For Multiple Myeloma Patients, Convenience Now an Important Factor in the Treatment Equation

COVID-19 had a significant impact on healthcare providers’ treatment of multiple myeloma, which may revolutionize future treatment, according to researchers who presented findings at the American Society of Hematology meeting in New Orleans earlier this month.

Robert Rifkin, M.D., medical director of biosimilars for McKesson and a hematologist with Rocky Mountain Cancer Centers in Colorado, along with Mohit Narang, M.D., a medical oncology specialist at Maryland Oncology Hematology, which has locations in Maryland and Washington, D.C., shared the results of their research using data from the Connect MM Registry.

Using data from the registry, Rifkin and Narang presented a comparison of 963 multiple myeloma patients during the two years before the COVID-19 pandemic to 637 patients during the pandemic’s first 17 months. Not surprisingly, they found the patients during the pandemic period made fewer in-person office visits and completed fewer disease assessments. The comparison also showed the increase in remote visits that occurred in in almost all areas of medical care in 2020 and 2021.

The registry data also an increased use in anti-CD38 agents, mainly Darzalex (daratumumab).

Managed Healthcare Executive^® connected with Rifkin via email to discuss the findings.

What is the significance of this research for healthcare providers and patients?

What we found in the CONNECT MM Registry is that with the emergence of the COVID-19 pandemic, everything changed very suddenly. For example, patients didn't want to come to the office — actually some offices didn't let the patients come. With the CONNECT MM Registry, which is now the oldest of the largest myeloma disease registries, we've been able to track, since 2009, all kinds of interesting patterns in healthcare.

With data from registry we were able to see the impact of COVID-19.

"What we found is that patients came to the office less frequently and oral regimens emerged as the preferred treatment, because then you didn't have to go into the office," say Robert Rifkin, M.D., of Rocky Mountain Cancer Centers.

Interestingly, therapies that are given less frequently moved to the forefront. A big focus (of) this abstract was the use of daratumumab (Darzalex), an anti-CD-38 monoclonal antibody.

Once you've established the initial doses and loading, it's a once-a-month treatment.

We saw that the uptake of that and all oral regimens really increased during the pandemic as in-person visits declined.

We also saw in the registry that telehealth emerged and there were numerous visits that were non-office-based. The CONNECT MM Registry allowed us to track this very nicely and likely paves the way for the future when treatment regimens for myeloma need to be very convenient, meaning you don't need a physician visit necessarily and something that's easily managed out of the office.

What is the significance of increasing uptake in use of anti-CD 38 agents, such as Darzalex? Are these agents more cost-effective or have improved efficacy to treat the disease versus other medications?

Daratumumab had already been released prior to the start of the pandemic. Everybody knew the traditional schedule of eight weekly doses, then eight every other week doses and then monthly doses until progression.

It also went from an intravenous formulation to a subcutaneous formulation that is much easier to give and had fewer infusion reactions.

Also during this time, another anti-CD38 antibody, Sarclisa (isatuximab) was approved by the FDA.But its uptake was somewhat slower because there is not a subcutaneous formulation.

Finally, there is one other monoclonal antibody that was being used not too commonly, Empliciti (elotuzumab).

How did the decrease in office visits impact both patients with multiple myeloma and other diseases?

During the COVID pandemic, patients with just about every disease got impacted in ways that we wouldn't think. It's always nice to have an in-person visit where you can evaluate people for toxicities of ongoing therap. But with the advent of telehealth, in a way, you could ask all the same questions through the telephone or over an iPad.

It may have de-personalized therapy a little bit — there can be difficulty in the physician-patient relationship when you do visits over the computer or on a telephone. It definitely changed frequency of office visits and, as a myeloma community, we looked for things that were very convenient, so convenience really moved up the ladder in terms of attributes of a good regimen.

What is important for managed healthcare executives to know about this research?

There is a replacement coming for the Oncology Care Model and multiple myeloma is going to be one of those diseases where we're really going to try to be safe, effective, nontoxic and convenient but, most importantly, hold down financial toxicities and get people adherent to pathways that we know will be very cost effective and really get the patients state-of-the-art care.

What type of follow-up to this study will you be conducting?

If you look at the original structure of CONNECT MM Registry, we recruited patients in a series of cohorts. Cohort One had about 1,500 patients. Cohort Two had another 1,500.

Now we’re in the process of designing Cohort Three, looking at a little bit different group of people with later lines of therapy and involving new novel agents such as CAR-T, BCMA (B-cell maturation antigen)-directed products, drug antibody conjugates and bispecific antibodies.