Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Analysis Group, Inc., Montreal, QC, Canada.
Medicine (Baltimore). 2024 Jun 28;103(26):e38609. doi: 10.1097/MD.0000000000038609.
Evidence on real-world clinical and economic outcomes in patients with multiple myeloma (MM) and renal impairment (RI) is limited in the United States. This retrospective study aimed to generate an updated comprehensive assessment of the clinical and economic outcomes of MM patients with RI using the Medicare research identifiable files data with Part D linkage, which might assist in assessing the total clinical and socioeconomic burden of these high-risk and challenging-to-treat patients. Treatment patterns and clinical and economic outcomes in first line (1L) to fourth line (4L) therapy were described in Medicare beneficiaries (2012 to 2018) for MM patients with RI (RI MM cohort). For reference purposes, information on a general cohort of MM patients was generated and reported to highlight the clinical and economic burden of RI. Since the goal was to describe the burden of these patients, this study was not designed as a comparison between the 2 cohorts. Compared with the general MM cohort (n = 13,573), RI MM patients (24.9%) presented high MM-associated comorbidities. In the RI MM cohort, bortezomib-dexamethasone (45.7%), bortezomib-lenalidomide (18.6%), lenalidomide (12.3%), and bortezomib-cyclophosphamide (12.1%) were the most prevalent regimens in 1L; carfilzomib and pomalidomide were mostly received in 3L to 4L; and daratumumab in 4L. Across 1L to 4L, the RI MM cohort presented shorter median real-world progression-free survival (1L: 12.9 and 16.4 months) and overall survival (1L: 31.1 and 46.8 months) and higher all-cause healthcare resource utilization (1L incidence rate of inpatient days: 12.1 and 7.8 per person per year) than the general MM cohort. In the RI MM cohort, the mean all-cause total cost increased from 1L to 4L ($14,549-$18,667 per person per month) and was higher than that of the general MM cohort. RI MM patients presented higher clinical and economic burdens across 1L to 4L than the general MM patients in real-world clinical practice.
在美国，关于患有多发性骨髓瘤（MM）和肾功能不全（RI）的患者的真实临床和经济结果的证据有限。本回顾性研究旨在利用医疗保险研究可识别文件数据和 Part D 链接，对 RI 患者的 MM 患者的临床和经济结果进行最新的综合评估，这可能有助于评估这些高风险和治疗挑战性患者的总体临床和社会经济负担。在医疗保险受益人群中（2012 年至 2018 年）描述了 RI 患者的一线（1L）至四线（4L）治疗的治疗模式以及临床和经济结果（RI MM 队列）。出于参考目的，生成并报告了一般 MM 患者队列的信息，以突出 RI 的临床和经济负担。由于研究目的是描述这些患者的负担，因此本研究未设计为两个队列之间的比较。与一般 MM 队列（n = 13573）相比，RI MM 患者（24.9%）存在高 MM 相关合并症。在 RI MM 队列中，硼替佐米-地塞米松（45.7%）、硼替佐米-来那度胺（18.6%）、来那度胺（12.3%）和硼替佐米-环磷酰胺（12.1%）是 1L 中最常见的方案；卡非佐米和泊马度胺主要在 3L 至 4L 中使用；而达雷妥尤单抗在 4L 中使用。在 1L 至 4L 中，RI MM 队列的中位真实无进展生存期（1L：12.9 和 16.4 个月）和总生存期（1L：31.1 和 46.8 个月）较短，全因医疗资源利用率较高（1L 住院天数发生率：12.1 和 7.8 人/年），高于一般 MM 队列。在 RI MM 队列中，全因总费用从 1L 增加到 4L（每人每月 14549-18667 美元），高于一般 MM 队列。在真实世界的临床实践中，RI MM 患者在 1L 至 4L 中表现出更高的临床和经济负担，高于一般 MM 患者。
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