Lenalidomide or Thalidomide for Transplant-Ineligible Patients With Newly Diagnosed Multiple Myeloma? An Overview of Systematic Reviews

Marília Berlofa Visacri; Mayra Carvalho Ribeiro; Denis Satoshi Komoda; Bruno Kosa Lino Duarte; Carlos Roberto Silveira Correa; Flávia de Oliveira Motta Maia; Daniela Fernanda Dos Santos Alves

doi:10.1016/j.vhri.2024.100998

Lenalidomide or Thalidomide for Transplant-Ineligible Patients With Newly Diagnosed Multiple Myeloma? An Overview of Systematic Reviews

Value Health Reg Issues. 2024 May 7:43:100998. doi: 10.1016/j.vhri.2024.100998. Online ahead of print.

Authors

Marília Berlofa Visacri¹, Mayra Carvalho Ribeiro², Denis Satoshi Komoda³, Bruno Kosa Lino Duarte⁴, Carlos Roberto Silveira Correa³, Flávia de Oliveira Motta Maia⁵, Daniela Fernanda Dos Santos Alves⁵

Affiliations

¹ Faculty of Pharmaceutical Sciences, University of São Paulo, SP, Brazil. Electronic address: visacri.mb@usp.br.
² Clinical Hospital, University of Campinas, Campinas, SP, Brazil.
³ School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
⁴ Hematology and Blood Transfusion Center, University of Campinas, Campinas, SP, Brazil.
⁵ School of Nursing, University of Campinas, Campinas, SP, Brazil.

PMID: 38718736
DOI: 10.1016/j.vhri.2024.100998

Abstract

Objectives: To present an overview of evidence of efficacy, safety, and health-related quality of life of lenalidomide or thalidomide for transplant-ineligible multiple myeloma.

Methods: A literature search was performed in 5 databases until July 2022. We included systematic reviews with network meta-analyses of randomized controlled trials on the use of lenalidomide compared with thalidomide for transplant-ineligible multiple myeloma. The A Measurement Tool to Assess Systematic Reviews 2 was used to appraise the quality of included reviews. The results were focused on the lenalidomide + dexamethasone until disease progression (RDc) versus thalidomide + dexamethasone until disease progression (TDc) and induction with melphalan + prednisone + lenalidomide, followed by maintenance with lenalidomide (MPR-R) versus induction with melphalan + prednisone + thalidomide, followed by maintenance with thalidomide (MPT-T) regimens.

Results: Nine studies were included. Only 1 study did not show any weakness in critical domains of A Measurement Tool to Assess Systematic Reviews 2. For overall survival, RDc proved to be superior to TDc; however, no study showed significant difference between MPR-R and MPT-T. For progression-free survival, 2 of 3 studies showed that RDc is better than TDc; however, no difference between MPR-R and MPT-T was found. Regarding safety, these lenalidomide-based regimens had a lower risk for neurologic adverse events, with an increased risk of hematologic adverse events. No health-related quality of life meta-analyses were found.

Conclusions: These findings suggest that, in terms of efficacy and safety, lenalidomide-based regimen is a good option for treatment of transplant-ineligible multiple myeloma in the public health system of Brazil, especially for those patients who develop severe neuropathy with thalidomide.

Keywords: lenalidomide; multiple myeloma; network meta-analysis; systematic review; thalidomide; treatment outcome.