Incidence and Risk of Cardiac Events in Patients With Previously Treated Multiple Myeloma Versus Matched Patients Without Multiple Myeloma: An Observational, Retrospective, Cohort Study
Incidence and Risk of Cardiac Events in Patients With Previously Treated Multiple Myeloma Versus Matched Patients Without Multiple Myeloma: An Observational, Retrospective, Cohort Study
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DOI：
10.1016/j.clml.2016.11.009
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发表时间：
2017-02-01
影响因子：
2.7
通讯作者：
Chari, Ajai
中科院分区：
文献类型：
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作者：
Kistler, Kristin D.;Kalman, Jill;Chari, Ajai
本研究提供了一个独特的视角，观察接受选定抗MM治疗的一大组多发性骨髓瘤（MM）患者的真实的世界心脏事件发生率。任何心脏事件的心脏事件风险，包括高血压或动脉事件、心律失常、充血性心力衰竭、缺血性心脏病、心肌病和传导障碍，在既往药物≥ 3种的MM患者中更高（n = 1723）与无MM的患者相比背景：多发性骨髓瘤（MM）患者具有年龄、疾病和治疗相关的心脏事件危险因素。材料与方法：我们分析了2006年至2011年MarketScan数据库，以确定MM患者的心脏事件风险是否高于非MM患者。纳入了1723例接受皮质类固醇和≥ 3种药物（硼替佐米、免疫调节衍生物和烷化剂或蒽环类）治疗的MM患者。索引日期（ID）是满足3种药物暴露标准的日期。还纳入了8615例年龄和性别匹配的非MM患者（5：1）。非MM患者ID的分布与MM患者ID的分布相匹配。基线为ID前6个月。随访持续时间为从ID至研究结束（即，2011年或入组或处方药覆盖结束）。当单变量分析显示差异> 10%时，调整基线变量的风险比（HR）和95%置信区间（CI）。结果：MM患者的中位观察持续时间为9个月（范围，0-60个月），非MM患者为19个月（范围，0-66个月）。任何心脏事件的风险（HR，2.2; 95% CI，1.9-2.5），心律失常（HR，4.1; 95% CI，3.5-4.8），充血性心力衰竭MM患者中的心肌病（HR，2.9; 95% CI，2.2-3.7）、心肌病（HR，2.6; 95% CI，1.8-3.8）和传导障碍（HR，1.7; 95% CI，1.2-2.5）的发生率显著高于非MM患者。两组间高血压或动脉事件和缺血性心脏病的发生率相似。结论：本研究首次比较了MM患者与年龄和性别匹配的非MM患者的心脏事件风险。与非MM患者相比，既往使用≥ 3种药物治疗任何心脏事件、心律失常、充血性心力衰竭、心肌病和传导障碍的MM患者的心脏事件风险更高。
The present study provides a unique look at real world cardiac event rates for a large group of multiple myeloma (MM) patients treated with selected anti-MM treatments. The cardiac event risk for any cardiac event, including hypertensive or arterial events, cardiac dysrhythmias, congestive heart failure, ischemic heart disease, cardiomyopathy, and conduction disorders, was greater in MM patients with >= 3 previous drugs (n = 1723) compared with patients without MM (n = 8615).Background: Multiple myeloma (MM) patients have age-, disease-, and treatment-related risk factors for cardiac events. Materials and Methods: We analyzed the 2006 to 2011 MarketScan database to determine whether the risk of cardiac events is greater in MM patients than in non-MM patients. Included were 1723 MM patients treated with corticosteroids and >= 3 drugs (bortezomib, immunomodulatory derivatives, and alkylating agents or anthracyclines). The index date (ID) was the date on which the 3-drug exposure criterion was met. Also included were 8615 age- and gender-matched non-MM patients (5:1). The distribution of non-MM patients' IDs matched that of the MM patients' IDs. Baseline was 6 months before the ID. The follow-up duration was from the ID to study end (ie, 2011 or end of enrollment or prescription drug coverage). Hazard ratios (HRs) and 95% confidence intervals (Cis) were adjusted for baseline variables when the univariate analyses showed a 10% difference. Results: The median duration of observation was 9 months (range, 0-60 months) for MM patients and 19 months (range, 0-66 months) for non-MM patients. The risk of any cardiac event (HR, 2.2; 95% CI, 1.9-2.5), dysrhythmia (HR, 4.1; 95% CI, 3.5-4.8), congestive heart failure (HR, 2.9; 95% CI, 2.2-3.7), cardiomyopathy (HR, 2.6; 95% CI, 1.8-3.8), and conduction disorders (HR, 1.7; 95% CI, 1.2-2.5) was significantly greater for MM than for non-MM patients. The incidence of hypertensive or arterial events and ischemic heart disease was similar between the 2 groups. Conclusion: The present study provides the first known comparison of cardiac event risk in patients with MM versus age- and gender-matched patients without MM. The cardiac event risk was greater in MM patients with >= 3 previous drugs for any cardiac event, dysrhythmias, congestive heart failure, cardiomyopathy, and conduction disorders compared with patients without MM.