Racial Disparities in First-Line Treatment of Myeloma: Focus on Bortezomib and Lenalidomide
Posted: Wednesday, August 19, 2020
An article published in Clinical Lymphoma, Myeloma & Leukemia highlighted discrepancies in dissemination of first-line multiple myeloma treatments to Black vs. White patients. Ravi Vij, MD, MBA, of Washington University School of Medicine, St. Louis, and colleagues reviewed utilization patterns of bortezomib and lenalidomide and found that bortezomib was used 31% less often in Black patients compared with White patients. They also found that overall, minorities were less likely to receive lenalidomide as a first-time treatment.
A total of 6,272 patients met criteria for inclusion in the study; 77% were White, 16% were Black, and 6% were another race. Data were collected from the National Cancer Institute’s Surveillance, Epidemiology, and End Results–Medicare linked database, and the procedure codes from the Healthcare Common Procedure Coding System were used to determine utilization and applicable costs billed via part A and part B Medicare claims.
Multivariate analysis revealed that Black patients were 31% less likely (P < .0001), and members of other races were 21% less likely (P = .0453), to receive bortezomib compared with White patients. Although there appeared to be no significant difference in lenalidomide utilization
by race, each 1-unit increase in Charlson Comorbidity Index score decreased the odds of lenalidomide use by 17% (P < .0001). Further analysis revealed that Medicaid enrollment reduced the likelihood of utilization of both bortezomib (P < .0001), and lenalidomide (P = .0422), and controlling for Medicaid enrollment changed very little in the model.
Past research has postulated that disparities in administration of front-line treatments may be attributed to the higher costs of these drugs. However, according to Dr. Vij and colleagues, “…logistical concerns of patients, structural barriers in the health-care system, and cultural differences between [W]hite and nonwhite patients are all likely also involved.”
Disclosure: For full disclosures of the study authors, visit clinical-lymphoma-myeloma-leukemia.com.
