Therapy of multiple myeloma (MM) is based on proteasome inhibitors (PIs) and immunomodulatory agents (IMiDs) used alone or in combination. Bortezomib, Thalidomide and Lenalidomide are approved in Europe but national differences in terms of reimbursement policies may determine their diverse use in MM treatment algorithm.
Anonymized MM patient level data collected through a large cross-sectional survey between April to December 2017 in EU5 (France, Germany, Italy, Spain & UK) was used.
2472 patients (pts) were included in this study. In pts ≤65 years of age, PIs were largely used in first line across all countries (94% pts) followed by IMiDs (77% pts) with the exclusion of Germany (15% pts) where IMiDs were largely replaced by alkylating agents (78%). In second line, IMiDs were generally the drug of choice across most countries (90% pts) with the exclusion of the UK (36% pts). Opposite picture was observed for PIs: 73% of UK pts received these, whilst only 24% pts in Spain. In pts >65 years in first line, PIs were mostly used (70% pts) whilst IMiDs were only used in 35% pts. The use of alkylating agents varied from 32% (Germany) to 63% pts (France). In second line PIs ranged from 12% in France to 64% in the UK where IMiDs were less used (45%) compared to other countries. Irrespective of age, third line treatment was largely based on IMiDs. In Spain and Germany 1/3 of pts had access to monoclonal antibodies. Interestingly, bone protection treatment (99% bisphosphonate) was administered to 66% of pts in the UK, 52% in Germany and 42% in Spain, but only 24% in Italy and 22% in France.
IMiDs are the most used class of drug to treat MM as single agent or in combination irrespectively from line of treatment even if in Germany their use is less common as first line. PIs are used particularly in first line with the exception of the UK where they are common part of second line treatment. Further analyses to determine the impact on progression-free survival of the different treatment algorithms by country are needed.
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Has not received any funding.
A. Rocci: Honoraria: Takeda, Sanofi, Celgene, Novartis, Amgen, Janssen; Advisory boards: Novartis, Janssen, Amgen. All other authors have declared no conflicts of interest.