Abstract
BackgroundSeveral bone-targeted agents (BTAs) are available for preventing skeletal-related events (SREs), but they vary in terms of efficacy, safety and mode of administration. This study assessed data on European physicians’ treatment preferences for preventing SREs in patients with bone metastases from solid tumours.MethodsPhysicians completed a web-based discrete-choice experiment survey of 10 choices between pairs of profiles of hypothetical BTAs for a putative patient. Each profile included five attributes within a pre-defined range (primarily based on existing BTAs’ prescribing information): time (months) until the first SRE; time (months) until worsening of pain; annual risk of osteonecrosis of the jaw (ONJ); annual risk of renal impairment; and mode of administration. Choice questions were developed using an experimental design with known statistical properties. A separate main-effects random parameters logit model was estimated for each country and provided the relative preference for the treatment attributes in the study.ResultsA total of 191 physicians in France, 192 physicians in Germany, and 197 physicians in the United Kingdom completed the survey. In France and the United Kingdom, time until the first SRE and risk of renal impairment were the most important attributes; in Germany, time until the first SRE and delay in worsening of pain were the most important. In all countries, a 120-min infusion every 4 weeks was the least preferred mode of administration (p < 0.05) and the annual risk of ONJ was judged to be the least important attribute.ConclusionsWhen making treatment decisions regarding the choice of BTA, delaying the onset of SREs/worsening of pain and reducing the risk of renal impairment are the primary objectives for physicians.
Highlights
Several bone-targeted agents (BTAs) are available for preventing skeletal-related events (SREs), but they vary in terms of efficacy, safety and mode of administration
Several BTAs are approved for use in the European Union (EU) to prevent SREs in patients with bone metastases secondary to solid tumours; the majority of BTAs are bisphosphonates
Zoledronic acid is the only agent approved for use in patients with all solid tumours and is considered by many to be the gold standard; placebo-controlled phase 3 studies show that treatment with zoledronic acid delays time to a SRE by up to 5.6 months in patients with cancer and bone metastases [7, 15]
Summary
Several bone-targeted agents (BTAs) are available for preventing skeletal-related events (SREs), but they vary in terms of efficacy, safety and mode of administration. Several BTAs are approved for use in the European Union (EU) to prevent SREs in patients with bone metastases secondary to solid tumours; the majority of BTAs are bisphosphonates (ibandronate, clodronate, pamidronate and zoledronic acid). Zoledronic acid is the only agent approved for use in patients with all solid tumours and is considered by many to be the gold standard; placebo-controlled phase 3 studies show that treatment with zoledronic acid delays time to a SRE by up to 5.6 months in patients with cancer and bone metastases [7, 15]. In contrast to bisphosphonates, denosumab can be used without dose adjustment in patients with severe renal disease Both bisphosphonates and denosumab are associated with a risk of osteonecrosis of the jaw (ONJ); in the integrated analysis of zoledronic acid versus denosumab, the incidence was 1.3 and 1.8%, respectively [23]. In addition to preventing SREs, bisphosphonates and denosumab have been shown to improve bone pain related outcomes, with denosumab delaying onset and increases in pain by considerably longer than zoledronic acid [17,18,19,20, 25]
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