Impact of Luspatercept on Healthcare Resource Use (HCRU) Among Patients with Lower-Risk, Myelodysplastic Syndromes (LR-MDS): A Medical Record Review in Canada, Germany, and Spain
Authors: Diez-Campelo Maria , Esterberg Elizabeth , Goyal Ravi K. , Glassberg Mrudula B. , Yucel Aylin , Rombi Julien , Davis Keith L. , Jimenez Maria , Miteva Dimana , Hnoosh Ahmed , Germing Ulrich 
Published: December 2024

Background: In patients with lower-risk myelodysplastic syndrome (LR-MDS), luspatercept has demonstrated significant clinical benefit. However, luspatercept's impact on healthcare resource use (HCRU) is not well documented. This study aimed to describe MDS-related HCRU in patients with LR-MDS who initiated luspatercept therapy in Canada, Germany, and Spain.

Methods: In this retrospective study, data for patients ≥ 18 years of age diagnosed with LR-MDS and treated with luspatercept after its approval in each country were obtained from patient medical records. Information on patient demographics, clinical characteristics, treatments, and MDS-related HCRU were abstracted by participating hematologists/hem-oncologists from October to November 2023. The date of luspatercept therapy initiation defined the study index date. The rate of inpatient (IP) admissions and emergency room (ER) visits were assessed per 100 patient-years (PYs) in the pre-index date period (i.e., between MDS diagnosis to initiation of luspatercept therapy) and in the post-index date period (i.e., during luspatercept therapy). A subgroup analysis was performed to assess HCRU patterns among patients who received luspatercept as first-line therapy. All analyses were descriptive in nature.

Results: A total of 167 patients with LR-MDS and treated with luspatercept (median age 69 years; 61.1% male) were included from 3 countries: Canada (n = 59), Germany (n = 56), and Spain (n = 52). More than one-third of all patients (34.7%) initiated luspatercept therapy in the first line; 58.7% in the second line, and 6.6% in the third or later lines. Of all patients, 62.3% had been treated with erythropoiesis-stimulating agents prior to initiating luspatercept therapy. Median time from MDS diagnosis to luspatercept initiation was 9.3 months (first quartile [Q1] = 2.7, third quartile [Q3] = 22.7) and the median duration of luspatercept therapy was 9.0 months (Q1 = 7.4, Q3 = 13.3). In patients with non-missing HCRU data (n = 165), 17.6% had at least one HCRU encounter (an IP admission or an ER visit) during the pre-index period versus 7.3% in the post-index period. There were 18.9 IP admissions (95% confidence interval [CI] = 13.0-24.7) per 100 PYs in the pre-index period as compared to 8.2 (95% CI = 3.8-12.7) in the post-index period (most common reasons for IP admission: disease-related complications [9.1% vs. 4.3%, respectively] and treatment-related complications [2.4% vs. 1.2%, respectively]). Likewise, the rate of ER visits was 18.4 (95% CI = 12.6-24.2) per 100 PYs in the pre-index period versus 4.4 (95% CI = 1.2-7.7) in the post-index period (most common reasons for ER visit: disease-related complications [7.4% vs. 3.1%, respectively] and treatment-related complications [4.9% vs. 0.6%, respectively]). In the subgroup analysis of first-line luspatercept patients (n = 58), rates of HCRU in the pre-index versus post-index periods were as follows: IP admissions (25.0 vs. 5.5 per 100 PYs); and ER visits (10.7 vs. 3.7 per 100 PYs).

Conclusions: In this retrospective study, a reduction in the rate of MDS-related IP admissions and ER visits was observed for patients with LR-MDS after initiating luspatercept, suggesting that the HCRU burden of LR-MDS may be lowered during luspatercept therapy. These findings were consistent for patients initiating luspatercept in the first line of therapy. Future research should examine potential heterogeneity in HCRU patterns that may exist across geographies.