Gay F, et al. - For this investigation, researchers performed two independent searches in PubMed and Cochrane databases, and then they identified all the medical records registered after 1999 and on or before November 20, 2017 to examine and compare the efficacy of different maintenance regimens (lenalidomide-prednisone, lenalidomide alone, thalidomide-interferon, thalidomide-bortezomib, bortezomib-prednisone, thalidomide alone) in newly diagnosed multiple myeloma (NDMM). By synthesizing the available evidence of novel agent-based maintenance in the past 20 years, and based on progression-free survival (PFS) and overall survival (OS), lenalidomide maintenance seems to be the best treatment choice.

Methods

• By blinded review, researchers determined prospective phase 3 randomized trials assessing novel agent-based maintenance in subjects with NDMM; the included studies compared at least two maintenance approaches; comparators included placebo and no maintenance.
• From 364 screened records, 11 studies were incorporated.
• The guidelines provided by the PRISMA Report and the EQUATOR Network were followed (independent extraction).
• Using network meta-analysis (NMA), the evidence was synthesized.
• No maintenance was selected as common comparator and the effect of placebo was assumed to be the same as no treatment to allow comparison of all treatments.
• The best option was recognized by a Bayesian consistency model based on hazard ratio (HR), 95% Credible Index (CrI), probability of being the best treatment (PbBT), and median ranking distribution (MedR).
• PFS and OS were the outcomes of interest.

Results

• According to the findings obtained, 11 trials and 8 treatments including 5,073 participants were incorporated.
• Researchers reported that lenalidomide-based regimens (lenalidomide-prednisone, lenalidomide alone) were identified as the most effective options, by PFS analysis (HR, 0.39 [95% CI, 0.28-0.53] and 0.47 [95% CI, 0.39-0.55], respectively; MedR, 1 and 2; overall PbBT, 74%).
• It was noted that four treatments (thalidomide-interferon, thalidomide-bortezomib, bortezomib-prednisone, thalidomide alone) exhibited an HR in favor of maintenance.
• They found that lenalidomide alone was identified as the best option (HR, 0.76; 95% CI, 0.51-1.16; MedR, 2; PbBT, 38%), followed by bortezomib-thalidomide and bortezomib-prednisone, by OS analysis.
• Similar features were seen in the restricted network, including transplant trials, in the sensitivity analysis, and in most of the prognostic subgroups.