Impact of COVID-19 on Treatment Patterns and Management of Multiple Myeloma: Insights from the Connect® MM Registry

Background: The COVID-19 pandemic greatly impacted health care delivery systems throughout the United States (US). In-person clinical office visits were postponed or replaced by telehealth as a measure to reduce the spread of COVID-19 (Health and Human Services. ASPR TRACIE. 2021). The pandemic's influence on multiple myeloma (MM) management, treatment patterns, and provider contact with patients has not yet been well studied. The Connect® MM Registry is a large, US, multicenter, prospective observational cohort study of patients with newly diagnosed MM. Real-world data (RWD) from the Connect MM Registry were evaluated to assess the impact of COVID-19 by examining baseline characteristics, treatment patterns, and the rates of clinical visits in both pre- and during-COVID-19 periods.

Methods: Adult patients with MM were enrolled from 250 community, academic, and government sites. Patients for this analysis were from two different time periods from the Connect MM Registry: pre-COVID-19 from January 2018 - February 2020 and during-COVID-19 from March 2020 - August 2021. Descriptive analyses were further stratified by line of therapy (LOT) number [second-line (2L), third-line (3L), fourth-line (4L), and fifth-line (5L)]. Baseline characteristics and treatment patterns were summarized by LOT and COVID-19 time period. Office/clinic/laboratory visits were defined as any in-person visit to a physician's office, clinic, or a laboratory. In-person scheduled office visits were defined as a quarterly scheduled office visit for which patients attended in-person. Non-in-person scheduled office visits were defined as any interaction with a patient or their family member through telephone, email, or mail. Paired t tests were used to compare changes in above incidence rates between pre- and during-COVID-19 time periods. Additionally, a mixed-model with double repeated measures on periods and LOTs was used to analyze above event rates between two COVID-19 time periods. A log transformation was also applied as needed.

Results: At data cutoff (August 2021), 963 and 637 patients were alive and still on study at the pre- and during-COVID-19 time periods, respectively. Among patients who initiated 2L through 5L during both time periods, no notable differences in baseline characteristics were observed. Treatment regimens by LOT revealed no substantial differences during either COVID-19 time period, except for the use of anti-CD38 agents, which increased from pre- to during-COVID-19 period for all LOT (Figure A). Top regimens in 2L through 5L in both COVID-19 time periods generally included daratumumab and/or pomalidomide. With strong statistical evidence (P < 0.0001), the incidence rates for office/clinic/lab visits, and in-person office visits decreased between the pre- and during-COVID-19 periods (Figure B). Similarly, there is strong statistical evidence for the increased incidence rate from pre- to during-COVID-19 for non-in-person office visits (P < 0.0001).

Conclusion: The COVID-19 pandemic has had a substantial impact on the management of MM. RWE from the Connect MM Registry revealed that whereas treatment patterns were generally similar pre- and during-COVID-19, an increased uptake occurred in anti-CD38 agents, mainly daratumumab, in the latter time period. Whether this uptake was attributable to COVID-19 warrants further investigation. Overall, in the during-COVID-19 period, patients attended fewer in-person office visits, completed fewer disease assessments, and had fewer office/clinic/lab visits. Additionally, patients had more non-in-person office visits, which may have been due to the increased availability/adoption of telemedicine visits during the pandemic (Anderson et al. Digital Health. 2022). Collectively, these findings indicate that COVID-19 may have had an impact on patient treatment approach, affecting how frequently a patient was seen as well as the type of therapy they received. Additional follow-up will be needed to determine the long-term impact of COVID-19 on patients with MM.

Richter:BMS/Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Secura Bio: Consultancy, Honoraria; Takeda: Consultancy; Oncopeptides: Consultancy, Honoraria. Lee:Oncopetides: Consultancy; Legend Biotech: Consultancy; Karyopharm: Consultancy; Monte Rosa Therapeutics: Consultancy; Immunitas Therapeutics: Consultancy; GSK: Consultancy, Research Funding; Pfizer: Consultancy; Regeneron: Research Funding; Amgen: Research Funding; Takeda Pharmaceuticals: Consultancy, Research Funding; Janssen: Research Funding; Sanofi: Consultancy; Genentech: Consultancy. Hardin:BMS: Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES. Terebelo:ADC Therapeutics Speakers Bureau: Speakers Bureau; BMS Scientific Advisory Board: Membership on an entity's Board of Directors or advisory committees. Abonour:Bristol Myers Squibb: Honoraria, Research Funding; Takeda: Honoraria, Research Funding; Janssen: Honoraria, Research Funding, Speakers Bureau; Prothena: Honoraria; GSK: Honoraria, Research Funding; Amgen: Honoraria. Wagner:Celgene/Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees. Durie:Celgene/BMS: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Janssen: Consultancy, Honoraria. Narang:J&J: Honoraria; BMS: Consultancy, Honoraria. Toomey:BMS: Consultancy. Rifkin:Janssen: Membership on an entity's Board of Directors or advisory committees; Fresenius/Kabi: Honoraria; GenMab: Membership on an entity's Board of Directors or advisory committees; McKesson: Current Employment, Current equity holder in publicly-traded company; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Coherus: Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS (celgene): Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; GSK: Membership on an entity's Board of Directors or advisory committees. Gasparetto:Janssen: Consultancy, Honoraria; Celgene: Consultancy, Honoraria, Other: Travel expenses, Research Funding; Oncopeptides: Consultancy, Speakers Bureau; karyopharm: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES, Speakers Bureau; Sanofi: Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES, Speakers Bureau; GSK: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES, Speakers Bureau; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Honoraria; AbbVie: Consultancy. Yu:BMS: Current Employment, Current equity holder in publicly-traded company, Other: travel and accommodation expenses. Anand:BMS: Current Employment; Pfizer: Ended employment in the past 24 months; Amgen: Current equity holder in publicly-traded company. Liu:BMS: Current Employment. Jou:Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Jagannath:Karyopharm: Consultancy; Legend Biotech: Consultancy; BMS: Consultancy; Takeda: Consultancy; Sanofi: Consultancy; Janssen Pharmaceuticals: Consultancy.