This Multiple Myeloma Drug Is Gaining Traction, Despite Costs

Since its approval in January 2018, Prolia® (denosumab) has seen an increase in use in patients with multiple myeloma (MM) compared with Reclast® (zoledronic acid), despite having a higher price tag ($2,500 vs. $50 per dose, respectively), according to research published in JAMA Oncology.

The study found that in 15 months following its approval, denosumab was being used in 40% of patients with MM. Zoledronic acid is a bisphosphonate, and denosumab has a novel mechanism of action that involves receptor activator of nuclear factor kappa-Β ligand.

A 2017 head-to-head comparison of the bone-modifying agents in more than 1,000 patients with MM found denosumab and zoledronic acid were noninferior in terms of time to skeletal-related events and survival. Denosumab reduced the risk of renal adverse events, thus the recent article noted that denosumab may be more beneficial in some, but not all, patients with kidney dysfunction.

Increased use of denosumab between 2017 and 2019

In the recent study, the authors used Medicare fee-for-service claims data from January 1, 2017, to March 31, 2019, to identify 15,872 patients with MM (mean age, 72.7 years) who had a total of 329,595 person-months of follow-up. The overall rate of denosumab use prior to its approval was 3.8 doses per 1,000 person-months compared with 84.1 doses per 1,000 person-months following its approval.

Of the total number of bone-modifying agent doses, the percentage of denosumab doses increased from 0.1% throughout 2017 to 38.1% in March 2019.The adjusted incidence rate ratio of denosumab use was 36.0 for patients without renal dysfunction and 17.9 for those with renal dysfunction.

The study did not assess the reason for this uptake.