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Research Letter
December 12, 2019

Use of Bone-Modifying Agents Among Medicare Beneficiaries With Multiple Myeloma

Author Affiliations
  • 1The Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
  • 2Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 3Division of Hematology, Mayo Clinic, Rochester, Minnesota
  • 4Division of Cancer Care and Epidemiology, Department of Oncology, Queen's University, Kingston, Ontario, Canada
  • 5Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
  • 6Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA Oncol. Published online December 12, 2019. doi:10.1001/jamaoncol.2019.5426

The US Food and Drug Administration (FDA) approved denosumab to prevent skeletal-related events in patients with multiple myeloma on January 5, 2018, based on the results of a noninferiority trial.1 However, denosumab requires a more frequent dosing schedule and is much more expensive than standard bisphosphonate therapy.2 Denosumab discontinuation is associated with rapid bone loss, and patients who discontinue denosumab therapy will likely require subsequent treatment with bisphosphonates to limit anticipated bone loss.2,3 Therefore, its routine use is difficult to justify except in patients with renal dysfunction or in those unable to tolerate bisphosphonates. In light of these issues, we describe the uptake in use of denosumab after FDA approval.

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