Non-interventional Study to Evaluate Patient and Healthcare Provider Satisfaction of Daratumumab Use in the Treatment of First-line Daratumumab, Lenalidomide, Dexamethasone (DRd) Multiple Myeloma Patients in Germany Depending on Application Route (sc or iv)

Study Overview
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Brief Summary
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MYLENE is a prospective, multicenter, NIS to evaluate the patient and HCP satisfaction of sc and iv application of daratumumab in routine clinical practice in Germany. Patients observed in this study will be transplant ineligible NDMM patients for which the physician foresees an anti-myeloma therapy using DRd regimen as per local label. 250 NDMM patients treated with DRd will be enrolled (excluding screening failures, i.e., enrolled patients not fulfilling selection criteria identified before treatment start will be replaced) within 12 months in a proportion of approximately 1/3 patients receiving daratumumab sc and 2/3 patients receiving daratumumab iv as per physician's decision.

Detailed Description
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Therapy options for MM are mainly dependent on the age and fitness of the patients. NDMM patients up to the age of 65-70 years in whom autologous stem cell transplantation is not indicated, anti-myeloma treatment traditionally consists of systemic chemotherapy, with adjunctive use of radiation or surgery in selected cases associated with extramedullary disease. However, the therapeutic landscape of multiple myeloma progressed in the past decade with the introduction of immunomodulatory agents, proteasome inhibitors and anti-CD38 antibodies, like Daratumumab. After approval of daratumumab iv in May 2016, the sc daratumumab application route was approved in June 2020 in Germany. Real-world evidence data, however, are not yet available neither related to daily experience nor to satisfaction with daratumumab sc application nor to the proportion of patients potentially switching from daratumumab iv to sc application. MYLENE aims to close these gaps with focus on NDMM patients who are ineligible for autologous stem cell transplantation and who will be treated with DRd; this is to guarantee a homogenous patient population. All aspects of treatment and clinical management of patients will be in accordance with local clinical practice and applicable local regulations, and at the discretion of the healthcare provider (or treating physician where different). Only data available per clinical practice will be collected within this study. Additionally, where permitted in accordance with local regulations, healthcare providers will be asked to obtain patient-reported outcome (PRO) data from patients within this study. Despite use of PROs and HCP as well as physician questionnaires, the design is non-interventional due to the fact that the questionnaires are structured documentation aids to document questions that are routinely part of the dialog between patient and physician or HCP during the patient visit and/or drug administration or that are considered by the HCP when evaluate treatment for the patient but are not documented in the medical record. MYLENE is unique as it is focusing on the satisfaction of all involved stakeholders (i.e., patients and HCPs) under real-word conditions and mainly in private practices, since this patient collective is treated preferentially in these institutions, allowing to receive direct feedback about the use of daratumumab sc application and its potential hurdles or/and limitations. Furthermore, this study will provide insights on how the sc/iv application is managed in clinical routine as well as how it is perceived by medical professionals over time. This NIS will be analyzed exploratively and is hence not designed to confirm or refute a predefined hypothesis.

Official Title
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Prospective, Multicenter, Non-interventional Study to Evaluate Patient and Healthcare Provider Satisfaction of Daratumumab Use in the Treatment of First-line Daratumumab, Lenalidomide, Dexamethasone (DRd) Multiple Myeloma Patients as Per Routine Clinical Practice in Germany Depending on Application Route (sc or iv)

Conditions
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Multiple Myeloma, Newly Diagnosed, Transplant Ineligible, Patient Satisfaction, Patient Preference, Personal Satisfaction

Intervention / Treatment
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* Biological: Daratumumab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged 18 years or older Newly diagnosed multiple myeloma (NDMM) and decision for first-line treatment with daratumumab/lenalidomide/dexamethasone (DRd) according to SmPCs of daratumumab Each patient must sign an informed consent form (ICF) indicating that he or she understands the purpose of the study and is willing to participate in the study Willingness and ability to read, understand and complete patients' questionnaires due to the primary objective of the NIS (i.e., patient satisfaction using the Patient Satisfaction and Time Questionnaire (PatSTQ)). Exclusion Criteria: Participation in an interventional clinical trial (participation in another non-Janssen sponsored NIS or registry is allowed) Prior anti-myeloma therapy, with the exception of local radiation therapy or an emergency use of a short course of corticosteroids before treatment Any restrictions/limitations preventing to be treated with DRd as per SmPCs of daratumumab

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| DRd with daratumumab iv de novo<br>Patients either continue DRd with daratumumab iv, switch to daratumumab sc or switch multiple times iv/sc | Biological: Daratumumab<br>* intravenous or subcutaneous<br>* Other names: Darzalex;|
| DRd with daratumumab sc de novo<br>Patients either continue DRd with daratumumab sc, switch to daratumumab iv or switch multiple times sc/iv | Biological: Daratumumab<br>* intravenous or subcutaneous<br>* Other names: Darzalex;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Satisfaction and Time with the application route of daratumumab (iv/sc) | The primary objective of this NIS is to exploratively analyze patients' satisfaction of sc and iv application of daratumumab over time as measured by the Patient Satisfaction and Time Questionnaire (PatSTQ). Overall patients´ satisfaction with daratumumab administration will be displayed as the result of one defined question in the PatSTQ, with descriptive statistics and boxplots. Results of PatSTQ will be displayed with frequencies per group and by time point. Additionally, stacked bar plots with questionnaire results (including missings) per item and time point will be presented | For patients with continuous application route the time frame will be 12 months. For patients with switch of application route, at least 4 daratumumab applications after the first switch should be documented. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| HCP satisfaction and time with the application route of daratumumab (iv/sc) | The secondary objective of this NIS is to assess HCPs' satisfaction of sc and iv application over time as measured by the HCP Satisfaction and Time Questionnaire - patient specific (HSTQ-ps). HCPs' application route satisfaction will be displayed by questionnaire time point as result of the HSTQ - ps questionnaire with frequencies for questions and with descriptive statistics. | Time frame will be approx. 12 months depending on switch of application route. | 
| Proportion of HCP active time spent on activities | The proportion of HCP active time spent on activities (drug preparation, drug administration, patient care/patient monitoring) over time | Time frame will be approx. 12 months depending on switch of application route. | 
| Patients' chair time over time | Patients' chair time over time | Time frame will be approx. 12 months depending on switch of application route. | 
| Patients' overall time spent at doctor's office | Patients' overall time spent at doctor's office | Time frame will be approx. 12 months depending on switch of application route. | 
| Switch rate (proportion of patients) of daratumumab application routes | The switch rate (proportion of patients) of daratumumab application routes during 12 months of study participation under real-word conditions | Time frame will be approx. 12 months depending on switch of application route. | 
| Median switch time | Median switch time | Time frame will be approx. 12 months depending on switch of application route. | 
| Main reasons for sc or iv application selection | The main reasons for sc or iv application selection evaluated by both, the Physician Therapy Decision Questionnaire - general (PTDQ-g) at study start and at the end of study (i.e., study close-out) and by the Physician Therapy Decision Questionnaire - patient specific (PTDQ-ps) at baseline and at switch of the application route | Time frame will be from date of site activation (start of potential enrolment at site) to site close-out (up to 14 months after last patient in).. | 
| Impact of different factors on therapy decision and application route selection (PTDQ-ps) | The impact of different factors on therapy decision and application route selection will be displayed as parameter estimates for selected fixed covariates (age, cytogenetics (high vs standard) and relevant comorbidities) in a mixed effects logistic regression model with the result of PTDQ-ps as outcome. The treating physician selects up to two main reasons why the (new) application route (sc or iv) of daratumumab for a patient is chosen. | Time frame will be approx. 12 months depending on switch of application route. | 
| Patients' preference of the application route | Patients' preference of the application route (only for patients switching from one application route to another) as measured by the Patient Preference Questionnaire (PatPQ). The patient selects which method of daratumumab administration (iv or sc) is preferred and up to two reasons for the preference. | Time frame will be approx. 12 months depending on switch of application route. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Daratumumab, DARZALEX, Lenalidomide, Dexamethasone