Treatment of relapsed refractory multiple myeloma: which new PI-based combination treatments do patients prefer?

• Published in: Patient preference and adherence 2018-01, Vol.12, p.2387-2396
• Main Authors: Wilke, Thomas, Mueller, Sabrina, Bauer, Sabine, Pitura, Silvia, Probst, Leona, Ratsch, Boris A, Salwender, Hans
• Format: Article
• Language: English
• Subjects: Analysis; Care and treatment; Carfilzomib; DCE; Development and progression; Dexamethasone; discrete choice experiment; Diseases; Glucocorticoids; Heart failure; Ixazomib; Lenalidomide; MM patient’s treatment preferences; Multiple myeloma; Original Research; Patient compliance; Recurrence (Disease); relapsed refractory multiple myeloma (RRMM); Time; Women's health
• ISSN: 1177-889X; 1177-889X
• DOI: 10.2147/PPA.S183187

This study describes preferences of German relapsed refractory multiple myeloma (RRMM) patients with novel proteasome inhibitor-based combination treatments. Patients with a minimum age of 18 years and a diagnosis of RRMM were included. Their preferences were assessed using a discrete choice experiment design, which was developed based on a literature review and two patient focus group discussions. The final discrete choice experiment design consisted of four attributes, namely "therapy application regimen," "time without progression of disease," "possibility of grade ≥3 adverse events (AEs) affecting the blood," and "possibility of grade ≥3 AE heart failure." Analysis was based on 84 patients (36.9% females, mean age 62.7 years, mean multiple myeloma disease duration 5.5 years). Among the tested attributes, "therapy application regimen" was assigned the highest importance for treatment decisions (38.8%), the second important attribute was "time without progression of disease" (38.7%), followed by "possibility of AE heart failure" (13.9%) and "possibility of AEs affecting the blood" (8.6%). Patients preferred oral intake once a day and once a week over other application modes such as oral intake once a day and once a week plus twice-weekly infusions. Furthermore, they preferred longer disease progression-free time and lower risk of grade ≥3 AEs. The highest overall utility was derived for ixazomib + lenalidomide + dexamethasone (utility: 3.218), compared with lenalidomide + dexamethasone (2.769), and carfilzomib + lenalidomide + dexamethasone (1.928). RRMM patients prefer treatments with an all-oral application, a longer disease-progression-free time, and a lower probability of AEs. If patients face tradeoffs, they accept a lower progression-free time and/or higher AE rates to get an all-oral therapy.