PMID- 32154922
OWN - NLM
STAT- MEDLINE
DCOM- 20210408
LR  - 20210408
IS  - 1097-0142 (Electronic)
IS  - 0008-543X (Linking)
VI  - 126
IP  - 12
DP  - 2020 Jun 15
TI  - Association of adverse events and associated cost with efficacy for approved 
      relapsed and/or refractory multiple myeloma regimens: A Bayesian network 
      meta-analysis of phase 3 randomized controlled trials.
PG  - 2791-2801
LID - 10.1002/cncr.32831 [doi]
AB  - BACKGROUND: Several new treatment options have been approved for relapsed and/or 
      refractory multiple myeloma (RRMM). In this systematic review, associations of 
      the efficacy of each approved regimen with adverse events (AEs) and the total 
      cost per cycle were compared with a Bayesian network meta-analysis (NMA) of phase 
      3 randomized controlled trials (RCTs). METHODS: Scopus, Cochrane, PubMed 
      Publisher, and Web of Science were searched from January 1999 to July 2018 for 
      phase 3 RCTs of regimens (approved by the US Food and Drug Administration) used 
      in RRMM. The relative ranking of agents was assessed with surface under the 
      cumulative ranking (SUCRA) probabilities. The primary efficacy, safety, and cost 
      outcomes were progression-free survival with the regimen, grade 3 to 4 AEs, and 
      the total cost per cycle (regimen cost plus average cost of managing AEs). 
      RESULTS: Fifteen studies including 7718 patients and evaluating 14 different 
      regimens were identified. Daratumumab, lenalidomide, and dexamethasone were 
      ranked highest for reducing progression (hazard ratio, 0.13; 95% credible 
      interval, 0.09-0.19; SUCRA, 1) but carried the highest probability of total cost 
      per cycle ($41,420; 95% Credible Interval [CrCl], $58,665-$78,041; SUCRA, 0.02). 
      Panobinostat, bortezomib, and dexamethasone were the least effective and least 
      safe (SUCRA, 0.24), whereas bortezomib, thalidomide, and dexamethasone emerged as 
      least effective with the highest total cost per cycle (SUCRA, 0.33). Carfilzomib 
      and dexamethasone emerged as the winner when this regimen was considered in terms 
      of efficacy and safety (SUCRA, 0.61) and efficacy and total cost per cycle 
      (SUCRA, 0.60). CONCLUSIONS: The results of this NMA can provide additional 
      guidance for the decision-making process when one is choosing the most 
      appropriate regimen for RRMM.
CI  - (c) 2020 American Cancer Society.
FAU - Dhakal, Binod
AU  - Dhakal B
AUID- ORCID: 0000-0002-4377-9742
AD  - Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, 
      Wisconsin.
FAU - Narra, Ravi K
AU  - Narra RK
AD  - Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, 
      Wisconsin.
FAU - Giri, Smith
AU  - Giri S
AD  - Division of Hematology/Oncology, Yale University, New Haven, Connecticut.
FAU - Szabo, Aniko
AU  - Szabo A
AD  - Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
FAU - Smunt, Timothy L
AU  - Smunt TL
AD  - Sheldon B. Lubar School of Business, University of Wisconsin Milwaukee, 
      Milwaukee, Wisconsin.
FAU - Ghose, Sanjoy
AU  - Ghose S
AD  - Sheldon B. Lubar School of Business, University of Wisconsin Milwaukee, 
      Milwaukee, Wisconsin.
FAU - Pathak, Lakshmi Kant
AU  - Pathak LK
AD  - Division of Nephrology, University of Illinois Chicago, Chicago, Illinois.
FAU - Aryal, Madan
AU  - Aryal M
AD  - Division of Hematology/Oncology, Roswell Park, Buffalo, New York.
FAU - Hamadani, Mehdi
AU  - Hamadani M
AUID- ORCID: 0000-0001-5372-510X
AD  - Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, 
      Wisconsin.
FAU - Chhabra, Saurabh
AU  - Chhabra S
AD  - Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, 
      Wisconsin.
FAU - Janz, Siegfried
AU  - Janz S
AD  - Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, 
      Wisconsin.
FAU - D'Souza, Anita
AU  - D'Souza A
AUID- ORCID: 0000-0002-1092-5643
AD  - Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, 
      Wisconsin.
FAU - Hari, Parameswaran N
AU  - Hari PN
AD  - Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, 
      Wisconsin.
LA  - eng
GR  - R01 CA151354/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20200310
PL  - United States
TA  - Cancer
JT  - Cancer
JID - 0374236
RN  - 0 (Oligopeptides)
RN  - 4Z8R6ORS6L (Thalidomide)
RN  - 69G8BD63PP (Bortezomib)
RN  - 72X6E3J5AR (carfilzomib)
RN  - 7S5I7G3JQL (Dexamethasone)
RN  - F0P408N6V4 (Lenalidomide)
SB  - IM
MH  - Antineoplastic Combined Chemotherapy Protocols/*adverse 
      effects/*economics/*therapeutic use
MH  - Bayes Theorem
MH  - Bortezomib/administration & dosage/economics
MH  - Clinical Trials, Phase III as Topic
MH  - Dexamethasone/administration & dosage/economics
MH  - Drug Costs
MH  - Humans
MH  - Lenalidomide/administration & dosage/economics
MH  - Multiple Myeloma/*drug therapy/mortality/pathology
MH  - Oligopeptides/administration & dosage/economics
MH  - Progression-Free Survival
MH  - Randomized Controlled Trials as Topic
MH  - Thalidomide/administration & dosage/economics
MH  - Treatment Outcome
OTO - NOTNLM
OT  - adverse events
OT  - relapsed and/or refractory multiple myeloma
OT  - total cost per cycle
EDAT- 2020/03/11 06:00
MHDA- 2021/04/10 06:00
CRDT- 2020/03/11 06:00
PHST- 2019/10/18 00:00 [received]
PHST- 2020/02/10 00:00 [revised]
PHST- 2020/02/13 00:00 [accepted]
PHST- 2020/03/11 06:00 [pubmed]
PHST- 2021/04/10 06:00 [medline]
PHST- 2020/03/11 06:00 [entrez]
AID - 10.1002/cncr.32831 [doi]
PST - ppublish
SO  - Cancer. 2020 Jun 15;126(12):2791-2801. doi: 10.1002/cncr.32831. Epub 2020 Mar 10.