This study analyzed the utilization of the drug bortezomib for the treatment of multiple myeloma at a Brazilian HMO from 2005 to 2014. The use of bortezomib increased over this period, with its use shifting from primarily second line treatment to primarily first line treatment. Specifically, bortezomib use increased from 4 cases in 2006 to 25 cases in 2013, with its proportion of first line use increasing from 25% in 2006 to 68% in 2013. While first line bortezomib has not been proven superior, patients receiving it as a first line treatment in this study had longer survival times compared to those receiving it as a second line treatment.

1. BORTEZOMIB UTILIZATION PROFILE SHIFT IN THE LAST DECADE AT A BRAZILIAN HMO
UNIMED BH
ABSTRACT
METHODS
This was a retrospective analysis of healthcare service utilization registers, retrieved from Unimed-BH
Prodige database system. For information retrieval, the code and the description of the drug and the
code of HCT were inputted. Statistical analysis were performed with STATA® and Excell® softwares.
RESULTS
Multiple myeloma (MM) treatment depends on autologous hematopoietic cell transplant (HCT)
eligibility. Several studies have evidenced that HCT offers longer overall and progression free survival
when compared to chemotherapy alone. Bortezomib use was initially restricted to first line treatment of
MM patients that were ineligible to high dose chemotherapy and HCT or to second line treatment,
including after HCT failure.
The evidence on bortezomib superiority, when compared to standard treatment, as a first line
treatment for HCT eligible MM patients is methodologically fragile. Nevertheless, this indication has
become more frequent over the years. Consequently, bortezomib represents nowadays the third
highest cost of the HMO Unimed-BH with antineoplastic drugs. In this work, we aimed to to describe
bortezomib utilization profile changes through January 2005 to March 2014, at Unimed-BH.
Luíza O Rodrigues, Silvana M B Kelles, Augusto C S Santos Júnior, Daniela C Azevedo, Lélia M A Carvalho, Maria da Glória C Horta, Mariana R
Fernandes, Sandra O S Avelar
Figure 1: Number of patients that started bortezomib use, by year, in the first (red) and the second (blue) line of
treatment. In 2014, numbers refer to the first trimester.
RESULTS
Ninety-three patients received bortezomib for MM in the studied period. There was a progressive
increase in the use of the drug, that ranged from 4 cases (2006) to 25 cases (2013; until March 2014, 5
cases had already been registered). The overall proportion of first line use was 49.5%, but during the
studied period this proportion shifted from 25% in 2006 to 68% in 2013 (Figure 1).
In this cohort, twenty patients (21.5%) received HCT, of which 11 received first line bortezomib and 9
received second line bortezomib. The median time of bortezomib use was of 146 days (ranging from 3
to 1,215). The median time of bortezimib use was not different between those who used it in first or
second line.

2. BORTEZOMIB UTILIZATION PROFILE SHIFT IN THE LAST DECADE AT A BRAZILIAN HMO
Luíza O Rodrigues, Silvana M B Kelles, Augusto C S Santos Júnior, Daniela C Azevedo, Lélia M A Carvalho, Maria da Glória C Horta, Mariana R
Fernandes, Sandra O S Avelar
UNIMED BH
RESULTS CONTINUED RESULTS CONTINUED
REFERENCES
The use of bortezomib in the first line setting has not been directly demonstrated to be superior to the
usual thalidomide-containing regimens. Nevertheless, first line use of bortezomib increased
progressively over the years and it currently is a more frequent indication than second line use. Overall,
first line use of bortezomib was related to longer survival in the present cohort. However, baseline
characteristics of the two groups, such as HCT eligibility, have not been compared or adjusted for.
The bortezomib utilization profile change has consistent financial implications for HMO sustainability.
1. Kumar A, Hozo I, Wheatley K, Djulbegovic B. Kumar A. Thalidomide versus bortezomib based regimens as first-line therapy for patients with multiple myeloma: a systematic review. Am J Hematol, 2011; 86(1):18-24.
2. Prescrire International. Treatment of multiple myeloma. Prescrire Int. 2009; 18(104):4.
3. Prescrire International. Bortezomib: with longer follow-up. - Myeloma: after failure of thalidomide. Prescrire Int. 2014; 23(147):66-67.
Figure 2: Kaplan-Meier estimates of overall survival for patinets in first and
second line use of bortezomib.
CONCLUSIONS
During the follow-up period (102 months), 24 deaths occurred (25.8%). Eight deaths were of patients in
first line (33.3% of all deaths) and the remaining 16 deaths (66.6%) were of patients in second line use
of bortezomib. Median overall survival time (Figure 2) of patients in first line had not been achieved in
40 months (follow-up period of this group), while the median overall survival time of patients in second
line use was around 30.5 months (follow-up period for this group was 102 months).