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    Myeloma Novel Drug Targets and agents

    Category: Myeloma Novel Drug Targets and agents

    Optimal Treatment Strategy of Bisphosphonate Therapy in Multiple Myeloma: A Target Trial Emulation Study of Fracture Prevention versus Osteonecrosis of the Jaw Risk Using Nationwide Data

    (PA-290) Optimal Treatment Strategy of Bisphosphonate Therapy in Multiple Myeloma: A Target Trial Emulation Study of Fracture Prevention versus Osteonecrosis of the Jaw Risk Using Nationwide Data

    Friday, September 19, 2025
    Introduction: To identify the optimal bisphosphonate (BP) treatment duration in multiple myeloma (MM) patients by balancing the risks of osteonecrosis of the jaw (ONJ) and the benefits of fracture prevention.
     

    Methods: This retrospective study utilized a nationally representative Korean healthcare database (2007–2022) and emulated a target trial using the clone-censor-weight method. The cohort included 4,494 MM patients initiating BP therapy. BP exposure was categorized into five cumulative defined daily dose (cDDD) durations: ≤6, 7–12, 13–18, 19–24, and ≥25 DDD-months. Outcomes included 5-year cumulative risks of ONJ and fractures, with net clinical benefit calculated by integrating fracture prevention against ONJ risk.
     

    Results: BP durations of 13–18 DDD-months achieved the optimal balance, reducing fracture risk (-5.66%; 95% CI: -8.72, -2.53) while limiting ONJ risk (1.91%; 95% CI: 0.55, 3.50). Durations >19 DDD-months increased ONJ risk (8.85%; 95% CI: 4.37, 12.74) without additional fracture prevention. Durations of 7–12 DDD-months minimized ONJ risk (1.68%; 95% CI: 0.35, 3.77) but provided less fracture protection.
     

    Conclusions: Intermediate BP therapy (13–18 DDD-months) optimizes fracture prevention and ONJ risk in MM patients, supporting individualized strategies. These findings provide evidence for refining BP treatment guidelines and emphasize the need for further research in diverse populations.