A combination of Pomalyst (pomalidomide) and low-dose dexamethasone is cheaper than either Darzalex (daratumumab) or Kyprolis (carfilzomib) alone as a treatment for relapsed or refractory multiple myeloma (RRMM), a study shows.
The research, published in Clinical Therapeutics, is titled “Cost-effectiveness of Pomalidomide, Carfilzomib, and Daratumumab for the Treatment of Patients with Heavily Pretreated Relapsed–refractory Multiple Myeloma in the United States.”
Celgene’s Pomalyst is a derivative of thalidomide that inhibits a tumor-growth-promoting process. The process, angiogenesis, involves creating new blood vessels. New ones are critical for tumor growth because larger tumors need more blood to survive.
Janssen’s Darzalex is an antibody that targets the CD38 protein on the surface of myeloma cells. When Darzalex binds with myeloma cells, it kills them.
Amgen’s Kyprolis inhibits a cell mechanism called proteasome that is responsible for breaking down abnormal proteins. When faulty proteins accumulate in cells, they start to die. Targeting proteasome is a commonly used way to treat a number of cancers.
The U.S. Food and Drug Administration has approved a combination of Pomalyst and dexamethasone for RRMM patients who have already received several treatments. It has also authorized Darzalex and Kyprolis as stand-alone treatments for these patients.
The approvals were based on the results of several trials, including the MM-002 (NCT00833833), SIRIUS (NCT01985126), and PX-171-003-A1 (NCT00511238) studies. Patients in the trials had received a median of five previous treatments.
Researchers built economic models that could compare the cost-effectiveness of each treatment. The models figured the cost of each treatment for a worst-case progression-free survival scenario situation with each treatment— that is, the length of time before a patient’s disease progressed. This meant that the models took into account patients’ outcomes in addition to costs.
Pomalyst was slightly more cost-effective than Darzalex or Kyprolis over three years, researchers said. In terms of just cost alone, Pomalyst plus dexamethasone was $11,799 cheaper than Darzalex and $12,595 cheaper than Kyprolis, however.
Researchers acknowledged that they used computer-generated models rather than head-to-head clinical trials. They said their results were not statistically significant, but that this might be due to a low sample size in their computer model.
The results suggested that Pomalyst plus dexamethasone should be the treatment U.S. patients choose. It provides benefits that are equal to or better than those of Darzalex and Kyprolis, in terms of both patient outcomes and costs.