Race, age linked to delayed treatment with oral antimyeloma therapies
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Key takeaways:
- Black race and older age appeared linked to delayed initiation of oral antimyeloma therapy.
- Researchers observed no link between treatment delays and insurance type or area deprivation index.
The timing with which patients with newly diagnosed multiple myeloma began treatment with oral antimyeloma medications varied greatly by age and race, according to retrospective study results.
Black individuals and older adults appeared significantly less likely to fill prescriptions for oral antimyeloma medications within 30 days of diagnosis.
“There has been considerable improvement in the OS of patients with multiple myeloma over the past 2 decades thanks to major advances in treatment,” Hamlet Gasoyan, PhD, assistant professor of medicine at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, told Healio. “This makes it even more important to examine and address the barriers to timely treatment initiation.”
Prior studies showed initiation of treatment with any systemic antimyeloma treatment varied by race, sex and treatment setting.
However, evidence is limited regarding how factors like demographic characteristics or insurance status may affect time to treatment initiation with more expensive oral antimyeloma medications.
Gasoyan and colleagues used a Taussig Cancer Center registry to identify 720 adults (mean age at diagnosis, 67 years; 55% men; 77% white; 22% Black) diagnosed with multiple myeloma from 2017 through 2021. More than one-third (36%) had private insurance, 29% had Medicare, 25% had Medicaid Advantage and 8.3% had Medicaid.
More than a third (37%) lived in an area categorized in the most disadvantaged area deprivation index quartile.
Time from diagnosis to initial prescription fill for an FDA-approved oral medication served as the primary outcome. Time from diagnosis to receipt of any FDA-approved oral or facility-administered antimyeloma therapy served as a secondary outcome.
Treatments included common triplet or quadruplet regimens with dexamethasone plus lenalidomide, bortezomib, carfilzomib and/or daratumumab (Darzalex, Janssen).
Median follow-up was 765 days (interquartile range, 401-1,280).
The majority (75%) of patients filled a prescription for an oral antimyeloma medication other than corticosteroids, with a median 28 days (interquartile range, 15-61) between diagnosis and prescription fill.
Lenalidomide accounted for 93.7% of prescription fills.
Multivariable analysis revealed several factors negatively associated with prescription fills for oral antimyeloma medication at 30 days. These included Black race (vs. white race, adjusted HR = 0.61; 95% CI, 0.42-0.87), older age at diagnosis (adjusted HR per 1 year = 0.97; 95% CI, 0.95-0.98) and diagnosis during inpatient admission (adjusted HR = 0.63; 95% CI, 0.43-0.92).
Lower estimated glomerular filtration rate — 29 mL/min/1.73 m2 vs. at least 60 mL/min/1.73 m2 — also appeared negatively associated with prescription fill (adjusted HR = 0.46; 95% CI, 0.29-0.73).
Likelihood of prescription fill did not vary significantly by insurance type or area deprivation index.
“The complex process of obtaining lenalidomide — including the risk evaluation and mitigation strategy program requirements for patients and health care providers to complete mandatory surveys before a prescription can be ordered, insurance prior authorization process, navigating patient support programs to help pay for out-of-pocket costs, and dispensing only via specialty pharmacies — can lead to delays in treatment initiation for multiple myeloma,” Gasoyan said. “However, the magnitude of discrepancies between the timing of any treatment initiation and oral antimyeloma medication fill was still surprising to us.”
Researchers acknowledged study limitations, including its retrospective nature, the inclusion only of adults treated in a single large integrated health system in Ohio, and the fact patients received treatment at a specialized cancer center.
“We are already working on the next step [in research],” Gasoyan said. “We will study which steps of the aforementioned complex process of obtaining lenalidomide pose the greatest challenge for the patients...
“We aim to examine the modifiable barriers to the utilization of guideline-recommended care and the timelines of treatment for multiple myeloma,” he added. “A better understanding of these factors is critical in planning health policy initiatives and patient navigation programs aimed at achieving equity.”
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Gasoyan H, et al. Blood Cancer J. 2024;doi:10.1038/s41408-024-01128-1.
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