Efficacy and safety of ixazomib maintenance therapy for patients with multiple myeloma: a meta-analysis

Figures & data

Figure 1. Flow diagram of study selection.

Table 1. Characteristics of studies included in the meta-analysis.

Study	People	ASCT	N	Maintenance therapy regimen	Planned maintenance duration	Median follow-up	Median PFS	Median OS
NCT02181413 (TOURMALINE-MM3)	Adults with confirmed diagnosis of symptomatic MM Median age:58	YES	656	Arm A (n = 395) Oral ixazomib 3 mg on days 1, 8, 15 in 28-day cycles. (Ixazomib 4 mg from cycle 5 if tolerated during cycles 1–4) Arm B (n = 261) Oral placebo capsule	24 months	Arm A:30.9 months Arm B:31.3 months	Arm A:26.5 months Arm B:21.3 months	Not available
NTR4910 (HOVON-126/NMSG 21.13 trial)	Newly diagnosed patients with multiple myeloma Median age:73	NO	78	Arm A (n = 39) Oral ixazomib 4 mg on days 1, 8, 15 in 28-day cycles. Arm B (n = 39) Oral placebo capsule	Not available	23.4 months	Arm A:9.5 months Arm B:8.4 months	Not available
NCT02312258 (TOURMALINE-MM4)	Newly diagnosed patients with multiple myeloma Median age:73	NO	706	Arm A (n = 425) Oral ixazomib 3 mg on days 1, 8, 15 in 28-day cycles. (Ixazomib 4 mg from cycle 5 if tolerated during cycles 1–4) Arm B (n = 281) Oral placebo capsule	24 months	21.1 months	Arm A:17.4 months Arm B:9.4 months	Not available

Figure 2. Risk of bias assessment of included studies. ‘+' low risk, ‘-' high risk, ‘?’ unclear risk.

Figure 3. Pooled HR of PFS comparing ixazomib maintenance therapy with placebo.

Figure 4. Pooled RR of deepening remission comparing ixazomib with placebo.

Figure 5. Forest plot of safety for treatment with ixazomib group versus placebo. (a) Forest plot of grade 3–4 neutropenia. (b) Forest plot of grade 3–4 thrombocytopenia. (c) Forest plot of grade 3–4 infections. (d) Forest plot of gastrointestinal disorders. (e) Forest plot of neuropathy. (f) Forest plot of the new primary malignant tumor.