Gay F, et al. - Authors evaluated and compared the efficacy of different maintenance regimens in newly diagnosed multiple myeloma (NDMM) via a network meta-analysis. According to findings, lenalidomide maintenance may be the best treatment option.

Methods

• Experts conducted two independent searches in PubMed and Cochrane databases to identify all the records registered after 1999 and on or before November 20, 2017.
• Prospective phase 3 randomized trials evaluating novel agent-based maintenance in patients with NDMM were identified by blinded review.
• The included studies compared at least two maintenance approaches; comparators included placebo and no maintenance.
• From 364 screened records, the investigators included 11 studies.
• Using NMA, the evidence was synthesized.
• No maintenance was selected as common comparator in order to allow comparison of all treatments, and the effect of placebo was assumed to be the same as no treatment.
• A Bayesian consistency model based on hazard ratio (HR), 95% credible interval (CrI), probability of being the best treatment (PbBT), and median ranking distribution (MedR) identified the best option.
• Progression-free survival (PFS) and overall survival (OS) were the outcomes of interest.

Results

• A total of 11 trials and 8 treatments represented 5,073 participants.
• Findings suggested that, by PFS analysis, lenalidomide-based regimens (lenalidomide-prednisone, lenalidomide alone) were the most effective options.
• An HR in favor of maintenance was demonstrated by four treatments: thalidomide-interferon, thalidomide-bortezomib, bortezomib-prednisone, and thalidomide alone.
• Upon OS analysis, the authors identified lenalidomide alone as the best option, followed by bortezomib-thalidomide and bortezomib-prednisone.
• Similar features were evident in the restricted network including transplant trials, in the sensitivity analysis, and in most of the prognostic subgroups.