Comparative efficacy of treatments for previously treated multiple myeloma

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Multiple myeloma (MM) is an incurable cancer of the bone marrow. It is the third-most-frequent blood cancer in the US, after lymphoma and leukemia. Several new therapies have recently been approved by the United States Food and Drug Administration (FDA) for treatment of MM, including daratumumab, a human IgGκ monoclonal anti -CD38 antibody. Daratumumab was approved in November 2016 by the FDA for use in combination with bortezomib plus dexamethasone and in combination with lenalidomide plus dexamethasone for treatment in patients with at least one prior line of therapy (previously treated MM).  
Therapy Comparisons

To compare daratumumab combination therapy to other MM therapies not studied in head-to-head trials, we first identified publications of randomized clinical trials (RCTs) investigating the clinical efficacy of MM therapies in patients with previously treated MM. Based on the identified publications, we then used network meta-analysis (NMA) methods to indirectly compare the therapies.  
In the NMA, we found that daratumumab, used with bortezomib plus dexamethasone or lenalidomide plus dexamethasone, significantly lowers the risk of disease progression or death in patients with previously treated MM compared to other therapies. Further, these combinations resulted in a higher overall response rate in this group. For treating first relapse, daratumumab-based regimens demonstrated significantly improved progression-free survival. 
First of Its Kind Study

This study is unique in that, to our knowledge, it is the first to include an analysis of patients treated for first relapse. It encompasses progression-free survival, and overall response rate, and provides indirect evidence on the comparative efficacy of new MM therapies. This information can aid physicians and patients in their treatment decision making. 


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