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Renal impairment and use of nephrotoxic agents in patients with multiple myeloma in the clinical practice setting in the United States.

ABSTRACT: Renal impairment is a common complication of multiple myeloma and deterioration in renal function or renal failure may complicate clinical management. This retrospective study in patients with multiple myeloma using an electronic medical records database was designed to estimate the prevalence of renal impairment (single occurrence of estimated glomerular filtration rate [eGFR] <60 mL/min per 1.73 m2 on or after multiple myeloma diagnosis) and chronic kidney disease (at least two eGFR values <60 mL/min per 1.73 m2 after multiple myeloma diagnosis that had been measured at least 90 days apart), and to describe the use of nephrotoxic agents. Eligible patients had a first diagnosis of multiple myeloma (ICD-9CM: 203.0x) between January 1, 2012 and March 31, 2015 with no prior diagnoses in the previous 6 months. Of 12,370 eligible patients, the prevalence of both renal impairment and chronic kidney disease during the follow-up period was high (61% and 50%, respectively), and developed rapidly following the diagnosis of multiple myeloma (6-month prevalence of 47% and 27%, respectively). Eighty percent of patients with renal impairment developed chronic kidney disease over the follow-up period, demonstrating a continuing course of declining kidney function after multiple myeloma diagnosis. Approximately 40% of patients with renal impairment or chronic kidney disease received nephrotoxic agents, the majority of which were bisphosphonates. As renal dysfunction may impact the clinical management of multiple myeloma and is associated with poor prognosis, the preservation of renal function is critical, warranting non-nephrotoxic alternatives where possible in managing this population.

SUBMITTER: Qian Y

PROVIDER: S-EPMC5504317 | biostudies-other | 2017 Jul

REPOSITORIES: biostudies-other

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Project description:BACKGROUND: Renal impairment is a common feature in multiple myeloma and is considered a poor prognostic factor. AIM: To determine the impact of novel drugs (i.e. bortezomib, lenalidomide and thalidomide) in the treatment of myeloma patients with renal impairment. The primary endpoint was overall survival and secondary endpoints were time to next treatment and response. METHODS: The study population included all patients diagnosed with treatment-demanding multiple myeloma January 2000 to June 2011 at 15 Swedish hospitals. Renal impairment was defined as an estimated glomerular filtration rate under 60 mL/min/1.73 m2. RESULT: The study population consisted of 1538 patients, of which 680 had renal impairment at diagnosis. The median overall survival in patients with renal impairment was 33 months, which was significantly shorter than 52 months in patients with normal renal function (P<0.001). Novel agents in first line improved overall survival (median 60 months) in non-high-dose treated patients with renal impairment (n = 143) as compared to those treated with conventional cytotoxic drugs (n = 411) (median 27 months) (P<0.001). In the multivariate analysis up front treatment with bortezomib was an independent factor for better overall survival in non-high-dose treated renally impaired patients. High-dose treated renally impaired patients had significantly better median overall survival than non-high-dose ones (74 versus 26 months) and novel drugs did not significantly improve survival further in these patients. Patients with renal impairment had both a shorter median time to next treatment and a lower response rate than those with normal renal function. However, novel drugs and high dose treatment lead to a significantly longer time to next treatment and the use of novel agents significantly improved the response rate of these patients. CONCLUSION: High dose treatment and novel drugs, especially bortezomib, can effectively overcome the negative impact of renal impairment in patients with multiple myeloma.

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Renal impairment and use of nephrotoxic agents in patients with multiple myeloma in the clinical practice setting in the United States.

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