Clinical Outcomes for Multiple Myeloma Patients With Prior Exposure to a Combination of a Proteasome Inhibitor and an Immunomodulatory Agent in Alberta, Canada

Abstract

Background

Proteasome inhibitors (PI) and immunomodulatory drugs (IMiDs) are important backbones in early line treatments for patients with multiple myeloma (MM). This study examined real-world treatment patterns, clinical outcomes and healthcare resource utilization (HCRU) of double-class exposed (DCE) patients with MM after prior PI and IMiD-based treatment.

Methods

DCE patients were identified using integrated administrative databases in the province of Alberta, Canada. DCE patients who commenced subsequent lines of therapy (LOT) between January 2012 and December 2022 were included.

Results

Among 831 DCE patients identified to have initiated subsequent LOT during the study period, median age was 68.0 years. IMiD (61%) was the most commonly used therapeutic class after progressing on double-class exposure, followed by PI (39%) and monoclonal antibodies (26%). Attrition rates after first subsequent LOT, defined as death before receiving the next LOT, was 27%, and attrition from second to third subsequent LOT was 30%. Median time to next treatment or death was 12.1 months (95% confidence interval: 10.3-14.1) and median overall survival was 34.4 months (30.3-40.2) from the start of the next subsequent LOT after double-class exposure. healthcare resource utilization (HCRU) during the first year of starting subsequent LOT was high, with a median of 1 ED visit, 1 inpatient admission, 30 clinic visits, 3 infusion appointments, 56 unique healthcare encounters. On average, patients spent 42.2 days on laboratory tests.

Conclusion

Clinical outcomes among patients with MM initiating postdouble-class exposure treatments remain suboptimal, with high attrition rates and significant healthcare use, highlighting the need for therapies that reduce patient burden.