Real-world treatment patterns, healthcare use and costs in triple-class exposed relapsed and refractory multiple myeloma patients in the United States

Lay abstract Treatment of multiple myeloma (MM) has evolved rapidly over recent decades, with the introduction of immunomodulatory drugs, proteasome inhibitors and the anti-CD38 monoclonal antibody, daratumumab. Patients who have received these three classes of treatment are termed 'triple-class exposed.' Despite improvements in survival outcomes associated with these treatments, most patients relapse. In this study, US claims data were used to estimate the costs of treating patients with relapsed and refractory MM who are triple-class exposed. The mean monthly cost of treating these patients was estimated as 35,657 US dollars. These findings suggest that there are high healthcare costs and unmet treatment needs in heavily treated MM patients in whom the disease may occur again, and therefore, more effective treatment options are needed for these patients. Aim: To estimate treatment patterns and healthcare costs among triple-class exposed relapsed and refractory multiple myeloma (RRMM) patients. Materials & methods: Eligible patients had >= 1 line of therapy (LOT) each of proteasome inhibitors, immunomodulatory drugs and daratumumab in December 2015-September 2018 and received a new LOT. Results: A total of 154 patients were included with a median follow-up of 6.2 months. Median time from diagnosis to new LOT was 41.0 months. Kaplan-Meier estimate of median time to therapy discontinuation was 4.2 months. Mean per-patient, per-month MM-related costs were 35,657 US dollars. Most frequently observed regimens were lenalidomide or pomalidomide + daratumumab (18.2%), lenalidomide or pomalidomide + proteasome inhibitors (15.6%) and lenalidomide or pomalidomide monotherapy (11.0%). Conclusion: Triple-class exposed RRMM patients receive heterogeneous treatments for a short duration with high healthcare resource utilization and costs.