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Evaluating results from the multiple myeloma patient subset treated with denosumab or zoledronic acid in a randomized phase 3 trial

Identifieur interne : 002F62 ( Ncbi/Curation ); précédent : 002F61; suivant : 002F63

Evaluating results from the multiple myeloma patient subset treated with denosumab or zoledronic acid in a randomized phase 3 trial

Auteurs : N. Raje ; S. Vadhan-Raj [États-Unis] ; W. Willenbacher [Autriche] ; E. Terpos [Grèce] ; V. Hungria [Brésil] ; A. Spencer [Australie] ; Y. Alexeeva [Russie] ; T. Facon [France] ; A K Stewart [États-Unis] ; A. Feng [États-Unis] ; A. Braun [États-Unis] ; A. Balakumaran [États-Unis] ; G D Roodman [États-Unis]

Source :

RBID : PMC:4742634

Descripteurs français

English descriptors

Abstract

In a phase 3 trial of denosumab vs zoledronic acid in patients (n=1776) with bone metastases and solid tumors or multiple myeloma, denosumab was superior to zoledronic acid for the primary end point of prevention of skeletal-related events. There was no difference in overall survival between the two groups; however, an ad hoc overall survival analysis in the multiple myeloma subset of patients (n=180) favored zoledronic acid (hazard ratio (HR) 2.26; 95% confidence interval (CI) 1.13–4.50; P=0.014). In the present analysis, we found imbalances between the groups with respect to baseline risk characteristics. HRs with two-sided 95% CIs were estimated using the Cox model. After adjustment in a covariate analysis, the CI crossed unity (HR 1.86; 95% CI 0.90–3.84; P=0.0954). Furthermore, we found a higher rate of early withdrawals for the reasons of lost to follow-up and withdrawal of consent in the zoledronic acid group; after accounting for these, the HR was 1.31 (95% CI 0.80–2.15; P=0.278). In conclusion, the survival results in multiple myeloma patients in this trial were confounded and will eventually be resolved by an ongoing phase 3 trial.


Url:
DOI: 10.1038/bcj.2015.96
PubMed: 26745852
PubMed Central: 4742634

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PMC:4742634

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N. Raje
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Le document en format XML

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<term>Transplantation de cellules souches hématopoïétiques</term>
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</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<p>In a phase 3 trial of denosumab vs zoledronic acid in patients (
<italic>n</italic>
=1776) with bone metastases and solid tumors or multiple myeloma, denosumab was superior to zoledronic acid for the primary end point of prevention of skeletal-related events. There was no difference in overall survival between the two groups; however, an
<italic>ad hoc</italic>
overall survival analysis in the multiple myeloma subset of patients (
<italic>n</italic>
=180) favored zoledronic acid (hazard ratio (HR) 2.26; 95% confidence interval (CI) 1.13–4.50;
<italic>P</italic>
=0.014). In the present analysis, we found imbalances between the groups with respect to baseline risk characteristics. HRs with two-sided 95% CIs were estimated using the Cox model. After adjustment in a covariate analysis, the CI crossed unity (HR 1.86; 95% CI 0.90–3.84;
<italic>P</italic>
=0.0954). Furthermore, we found a higher rate of early withdrawals for the reasons of lost to follow-up and withdrawal of consent in the zoledronic acid group; after accounting for these, the HR was 1.31 (95% CI 0.80–2.15;
<italic>P</italic>
=0.278). In conclusion, the survival results in multiple myeloma patients in this trial were confounded and will eventually be resolved by an ongoing phase 3 trial.</p>
</div>
</front>
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