(315) Treatments of multiple myeloma in Europe from 2012 to 2022: a population-based network cohort study

Background: Insights into therapies for treating Multiple Myeloma (MM) hold regulatory significance. However, the rarity of MM poses challenges in understanding the diverse therapies patients receive across Europe.

Objectives: To describe MM treatments between 2012-2022 across Europe.

Methods: Population-based cohort study in routinely collected health data from 4 databases: Institut Municipal Assistencia Sanitaria Information System (IMASIS), Spain; Estonian Biobank (EBB); Clinical Data Warehouse of Bordeaux University Hospital (CDWBordeaux), France; and the Netherlands Cancer Registry (NCR). The study population included all individuals with a first diagnosis of MM between 2012 and 2022. Individuals were required to have a minimum follow-up of 30 days after diagnosis and no prior history of cancer (excluding non-melanoma skin cancer). The main outcomes were therapies initiated based on a list of 32 pre-specified MM treatments. The number of patients receiving each of the pre-specified MM treatments at index date or within 30, 90 and/or 365 after diagnosis were described. All analyses were reported by database, and stratified by age, sex, and study periods (2012-2017 and 2018-2022).

Results: 13,258 individuals with MM were identified (CDWBordeaux: 1,587, EBB: 107, IMASIS: 275, NCR:11,289), along with 18 MM treatments. The most frequently used class of treatments within a year of diagnosis were glucocorticoids (50% to 63%), proteasome inhibitors (PIs; 46% to 57%), and chemotherapies (18% to 46%), followed by immunomodulatory agents (IMiDs; 2% to 35%) and monoclonal antibodies (5% to 17%). Use of treatments were similar by sex but varied across age groups. In particular, IMiDs and PIs were consistently used less in older individuals. In CDWBordeaux, those aged >70 were less frequently treated with chemotherapies, with contrasting results in NCR.
Treatment sequences were only described in CDWBordeaux. The most common sequences of treatment were Melphalan alone (27%), Dexamethasone-Thalidomide-Bortezomib-Cyclophosphamide-Melphalan (7%), Daratumumab alone (6%), and Prednisone-Melphalan-Bortezomib (5%). Treatment sequences varied by age group and study period. Further results can be explored at: https://data-dev.darwin-eu.org/EUPAS105033/.

Conclusions: The most frequently used treatments for MM were glucocorticoids and PIs. We found heterogeneity in treatment and treatment sequences by age group and data sources. Evidence from data sources with second-line therapies are needed to complement results surrounding treatment sequences for MM.