Systematic Review Protocol Explores Impact of Bortezomib in Multiple Myeloma Treatment

The protease inhibitor, bortezomib, is one of the most commonly utilized medications in first-line treatment and subsequent relapses of multiple myeloma (MM), either as a single agent or in combination with other therapies.

In a recent publication in the BMJ Open, Lucas Oliveria Cantadori, MD, Department of Internal Medicine, Universidade Estadual Paulista Júlio de Mesquita Filho Câmpus de Botucatu Faculdade de Medicina, Botucatu, Brazil and colleagues detailed their systematic review protocol which will aim to evaluate the effects of bortezomib on the overall survival (OS), progression-free survival, overall response rate, time to next treatment, health-related quality of life, compliance, adverse events and treatment-related death in patients with MM (2022;12(6):e061808. doi:10.1136/bmjopen-2022-061808. PMID: 35768117).

Dr Cantadori and colleagues have so far performed a systematic review and meta-analysis that included  both randomized and non-randomized controlled studies where the effect of bortezomib was compared in similar or dissimilar background therapies in each arm. General and adaptive search strategies were generated for the following electronic health databases: Embase, Medline, LILACS and CENTRAL. Two reviewers independently selected eligible studies evaluated them for the risk of bias, and extracted data from the included studies.

Comparable outcomes were plotted in the meta-analysis using the Stata Statistical Software V.17 and the relative risk was calculated with a 95% CI as the effect size of bortezomib. For the OS and progression-free survival, they calculated the overall OR from the hazard ratios (HRs) of each included study. Additionally, Peto’s one-step OR was calculated for event rates below 1% and the researchers employed the Grading of Recommendations Assessment, Development and Evaluation system to evaluate the certainty of evidence.

In the publication, the authors noted the strengths and limitations of this study. For example, trial eligibility evaluation, risk-of-bias-assessments will be performed by teams of reviewers, independently and in pairs. The study will include randomized clinical trials (RCTs) and non-RCTs. They also note there is possibility of heterogeneity between studies which will be evaluated by sub group analysis or meta-regression. Lastly, they also anticipate unpredictability in effect estimates according to the treatment regimens.