Treatment Outcomes and Health Care Resource Utilization in Patients With Newly Diagnosed Multiple Myeloma Receiving Lenalidomide-Only Maintenance, Any Maintenance, or No Maintenance: Results from the Connect MM Registry

Robert M. Rifkin, Sundar Jagannath, Brian G.M. Durie, Mohit Narang, Howard R. Terebelo, Cristina J. Gasparetto, Kathleen Toomey, James W. Hardin, Lynne Wagner, Kejal Parikh, Safiya Abouzaid, Shankar Srinivasan, Amani Kitali, Faiza Zafar, Rafat Abonour

Research output: Contribution to journalArticle

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Abstract

Purpose: Maintenance therapy after autologous stem cell transplantation (ASCT) improves clinical outcomes in multiple myeloma (MM), but the effect of continued treatment with lenalidomide-only maintenance, or any maintenance, on health care resource utilization (HCRU) is largely unknown. Methods: Here we present an analysis of HCRU and clinical outcomes in a cohort of patients from the Connect MM registry, the largest, ongoing, observational, prospective US registry of patients with symptomatic newly diagnosed MM. In this study, patients with newly diagnosed MM who completed induction and single ASCT without subsequent consolidation received lenalidomide-only maintenance (n = 180), any maintenance (n = 256), or no maintenance (n = 165). HCRU (hospitalization, surgery/procedures, and concurrent medications [growth factors, bisphosphonates, or neuropathic pain medication]) was assessed starting from 100days post-ASCT for up to 2years. Findings: Although the rates of hospitalization per 100 person-years were similar across groups at the end of years 1 and 2, the median duration of hospitalization was numerically longer with no maintenance. The rates of use of growth factors, bisphosphonates, and neuropathic pain medication were generally similar in all 3 groups. The receipt of any maintenance was associated with significantly reduced use of neuropathic pain medications during year 1. Of note, lenalidomide-only maintenance was associated with significantly longer progression-free survival (54.5vs 30.4 months; hazard ratio [HR] = 0.58; 95% CI, 0.43–0.79; P = 0.0005) and overall survival (OS) (median OS not reached in either group; HR = 0.45; 95% CI, 0.28–0.73; P = 0.001) compared with no maintenance. Likewise, the group treated with any maintenance had significantly longer median progression-free survival (44.7vs 30.4 months; HR = 0.62; 95% CI, 0.47–0.82; P = 0.0008) and OS (median OS not reached in either group; HR = 0.50; 95% CI, 0.33–0.76; P = 0.001) than did the group that did not receive maintenance. Implications: These findings suggest that in this largely community-based study population, post-ASCT maintenance therapy, including lenalidomide-only maintenance, improves clinical outcomes without negatively affecting HCRU. ClinicalTrials.gov identifier: NCT01081028.

Original languageEnglish (US)
JournalClinical Therapeutics
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Patient Acceptance of Health Care
Health Resources
Multiple Myeloma
Registries
Maintenance
Stem Cell Transplantation
Neuralgia
Hospitalization
Survival
Diphosphonates
Disease-Free Survival
lenalidomide
Intercellular Signaling Peptides and Proteins

Keywords

  • health care
  • maintenance therapy
  • newly diagnosed multiple myeloma

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Treatment Outcomes and Health Care Resource Utilization in Patients With Newly Diagnosed Multiple Myeloma Receiving Lenalidomide-Only Maintenance, Any Maintenance, or No Maintenance : Results from the Connect MM Registry. / Rifkin, Robert M.; Jagannath, Sundar; Durie, Brian G.M.; Narang, Mohit; Terebelo, Howard R.; Gasparetto, Cristina J.; Toomey, Kathleen; Hardin, James W.; Wagner, Lynne; Parikh, Kejal; Abouzaid, Safiya; Srinivasan, Shankar; Kitali, Amani; Zafar, Faiza; Abonour, Rafat.

In: Clinical Therapeutics, 01.01.2018.

Research output: Contribution to journalArticle

Rifkin, Robert M. ; Jagannath, Sundar ; Durie, Brian G.M. ; Narang, Mohit ; Terebelo, Howard R. ; Gasparetto, Cristina J. ; Toomey, Kathleen ; Hardin, James W. ; Wagner, Lynne ; Parikh, Kejal ; Abouzaid, Safiya ; Srinivasan, Shankar ; Kitali, Amani ; Zafar, Faiza ; Abonour, Rafat. / Treatment Outcomes and Health Care Resource Utilization in Patients With Newly Diagnosed Multiple Myeloma Receiving Lenalidomide-Only Maintenance, Any Maintenance, or No Maintenance : Results from the Connect MM Registry. In: Clinical Therapeutics. 2018.
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title = "Treatment Outcomes and Health Care Resource Utilization in Patients With Newly Diagnosed Multiple Myeloma Receiving Lenalidomide-Only Maintenance, Any Maintenance, or No Maintenance: Results from the Connect MM Registry",
abstract = "Purpose: Maintenance therapy after autologous stem cell transplantation (ASCT) improves clinical outcomes in multiple myeloma (MM), but the effect of continued treatment with lenalidomide-only maintenance, or any maintenance, on health care resource utilization (HCRU) is largely unknown. Methods: Here we present an analysis of HCRU and clinical outcomes in a cohort of patients from the Connect MM registry, the largest, ongoing, observational, prospective US registry of patients with symptomatic newly diagnosed MM. In this study, patients with newly diagnosed MM who completed induction and single ASCT without subsequent consolidation received lenalidomide-only maintenance (n = 180), any maintenance (n = 256), or no maintenance (n = 165). HCRU (hospitalization, surgery/procedures, and concurrent medications [growth factors, bisphosphonates, or neuropathic pain medication]) was assessed starting from 100days post-ASCT for up to 2years. Findings: Although the rates of hospitalization per 100 person-years were similar across groups at the end of years 1 and 2, the median duration of hospitalization was numerically longer with no maintenance. The rates of use of growth factors, bisphosphonates, and neuropathic pain medication were generally similar in all 3 groups. The receipt of any maintenance was associated with significantly reduced use of neuropathic pain medications during year 1. Of note, lenalidomide-only maintenance was associated with significantly longer progression-free survival (54.5vs 30.4 months; hazard ratio [HR] = 0.58; 95{\%} CI, 0.43–0.79; P = 0.0005) and overall survival (OS) (median OS not reached in either group; HR = 0.45; 95{\%} CI, 0.28–0.73; P = 0.001) compared with no maintenance. Likewise, the group treated with any maintenance had significantly longer median progression-free survival (44.7vs 30.4 months; HR = 0.62; 95{\%} CI, 0.47–0.82; P = 0.0008) and OS (median OS not reached in either group; HR = 0.50; 95{\%} CI, 0.33–0.76; P = 0.001) than did the group that did not receive maintenance. Implications: These findings suggest that in this largely community-based study population, post-ASCT maintenance therapy, including lenalidomide-only maintenance, improves clinical outcomes without negatively affecting HCRU. ClinicalTrials.gov identifier: NCT01081028.",
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T1 - Treatment Outcomes and Health Care Resource Utilization in Patients With Newly Diagnosed Multiple Myeloma Receiving Lenalidomide-Only Maintenance, Any Maintenance, or No Maintenance

T2 - Results from the Connect MM Registry

AU - Rifkin, Robert M.

AU - Jagannath, Sundar

AU - Durie, Brian G.M.

AU - Narang, Mohit

AU - Terebelo, Howard R.

AU - Gasparetto, Cristina J.

AU - Toomey, Kathleen

AU - Hardin, James W.

AU - Wagner, Lynne

AU - Parikh, Kejal

AU - Abouzaid, Safiya

AU - Srinivasan, Shankar

AU - Kitali, Amani

AU - Zafar, Faiza

AU - Abonour, Rafat

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: Maintenance therapy after autologous stem cell transplantation (ASCT) improves clinical outcomes in multiple myeloma (MM), but the effect of continued treatment with lenalidomide-only maintenance, or any maintenance, on health care resource utilization (HCRU) is largely unknown. Methods: Here we present an analysis of HCRU and clinical outcomes in a cohort of patients from the Connect MM registry, the largest, ongoing, observational, prospective US registry of patients with symptomatic newly diagnosed MM. In this study, patients with newly diagnosed MM who completed induction and single ASCT without subsequent consolidation received lenalidomide-only maintenance (n = 180), any maintenance (n = 256), or no maintenance (n = 165). HCRU (hospitalization, surgery/procedures, and concurrent medications [growth factors, bisphosphonates, or neuropathic pain medication]) was assessed starting from 100days post-ASCT for up to 2years. Findings: Although the rates of hospitalization per 100 person-years were similar across groups at the end of years 1 and 2, the median duration of hospitalization was numerically longer with no maintenance. The rates of use of growth factors, bisphosphonates, and neuropathic pain medication were generally similar in all 3 groups. The receipt of any maintenance was associated with significantly reduced use of neuropathic pain medications during year 1. Of note, lenalidomide-only maintenance was associated with significantly longer progression-free survival (54.5vs 30.4 months; hazard ratio [HR] = 0.58; 95% CI, 0.43–0.79; P = 0.0005) and overall survival (OS) (median OS not reached in either group; HR = 0.45; 95% CI, 0.28–0.73; P = 0.001) compared with no maintenance. Likewise, the group treated with any maintenance had significantly longer median progression-free survival (44.7vs 30.4 months; HR = 0.62; 95% CI, 0.47–0.82; P = 0.0008) and OS (median OS not reached in either group; HR = 0.50; 95% CI, 0.33–0.76; P = 0.001) than did the group that did not receive maintenance. Implications: These findings suggest that in this largely community-based study population, post-ASCT maintenance therapy, including lenalidomide-only maintenance, improves clinical outcomes without negatively affecting HCRU. ClinicalTrials.gov identifier: NCT01081028.

AB - Purpose: Maintenance therapy after autologous stem cell transplantation (ASCT) improves clinical outcomes in multiple myeloma (MM), but the effect of continued treatment with lenalidomide-only maintenance, or any maintenance, on health care resource utilization (HCRU) is largely unknown. Methods: Here we present an analysis of HCRU and clinical outcomes in a cohort of patients from the Connect MM registry, the largest, ongoing, observational, prospective US registry of patients with symptomatic newly diagnosed MM. In this study, patients with newly diagnosed MM who completed induction and single ASCT without subsequent consolidation received lenalidomide-only maintenance (n = 180), any maintenance (n = 256), or no maintenance (n = 165). HCRU (hospitalization, surgery/procedures, and concurrent medications [growth factors, bisphosphonates, or neuropathic pain medication]) was assessed starting from 100days post-ASCT for up to 2years. Findings: Although the rates of hospitalization per 100 person-years were similar across groups at the end of years 1 and 2, the median duration of hospitalization was numerically longer with no maintenance. The rates of use of growth factors, bisphosphonates, and neuropathic pain medication were generally similar in all 3 groups. The receipt of any maintenance was associated with significantly reduced use of neuropathic pain medications during year 1. Of note, lenalidomide-only maintenance was associated with significantly longer progression-free survival (54.5vs 30.4 months; hazard ratio [HR] = 0.58; 95% CI, 0.43–0.79; P = 0.0005) and overall survival (OS) (median OS not reached in either group; HR = 0.45; 95% CI, 0.28–0.73; P = 0.001) compared with no maintenance. Likewise, the group treated with any maintenance had significantly longer median progression-free survival (44.7vs 30.4 months; HR = 0.62; 95% CI, 0.47–0.82; P = 0.0008) and OS (median OS not reached in either group; HR = 0.50; 95% CI, 0.33–0.76; P = 0.001) than did the group that did not receive maintenance. Implications: These findings suggest that in this largely community-based study population, post-ASCT maintenance therapy, including lenalidomide-only maintenance, improves clinical outcomes without negatively affecting HCRU. ClinicalTrials.gov identifier: NCT01081028.

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KW - maintenance therapy

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