Overview
Recent guideline updates supporting the use of BCMA- and GPRC5D-directed (novel) therapies in earlier lines of therapy have expanded treatment options for patients with relapsed/refractory multiple myeloma (RRMM). However, real-world uptake of novel therapies following these updates remains poorly understood. This cross-sectional study evaluated contemporary real-world treatment patterns among 1,936 patients initiating a new line of therapy for RRMM in the US Flatiron Health Research Database between January 2025 and April 2026.
Non-BCMA/GPRC5D doublet and triplet regimens remained the primary therapies across lines, accounting for 77% of treatments in second/third line (2L/3L), 69% in fourth line (4L), and 53% in fifth line or higher (5L+). Utilization of novel BCMA- or GPRC5D-directed therapies was 8% in 2L/3L and reached 24% in 4L, with higher uptake in academic (34% in 4L) compared to community settings (16% in 4L). Patient numbers decreased significantly across successive lines (1,016 in 2L vs 357 in 4L).
Why this matters
These findings illustrate a gap between recent guideline updates and real-world uptake, indicating that novel immune-based therapies are predominantly used in later lines of care where cumulative patient attrition limits overall exposure and benefits to health outcomes.