First-line therapy for non-transplant eligible patients with multiple myeloma: direct and adjusted indirect comparison of treatment regimens on the existing market in Germany.

Kathrin Kuhr, Daniel Wirth, Kunal Srivastava, Walter Lehmacher, Martin Hellmich

Abstract readMeta-AnalysisReview

In one paragraph

Synthesis in European journal of clinical pharmacology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it

0cells of the map it votes in

6citing papers in PubMed, 1 pooled it

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

Multiple drug combinations of bortezomib, lenalidomide, and thalidomide for first-line treatment in adults with transplant-ineligible multiple myeloma: a network meta-analysis.The Cochrane database of systematic reviews · 2019
Pooled it
Efficacy of Interventions for Newly Diagnosed Multiple Myeloma: An Umbrella Review.Journal of clinical & experimental oncology · 2025
Article
The value of anticancer drugs - a regulatory view.Nature reviews. Clinical oncology · 2022
Review
Efficacy of first-line treatments for multiple myeloma patients not eligible for stem cell transplantation: a network meta-analysis.Haematologica · 2019
Article
Survival of non-transplant patients with multiple myeloma in routine care differs from that in clinical trials-data from the prospective German Tumour Registry Lymphatic Neoplasms.Annals of hematology · 2018
Observational
Multiple myeloma presenting with bilateral ankle pain (microangiopathy) and complicated by streptococcal meningitis and Pneumocystis carinii pneumonia.BMJ case reports · 2017
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Kathrin KuhrInstitute of Medical Statistics, Informatics and Epidemiology, University of Cologne, 50924, Koeln, Germany. kathrin.kuhr@uni-koeln.de.

Daniel WirthJanssen-Cilag GmbH, Neuss, Germany.

Kunal SrivastavaHERON Health Pvt. Ltd, Chandigarh, India.

Walter LehmacherInstitute of Medical Statistics, Informatics and Epidemiology, University of Cologne, 50924, Koeln, Germany.

Martin HellmichInstitute of Medical Statistics, Informatics and Epidemiology, University of Cologne, 50924, Koeln, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe purpose of this study was to compare approved first-line therapies for patients with multiple myeloma.

methodsA systematic literature search for phase III randomized controlled trials (RCTs) comparing first-line chemotherapies approved in Germany and recommended by guidelines at the time of study design was conducted. Random-effects meta-analysis (MA) was used for direct and the Bucher method for adjusted indirect treatment comparison.

resultsOne RCT comparing melphalan and prednisone plus bortezomib (VMP) vs. melphalan and prednisone (MP) and six RCTs comparing MP plus thalidomide (MPT) vs. MP were analysed. For MPT vs. MP, an individual patient data (IPD) MA was used for sensitivity analyses. VMP and MPT were superior to MP regarding efficacy endpoints (VMP vs. MP, overall survival (OS): hazard ratio (HR) 0.70, 95 % confidence interval (CI) 0.57-0.86; progression-free survival (PFS): HR 0.56, 0.39-0.79; complete response (CR), risk-ratio (RR) for non-response: 0.70, 0.65-0.75; MPT vs. MP, OS: HR 0.83, 0.66-1.03; PFS: HR 0.67, 0.56-0.81; CR, RR for non-response 0.92, 0.88-0.95); but had a higher risk of developing any grade 3-4 adverse events (AEs) (VMP vs. MP: RR 1.13, 1.06-1.20; MPT vs. MP: RR 2.06, 1.43-2.98). The indirect comparison of VMP vs. MPT via MP showed a statistically not significant advantage for VMP regarding survival outcomes (OS: HR 0.85, 0.63-1.14; PFS: HR 0.83, 0.56-1.23) and a significant advantage regarding CR (RR for non-response 0.76, 0.70-0.83) and AEs (RR 0.55, 0.38-0.80). Treatment comparisons using results of IPD MA yielded similar effect sizes.

conclusionsVMP and MPT seem more effective than MP, VMP was superior to MPT regarding response criteria and AEs. Our results may best be confirmed by a head-to-head trial of VMP vs. MPT.

Indexed as

Antineoplastic AgentsAntineoplastic Combined Chemotherapy ProtocolsBortezomibClinical Trials, Phase III as TopicGermanyHumansMelphalanMultiple MyelomaPrednisoneRandomized Controlled Trials as TopicThalidomideAntineoplastic AgentsBortezomibMelphalanPrednisoneThalidomideAdjusted indirect treatment comparisonFirst-line therapyMeta-analysisMultiple myeloma

Identifiers

PMID26671239

DOI10.1007/s00228-015-1998-5

What OpenQuestion holds

Textmetadata

Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.