Section of Hematology, Department of Medicine, Yale School of Medicine, and Yale Cancer Center, Smilow Cancer Hospital, New Haven, CT.
OPEN Health, Bethesda, MD.
Clin Lymphoma Myeloma Leuk. 2022 Sep;22(9):670-679. doi: 10.1016/j.clml.2022.04.016. Epub 2022 Apr 22.
Previous analyses using the SEER-Medicare database have reported substantial underutilization of hypomethylating agents (HMAs) among patients with higher-risk myelodysplastic syndromes (MDS), and an association between poor HMA persistence and high economic burden. We aimed to compare rates of hospitalizations and emergency room (ER) visits among patients with higher-risk MDS according to use or non-use of HMA therapy, and to explore factors associated with early discontinuation of HMA therapy.
We used the 2010-2016 SEER-Medicare database to identify patients aged ≥66 years with a new diagnosis of refractory anemia with excess blasts (RAEB; a surrogate for higher-risk MDS) between 2011 and 2015. New hospitalizations and ER visits during the 12 months following MDS diagnosis were determined. Treatment discontinuation was defined as stopping HMA therapy before 4 cycles.
Overall, 664 (55.8%) patients were HMA users and 526 (44.2%) non-users. Non-users had more hospitalizations (mean 0.47 vs. 0.30, P < .001) and ER visits (mean 0.69 vs. 0.41, P = .005) per month than HMA users. Among HMA users, 193 (29.1%) discontinued HMA therapy before 4 cycles, and 91 (47.2%) of these after 1 cycle. Older age and poor performance status were associated with higher risk of HMA discontinuation.
An increased rate of hospitalizations and ER visits occurred in HMA non-users vs. HMA users. Approximately one-third of patients discontinued HMA therapy early. Predictors of discontinuation included older age and poor performance status. Novel approaches are needed to improve utilization and persistence with HMA therapy and associated outcomes, particularly among these higher-risk groups.
利用 SEER-Medicare 数据库进行的先前分析报告称，高危骨髓增生异常综合征（MDS）患者中低甲基化剂（HMAs）的使用率较低，且 HMAs 维持率差与经济负担高之间存在关联。我们旨在比较高危 MDS 患者根据是否使用 HMAs 治疗的住院率和急诊室（ER）就诊率，并探讨与 HMAs 治疗早期停药相关的因素。
我们使用 2010-2016 年 SEER-Medicare 数据库，于 2011 年至 2015 年期间，确定新诊断为难治性贫血伴原始细胞过多（RAEB；高危 MDS 的替代指标）且年龄≥66 岁的患者。确定 MDS 诊断后 12 个月内的新住院和 ER 就诊。治疗停药定义为在 4 个周期前停止 HMAs 治疗。
总体而言，664 例（55.8%）患者为 HMAs 使用者，526 例（44.2%）为非使用者。与 HMAs 使用者相比，非使用者每月的住院（平均 0.47 次 vs. 0.30 次，P <.001）和 ER 就诊（平均 0.69 次 vs. 0.41 次，P = .005）次数更多。在 HMAs 使用者中，193 例（29.1%）在 4 个周期前停止 HMAs 治疗，其中 91 例（47.2%）在 1 个周期后停止治疗。年龄较大和较差的表现状态与 HMAs 停药风险较高相关。
与 HMAs 使用者相比，HMAs 非使用者的住院和 ER 就诊率增加。约有三分之一的患者早期停止 HMAs 治疗。停药的预测因素包括年龄较大和较差的表现状态。需要采取新的方法来提高 HMAs 治疗的使用率和维持率，改善相关结局，尤其是在这些高危人群中。
