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Treatment outcomes, health-care resource utilization and costs of bortezomib and dexamethasone, with cyclophosphamide or lenalidomide, in newly diagnosed multiple myeloma

Leukemia volume 30, pages 995–998 (2016)Cite this article

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The introduction of proteasome inhibitors and immunomodulatory drugs has led to significant survival improvements in multiple myeloma (MM).1, 2 Two of the most commonly used regimens for initial MM therapy are bortezomib/dexamethasone plus either cyclophosphamide (VCD) or lenalidomide (VRD).3 Although not compared head-to-head, phase-2 trials' results support the use of either regimen for newly diagnosed MM.4, 5, 6, 7 Although more efficacious than previous classes, these drugs are associated with substantial cost.8, 9, 10 In an era focusing on value of care and efficient resource allocation, use of VCD may lower costs by employing only one novel drug, ‘reserving’ lenalidomide for subsequent line(s) of therapy. This is particularly relevant for MM where no curative treatments exist, and all available therapies may be used along the care continuum. A paucity of comparative effectiveness research on VCD and VRD as initial therapies for MM exists, thus we designed this retrospective, non-interventional, observational cohort study to compare clinical outcomes, health-care resource utilization and total health-care costs of VCD and VRD as initial MM treatment in the US clinical setting.

Medical charts of a random sample of 176 newly diagnosed MM patients who initiated VCD or VRD at Mayo Clinic, Rochester, or within the US Oncology Network in January 2008–August 2013 were studied. Patients with ⩾2 clinic visits and ⩾6 months’ follow-up from VCD/VRD initiation of initial therapy were included; those treated in clinical trials were excluded. Study was conducted as per the Helsinki Declaration, with Institutional Review Board approvals.

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Acknowledgements

The authors would like to thank Mark Yap and Shanmugapriya Saravanan of McKesson Specialty Health for their support with data collection for this analysis. The authors would also like to thank Iwen Pan of McKesson Specialty Health, Rahul Dhanda, formerly of McKesson Specialty Health, and Abbie Ba-Mancini of Millennium Pharmaceuticals, Inc, Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, for their input into the study design and preliminary analysis. The authors would like to acknowledge Steve Hill of FireKite, an Ashfield company, part of UDG Healthcare plc, for writing support during the development of this manuscript, which was funded by Millennium Pharmaceuticals Inc and complied with Good Publication Practice 2 ethical guidelines (Graf et al., BMJ 2009). This research was sponsored by Millennium Pharmaceuticals, Inc, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited.

Author contributions

SKK and EM designed the research. SKK, AEE, FKB, MQL, AD, MSD, M-HL, PL, WYC, KD, DR, DP and SVR performed the research. EM, AEE, MSD, M-HL, PL, WYC, KD, DR and DP collected data. MSD, M-HL, PL, WYC and KD performed statistical analysis. SKK, EM, MSD, M-HL, PL, WYC, KD, DR, DP, LN and MQ analyzed and interpreted data. SKK and EM wrote the manuscript. All authors reviewed and revised the draft manuscript, and reviewed and approved the final version for submission.

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Authors and Affiliations

  1. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    S K Kumar, A E Engebretson, F K Buadi, M Q Lacy, A Dispenzieri & S V Rajkumar

  2. Millennium Pharmaceuticals Inc, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA

    E Ma, L Niculescu & M Quick

  3. Analysis Group, Inc, Boston, MA, USA

    M S Duh, M-H Lafeuille & W Y Cheng

  4. Groupe d’analyse, Ltée, Montreal, QC, Canada

    P Lefebvre & K Dea

  5. McKesson Specialty Health, The Woodlands, TX, USA

    D Rembert & D Patt

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Corresponding author

Correspondence to S K Kumar.

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Competing interests

Dr Kumar has acted as a consultant for Merck, Celgene, Millennium Pharmaceuticals, Inc and Onyx; and has received research funding from Millennium Pharmaceuticals, Inc, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Celgene, Novartis, Genzyme, Onyx and Cephalon. Ms Ma, Dr Niculescu and Dr Quick are employees of Millennium Pharmaceuticals, Inc. Dr Lacy has received research funding from Celgene Corporation. Dr Dispenzieri has received research funding from Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Pfizer, Celgene Corporation and Janssen. Dr Duh, Ms Lafeuille, Mr Lefebvre, Ms Cheng and Ms Dea have received research funding from Millennium Pharmaceuticals, Inc, via engagement with employer Analysis Group Inc. Dr Rembert and Dr Patt are employees of McKesson Specialty Health Ms Engebretson, Dr Buadi and Dr Rajkumar declare no conflict of interest.

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Kumar, S., Ma, E., Engebretson, A. et al. Treatment outcomes, health-care resource utilization and costs of bortezomib and dexamethasone, with cyclophosphamide or lenalidomide, in newly diagnosed multiple myeloma. Leukemia 30, 995–998 (2016). https://doi.org/10.1038/leu.2015.225

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