In recent years, 3-drug combinations have begun to emerge as the standard of care at first relapse for patients with multiple myeloma (MM). This study assessed factors that influenced treatment choice with 3-drug combinations in a group of patients with relapsed/refractory MM (RRMM) who were managed in routine care.
Investigators identified adult patients with MM by using medical and pharmacy data from a US administrative claims database. Newly diagnosed patients were followed from the first claim with an International Classification of Diseases, Ninth Revision (ICD-9) code for MM. Patients with claims for stem-cell transplants were excluded. Frontline therapy (FLT) began with the first claim for systemic antimyeloma therapy. Second-line therapy (SLT) after the first relapse of RRMM was identified by a treatment gap >6 months between the end of FLT and the start of a second regimen, start of a follow-up regimen with a treatment gap of >3 and up to 6 months after the end of FLT, or a switch to another drug combination after the FLT regimen. Patients were stratified into 2 groups: those receiving 1- or 2- (1-2) versus 3- or 4-drug (3+) combinations.
Among the 623 patients who initiated SLT in 2013–2014, 146 (23%) received a 3+ SLT regimen. After adjusting for age, sex, and CRAB symptoms (hypercalcemia, renal insufficiency, anemia, and bone disease), predictors of 3- or 4-drug combination regimens included high risk of relapse and 3+ agents in FLT. Interestingly, age, Charlson Comorbidity Index, and poor disability status were not independently associated with receipt of 3+ SLT.
Despite wider adoption, researchers concluded that a majority of patients do not receive triplet-based SLT in routine care. Increased screening in the routine care of patients based on measures of age, comorbidity, and disability status may help clinicians optimize treatment choices for patients with RRMM.
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