Longitudinal study of anti-myeloma treatment patterns in a U.S. commercial population before and after approval of bortezomib (BOR).

Abstract

e18533 Background: During the past decade, the IMiDs [thalidomide (THA) and lenalidomide (LEN)] and BOR received FDA approval for multiple myeloma (MM). Our objectives were to characterize treatment patterns before and after introduction of BOR in 6/2003. Methods: This was a retrospective cohort study using enrollment and claims data from a large managed care organization with an annual enrollment ranging from 9-15 million. Patients ≥ 18 years with MM, newly diagnosed between 7/1/2000 and 12/31/2007, and treated with anti-MM therapies were included. Patients were identified by ICD-9-CM diagnosis code and followed from diagnosis to end of continuous enrollment or 12/31/2008. Anti-MM regimens were defined as sequentially administered groups of anti-neoplastic drugs or stem cell transplant (SCT) procedure(s) identified from Rx and medical claims and grouped into mutually exclusive regimens: SCT, BOR, THA, LEN, ALK (melphalan or cyclophosphamide), VIN (vincristine) or STE (≥ 6 weeks of corticosteroids). Results: 2,210 patients were included. The mean age was 59.9 yrs; 44.5% were female. 29.4% and 70.6% were diagnosed pre and post 6/2003. Patients received a mean of 2.16 regimens (med: 2; range 1-18) over 1.68 years of follow up (SD= 1.29). 40.3% of the patients died by the death file cutoff date 2/2009. Regimens most commonly used are shown below (Table). Conclusions: After 6/2003, THA and SCT displaced VIN and ALK as most frequently administered 1st line or 2nd line therapies. BOR and LEN displaced STE and VIN as 3rd line therapy. Line oftherapy Pre 6/2003 Post 6/2003 N % N % 1 650 STE 21.8 ALK 21.4 VIN 18.2 THA 14.9 1,560 THA 26.3 STE 21.8 SCT 13.3 VIN 9.4 2 312 THA 27.2 STE 19.2 VIN 17.9 SCT 12.8 809 THA 27.3 STE 19.4 SCT 12.7 BOR 12.4 3 170 THA 33.5 STE 19.4 SCT 12.9 VIN 10.0 429 THA 23.8 BOR 19.6 STE 14.7 LEN 13.3 Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Merck Merck Merck Merck