Real-world use and outcomes of hypomethylating agent therapy in higher-risk myelodysplastic syndromes: why are we not achieving the promise of clinical trials?
- PMID: 34636250
- DOI: 10.2217/fon-2021-0936
Real-world use and outcomes of hypomethylating agent therapy in higher-risk myelodysplastic syndromes: why are we not achieving the promise of clinical trials?
Abstract
Myelodysplastic syndromes are hematological malignancies characterized by ineffective hematopoiesis and a high risk of progression to acute myeloid leukemia. Hypomethylating agents (HMAs), azacitidine and decitabine, are standard of care therapy for higher-risk myelodysplastic syndromes. However, outcomes reported for real-world studies fall short of those achieved in clinical trials. We conducted a targeted literature review exploring real-world utilization, persistence and outcomes with intravenous and subcutaneous HMA therapies to better understand barriers to achieving optimal outcomes in clinical practice. The potential benefits of oral HMA therapy were also explored. Underutilization and poor persistence with HMA therapy are associated with suboptimal outcomes, highlighting the need for approaches to improve utilization and persistence, so that patients achieve the optimum benefit from HMA therapy.
Keywords: HMA therapy; MDS; hypomethylating agents; myelodysplastic syndromes; outcomes; persistence; real-world evidence.
Plain language summary
Lay abstract Myelodysplastic syndromes (MDS) are bone marrow disorders affecting the production of blood cells. In some patients, MDS can progress to acute myeloid leukemia (AML), an aggressive blood cancer with poor prognosis. Patients with higher-risk MDS are often treated with a type of chemotherapy called hypomethylating agents (HMAs). Studies conducted in real-world clinical practice have shown HMAs to be less effective than has been found in clinical trials. We reviewed available studies exploring real-world utilization, persistence and outcomes with current HMA therapies to better understand any barriers to patients achieving the best outcomes. Two important factors were found to be the underuse of HMAs and poor persistence with HMA therapy, highlighting the need for approaches to improve HMA utilization and persistence.
Similar articles
-
Clinical activity, pharmacokinetics, and pharmacodynamics of oral hypomethylating agents for myelodysplastic syndromes/neoplasms and acute myeloid leukemia: A multidisciplinary review.J Oncol Pharm Pract. 2024 Jun;30(4):721-736. doi: 10.1177/10781552241238979. Epub 2024 Mar 21. J Oncol Pharm Pract. 2024. PMID: 38509812 Free PMC article. Review.
-
Persistence to hypomethylating agents and clinical and economic outcomes among patients with myelodysplastic syndromes.Hematology. 2021 Dec;26(1):261-270. doi: 10.1080/16078454.2021.1889161. Hematology. 2021. PMID: 33631084
-
Outcome of patients with low-risk and intermediate-1-risk myelodysplastic syndrome after hypomethylating agent failure: a report on behalf of the MDS Clinical Research Consortium.Cancer. 2015 Mar 15;121(6):876-82. doi: 10.1002/cncr.29145. Epub 2014 Nov 19. Cancer. 2015. PMID: 25410759 Free PMC article.
-
Optimizing the use of hypomethylating agents in myelodysplastic syndromes: Selecting the candidate, predicting the response, and enhancing the activity.Semin Hematol. 2017 Jul;54(3):147-153. doi: 10.1053/j.seminhematol.2017.06.001. Epub 2017 Jun 23. Semin Hematol. 2017. PMID: 28958288 Review.
-
Impact of Hypomethylating Agent Use on Hospital and Emergency Room Visits, and Predictors of Early Discontinuation in Patients With Higher-Risk Myelodysplastic Syndromes.Clin Lymphoma Myeloma Leuk. 2022 Sep;22(9):670-679. doi: 10.1016/j.clml.2022.04.016. Epub 2022 Apr 22. Clin Lymphoma Myeloma Leuk. 2022. PMID: 35614009
Cited by
-
Clinical activity, pharmacokinetics, and pharmacodynamics of oral hypomethylating agents for myelodysplastic syndromes/neoplasms and acute myeloid leukemia: A multidisciplinary review.J Oncol Pharm Pract. 2024 Jun;30(4):721-736. doi: 10.1177/10781552241238979. Epub 2024 Mar 21. J Oncol Pharm Pract. 2024. PMID: 38509812 Free PMC article. Review.
-
Treatment patterns and outcomes with luspatercept in patients with lower-risk myelodysplastic syndromes: A retrospective US cohort analysis.Hemasphere. 2024 Jan 30;8(1):e38. doi: 10.1002/hem3.38. eCollection 2024 Jan. Hemasphere. 2024. PMID: 38434524 Free PMC article. No abstract available.
-
Frontline treatment options for higher-risk MDS: can we move past azacitidine?Hematology Am Soc Hematol Educ Program. 2023 Dec 8;2023(1):65-72. doi: 10.1182/hematology.2023000421. Hematology Am Soc Hematol Educ Program. 2023. PMID: 38066872
-
Are We Ready For "Triplet" Therapy in Higher-Risk MDS?Clin Hematol Int. 2023 Nov 3;5(4):88301. doi: 10.46989/001c.88301. eCollection 2023. Clin Hematol Int. 2023. PMID: 37933301 Free PMC article.
-
Immunotherapy with Monoclonal Antibodies for Acute Myeloid Leukemia: A Work in Progress.Cancers (Basel). 2023 Oct 19;15(20):5060. doi: 10.3390/cancers15205060. Cancers (Basel). 2023. PMID: 37894427 Free PMC article. Review.
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Medical
Research Materials
Miscellaneous