ISSN:
1569-8041
Keywords:
cost-effectiveness
;
induction
;
interferon-α
;
maintenance
;
meta-analysis
;
multiple myeloma
;
overall survival
;
relapse-free survival
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Background:After two decades of interferon (IFN) treatment inmyeloma patients and many randomised clinical trials, no definite proof of itsbenefits exists. This meta-analysis of all available relevant published datatests the differences between IFN and control arms in a large patientpopulation and addresses the issue of cost-effectiveness. Patients and methods:Meta-analysis was performed on 17 trialsamong 2333 patients who received IFN-chemotherapy induction treatment orchemotherapy alone and on 13 trials among 1615 patients on IFN maintenancetherapy or without treatment. Response rates and parameters of publishedKaplan–Meier relapse-free and overall survival curves were analysed. Results:Patients in IFN arms showed significantly better resultsin all investigated parameters: IFN-chemotherapy induction treatment yielded6.6% higher response rates (2P 〈 0.002) as well as4.8-month and 3.1-month prolongations of relapse-free (P 〈 0.01)and overall survival (P 〈 0.01), respectively. Interferonmaintenance therapy lead to 4.4-month (P 〈 0.01) and 7.0-month(P 〈 0.01) prolongations of relapse-free and overall survival,respectively. Meta-analysis of all IFN trials combined resulted in 4.6-monthand 3.7-month IFN-related gains in relapse-free and overall survival,respectively. As early as 6 and 12 months after the start of IFN treatment,percentages of cumulative relapse-free and overall survival were alwayssignificantly higher in IFN trial arms. IFN drug expenses for a one-yearsurvival gain, as determined from AUCs of best-fitted Gompertz functions ofIFN and control survival curves, were estimated to be US$42,482.28 forinduction therapy and US$18,968.16 for maintenance treatment. Conclusions:Significantly superior outcomes were consistentlyfound in IFN trial arms by meta-analysis of published data. These results arein accordance with a concomittantly conducted meta-analysis on individualpatient data but were much easier to accrue. Taking all our results intoaccount, i.e., the consistently significant, although limited, improvement ofclinical outcomes and its acceptable cost-effectiveness, IFN treatment ofpatients with multiple myeloma seems worthwhile to be considered.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1023/A:1026548226770
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