2, 3, and 4 have no other relevant financial relationships to disclose.

Acknowledgments

This paper benefited from the editorial contributions of Santosh Tiwari.