Impact of skeletal-related events on multiple myeloma treatment.

Abstract

e20009 Background: Skeletal-related events (SREs), sequelae of bone lesions, are common and devastating complications in patients with multiple myeloma (MM).This study assessed the impact of SREs on progress to Next line of anti-MM Therapy (NT), a proxy for disease progression. Methods: In this retrospective cohort study, adults with ≥1 inpatient or ≥2 outpatient MM diagnoses claims between 01/01/2010 and 03/31/2016 were identified from the Truven Health MarketScan Commercial and Medicare databases. The index date was the first anti-MM treatment date post-MM diagnosis. All patients had ≥6-months of continuous enrollment pre- and post-index. SREs were identified during 6 month pre-index period and during first anti-MM treatment post-index. The impact of SREs on progress to NT was assessed, using Cox proportional hazard regression analysis, with occurrence of post-index SREs and renal impairment as time-varying covariates. Results: A total of 5,580 patients met the study criteria, 1,362 (24.4%) of them had SREs pre-index. A total of 1,175 (21.1%) patients experienced SREs during first anti-MM treatment post-index [mean age: 64.3 (±11.8) years, mean Charlson Comorbidity Index score: 3.9 (±2.6), opioid use: 80.4%]. Occurrence of post-index SREs was significantly associated with NT [Hazard ratio (HR): 1.25 {95% confidence interval (CI): 1.13-1.37}] (Table 1). Conclusions: Occurrence of post-index SREs was significantly associated with 25% higher likelihood of progressing to next line of anti-MM therapy, suggesting that SREs may indicate disease worsening in patients with MM. Table 1: Impact of Skeletal-Related Events (SREs) on Progress to Next Line of Therapy in Multiple Myeloma: Cox Proportional Hazard Regression Model Results Patient Characteristics Hazard Ratios (95% Confidence Interval) P-values Post-index SREs 1.25 (1.13-1.37) < 0.0001 Pre-index SREs 0.96 (0.87-1.07) 0.4787 Pre-index Renal impairment 0.83 (0.73-0.95) 0.0050 Post-index Renal Impairment 1.05 (0.95-1.17) 0.3354 Bone lesion 1.14 (1.04-1.25) 0.0066 Hypercalcemia 1.30 (1.15-1.46) < 0.0001 The model was adjusted for age, gender, health plan type, index year, region, comorbidity score, osteoporosis, use of intravenous bisphosphonates, corticosteroids, and opioids