OBJECTIVES: A Bayesian NMA was developed from a systematic literature review (SLR) to evaluate the efficacy of XVd relative to other therapies in previously treated MM.

METHODS: Ovid was systematically searched for phase II-III randomized clinical trials (RCTs) that assessed progression-free survival (PFS), overall survival (OS) and overall response rates (ORR). As treatment line is an important factor in MM, two population subsets were assessed: second-line patients (2L) and third-line or greater patients (3L+). Fixed and random effect models were assessed for each outcome. Base case results compared all regimens against twice weekly bortezomib and dexamethasone (Vd) as the anchored comparator regimen.

RESULTS: 47 RCTs met inclusion. For 2L PFS, OS and ORR, XVd had, on average out of all iterations, the 6th (out of 21), 4th (out of 15), and 5th (out of 20) best result, respectively, versus Vd. This translated to a 24.5%, 68.6%, and 50.1% probability that XVd would be a top-5 ranked regimen. For 3L+ PFS, OS and ORR, XVd had the 12th (out of 24), 11th (out of 22), and 8th (out of 25) best result, respectively, versus Vd. This translated to a 7.6%, 12.8%, and 27.8% probability that XVd would be a top-5 ranked regimen. There was no statistically significant difference between XVd and other top-ranking therapies for PFS, OS, and ORR in either 2L and 3L+. except for daratumumab/bortezomib/dexamethasone [DVd] favorable versus XVd (2L PFS); however, XVd uses once-weekly Vd (versus twice-weekly in DVd).

CONCLUSIONS: Results for XVd were more favorable in 2L, having a higher probability of being a top 5 regimen, compared with 3L+ therapies. The addition of XVd to the treatment landscape for previously treated MM provides a novel, oral regimen that may potentially be noninferior to other top 5 regimens in both 2L and 3L+ settings.