Racial Disparities Noted in Treatment With Bone-Modifying Agents Among Patients With Multiple Myeloma

Substantial racial disparities in treatment with bone-modifying agents (BMAs) appear to exist among patients with newly diagnosed multiple myeloma (MM), according to research presented at the AACR Annual Meeting 2022.

“BMAs reduce the frequency of fractures and skeletal-related pain, and some evidence suggests that more recently approved — and more expensive — agents (ie, denosumab) confer greater progression-free and overall survival benefits than older agents (ie, bisphosphonates),” the authors stated in their presentation.

To evaluate racial disparities in the initiation of BMAs and uptake of denosumab among patients with newly diagnosed MM, the researchers conducted a retrospective cohort study using the nationwide Flatiron Health electronic health record-derived de-identified database.

Their analyses included adults (18 years or older) with newly diagnosed MM who initiated first-line therapy between January 2018 and September 2021. The research team estimated the initiation of BMAs within 90 days before the start of first-line MM therapy and 30 days post-therapy, while accounting for competing risks, and evaluated the association of patient race with differences in the receipt of denosumab vs bisphosphonates alone (zoledronic acid or pamidronate) among patients who initiated BMAs.

Among 4460 patients with newly diagnosed MM, 52% were White, 17% were Black, 7% were Latinx, and 2% were Asian. Approximately 50% of patients initiated BMA treatment. Rates of BMA initiation differed across racial groups. Higher rates were observed among Asian (55%), White (51%), and Latinx (50%) patients compared with Black patients (44%; P =.023).

Among those who initiated BMAs, 53% received denosumab, while 47% received bisphosphonates alone. In a model adjusted for demographic and clinical characteristics, Black (OR, 1.14; 95% CI, 0.88-1.48; P =.30) and Asian (OR 0.85, 95% CI 0.45-1.59; P =.60) patients had similar odds of receiving denosumab as White patients. Latinx patients (OR, 0.55; 95% CI, 0.39-0.79; P <.01) and patients of other/unknown race (OR, 0.74; 95% CI, 0.59-0.93; P =.01) had significantly lower odds of receiving denosumab than White patients.

The researchers suggested that future studies should use real-world data to determine whether these treatment disparities impact progression-free survival and overall survival among MM patients and whether the disparities are driven by clinical characteristics or inequitable prescribing practices and the costs of BMAs.

Limitations of the study included the lack of important variables and potential care not documented in in the database, including the presence of comorbidities; missing data; loss to follow up and disparate capture of BMA receipt; and self-reporting for certain variables.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Guadamuz JS, Rohrer R, Mohyuddin GR, et al. Racial/ethnic disparities in treatment with bone-modifying agents among newly diagnosed multiple myeloma patients. Presented at AACR 2022; April 8-13, 2022. Abstract 3669/8.

This article originally appeared on Hematology Advisor