Page 24 - Haematologica-5

Perspectives
with 859 participants. With regards to delaying time to first on-study skeletal-related event, denosumab was not inferior to zoledronic acid [P=0.01; hazard ratio (HR)=0.98; 95% confidence interval (95% CI): 0.85-1.14]. Fewer adverse events potentially related to renal impair- ment were reported with denosumab than with zole- dronic acid (10.0% versus 17.1%, P<0.001). The HR for progression-free survival was 0.82 (95% CI: 0.68-0.99; P=0.036). The overall survival HR between denosumab and zoledronic acid was 0.9 (95% CI: 0.70-1.16; P=0.41), with fewer deaths in the denosumab arm (n=121; 14.1%)
than in the zoledronic acid group (n=129; 15.0%). Therefore, denosumab showed non-inferiority to zole- dronic acid in delaying time to first on-study skeletal- related event. Patients on denosumab had a significantly lower rate of renal adverse events compared to those on zoledronic acid. The bone-specific benefits in combina- tion with the renal function results and possible prolonga- tion of progression-free survival with denosumab were promising and have led to invigorating discussions about why progression-free survival data were more favorable with denosumab. The observations definitely need deep-
Table 1. Cost comparison of osteoprotective medications for MM: Germany versus USA.
756
Drug (original)
Denosumab (Xgeva®)
Zoledronic acid (Zometa®)
Pamidronate
Dose & mode of administration
120 mg s.c. bolus
4 mg i.v. over 15 min
90 mg i.v. over 3 hours
Costs Germany [Monthly costs in Euro (€)]
Costs USA
[Monthly costs in Euro (€)]
C
D
Original price
440
368
out of trade
Generic price
-
279
251
Original price
1890
814
out of trade
Generic price
-
49
47
Germanprices:ATaxx® (Dr.HeniSoftwareGmbH&Co.KG,Freiburg);USAprices:https://www.drugs.com/price-guide/.InGermany,theAMNOGislimitingthecostofnewphar- maceutical products; In the USA, a deflation of generic prices has been reported, due to an increasing number of competing companies entering the market (https://www.nytimes.com/2017/08/08/health/generic-drugs-prices-falling.html).
A
B
Figure 1. Features of the diagnosis of multiple myeloma. (A) Time from onset of symptoms to the diagnosis of MM: patients (%) diagnosed within <3, 3-6, 6-11 or >12 months in the retrospective versus prospective analysis. (B) First suspicion of MM: frequency (%) of patients whose MM was first suspected by different types of physicians (n=176 patients; prospective cohort). (C-D) Prospective analysis: patients‘ satisfaction (n=176).
haematologica | 2018; 103(5)