Lenalidomide for newly diagnosed multiple myeloma, October 2019
Page last updated: 6 March 2020
Drug utilisation sub-committee (DUSC)
To compare the predicted and actual utilisation of lenalidomide for newly diagnosed multiple myeloma (NDMM) patients who are ineligible for autologous stem cell transplantation.
Date of listing on the Pharmaceutical Benefits Scheme (PBS)
Lenalidomide for the treatment of NDMM in transplant ineligible patients was PBS listed on 1 February 2017.
Data to assess utilisation was obtained from the PBS supplied prescriptions database.
- The listing of lenalidomide in the NDMM setting had not grown the overall NDMM market. Lenalidomide had mainly substituted for thalidomide with bortezomib use largely unchanged in the NDMM setting. Between Year 1 and Year 2 of listing, the number of lenalidomide patients in NDMM increased by 62.4%. In contrast, the number of thalidomide patients in NDMM decreased by 77.6% between the period 1 February 2017 and 30 June 2019 inclusive.
- There was a higher number of actual than predicted patients using lenalidomide for NDMM. The higher patient numbers did not translate to higher expenditure due to lower than predicted number of prescriptions per patient.
- The lower than expected number of overall prescriptions for lenalidomide was mainly due to an overestimate of the number of prescriptions per patient. Other possible reasons for the relatively low number of prescriptions per patient included:
- patients who were unable to tolerate lenalidomide toxicity despite dose adjustments or those with partial response who subsequently move to another anti-myeloma therapy (AMT); and
- potential use of lenalidomide in transplant eligible patients as induction therapy prior to stem cell transplant. The usual duration of induction therapy was between three to six cycles.
- The median time on PBS subsidised lenalidomide therapy (322 days) was less than the progression-free survival time reported from the MM-020 trial of 25.5 months. The median time on lenalidomide therapy was more than double the median time on thalidomide therapy (322 vs 153 days).
- A total of 39.2% of patients were using a lenalidomide capsule strength lower than 25 mg. Additionally, a total of 21.8% of patients undertook a dose reduction based on the sequence analysis of the capsule strength that was supplied.
- The average lenalidomide dose of 94.5 mg/week was slightly higher than the average dose from the MM-020 trial of 90.5 mg/week. However, the financial estimates were based on an assumption that patients would be treated with [redacted] mg per day for [redacted] cycles without dose reductions or dose interruptions which likely led to the overestimate of the financial estimates.