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Abstracts
P027
Exploring Barriers to Bone-Targeted Agent Initiation in Multiple Myeloma
Introduction:
Skeletal-related events (SREs) are common among patients with Multiple Myeloma (MM), causing increased disease burden and mortality. Bisphosphonates and denosumab are successful in the prevention and reduction of SREs; however, these medications were historically recommended for patients with evidence of lytic lesions. International guidelines now suggest starting all patients on bone-targeted agents following a diagnosis of MM, regardless of the presence of lytic lesions in imaging.2 Despite their proven efficacy, the initiation of these therapies is often delayed and many MM patients are never prescribed a bone-targeted agent.
Methods:
The objective of this study was to investigate the rationale for the delay or non-initiation of bone-targeted agents in patients with MM. We conducted a retrospective chart review through the University of Pennsylvania EPIC system, screening all patients with for MM who attended the Pennsylvania Hospital (PAH) since 2012. 141 charts met inclusion criteria. Patients involved in bone-targeted agent clinical trials, patients who only attended PAH for a second opinion, and patients who were followed outside of PAH were excluded from the analysis. As a secondary outcome, we investigated the occurrence of SREs after initiation of zoledronic acid compared to denosumab.
Results:
70% (98) of patients were placed on bone-targeted agents during their treatment; with 81% (79) of these patients beginning the treatment within four months of diagnosis and 19% (19) having a delayed initiation. The most common reasons for the delay were; awaiting dental clearance (4), patients being on active observation without any MM treatment (4), and physicians waiting for progression of bone disease (4).
54% (35) of patients on zoledronic acid suffered an SRE after being placed on the medication compared to 31% (4) of patients on denosumab. 19% (8) of patients who were never placed on a bone-targeted agent suffered an SRE.
Skeletal-related events (SREs) are common among patients with Multiple Myeloma (MM), causing increased disease burden and mortality. Bisphosphonates and denosumab are successful in the prevention and reduction of SREs; however, these medications were historically recommended for patients with evidence of lytic lesions. International guidelines now suggest starting all patients on bone-targeted agents following a diagnosis of MM, regardless of the presence of lytic lesions in imaging.2 Despite their proven efficacy, the initiation of these therapies is often delayed and many MM patients are never prescribed a bone-targeted agent.
Methods:
The objective of this study was to investigate the rationale for the delay or non-initiation of bone-targeted agents in patients with MM. We conducted a retrospective chart review through the University of Pennsylvania EPIC system, screening all patients with for MM who attended the Pennsylvania Hospital (PAH) since 2012. 141 charts met inclusion criteria. Patients involved in bone-targeted agent clinical trials, patients who only attended PAH for a second opinion, and patients who were followed outside of PAH were excluded from the analysis. As a secondary outcome, we investigated the occurrence of SREs after initiation of zoledronic acid compared to denosumab.
Results:
70% (98) of patients were placed on bone-targeted agents during their treatment; with 81% (79) of these patients beginning the treatment within four months of diagnosis and 19% (19) having a delayed initiation. The most common reasons for the delay were; awaiting dental clearance (4), patients being on active observation without any MM treatment (4), and physicians waiting for progression of bone disease (4).
54% (35) of patients on zoledronic acid suffered an SRE after being placed on the medication compared to 31% (4) of patients on denosumab. 19% (8) of patients who were never placed on a bone-targeted agent suffered an SRE.
Publisher
John Wiley & Sons; Hoboken, USA
Source Journal
American Journal of Hematology
2022 Wiley Periodicals LLC.
