Persistence to Multiple Myeloma Treatments Given at First Relapse-Results From the Australian Real-World OPTIMISE Study.

BACKGROUND: Daratumumab became publicly available in Australia in 2021 in combination with bortezomib and dexamethasone (DVd), as a second-line (2L) therapy for multiple myeloma (MM). We evaluated real-world persistence to any MM treatment after first relapse before and after DVd availability using the Pharmaceutical Benefits Scheme 10% sample dataset. METHODS: Dispensing records for adults receiving 2L MM treatment from January 2018 to December 2020 (Period 1) and January 2021 to April 2025 (Period 2) were analyzed using Kaplan-Meier to determine treatment persistence. RESULTS: Eighty patients were included in Period 1 and 290 in Period 2. Median treatment persistence was longer in Period 2 (15 months) than Period 1 (9.8 months) (hazard ratios [HRs]: 0.46; 99.9% CI: 0.23-0.90; p < 0.001). Treatment persistence in patients who progressed within 18 months on first-line therapy was longer in Period 2 (13 months) than Period 1 (9.2 months) (HR: 0.53; 95% CI: 0.34-0.81; p < 0.01). The Period 2 lenalidomide-refractory cohort (n = 78) demonstrated a median persistence of 11 months (95% CI: 8.3-23 months). The number of lenalidomide-refractory patients in Period 1 (n = 11) was insufficient for comparative analysis. CONCLUSIONS: The observed improvements in treatment persistence among patients with MM including those refractory to lenalidomide, following reimbursement-driven availability of DVd, indicate meaningful clinical benefit in routine practice after the introduction of novel therapies, and underscores the need for sustained access to diverse and effective treatment options for relapsed MM. UNLABELLED: Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.