(PA-431) Global Research Trends and Inequities in Clinical Trials in Multiple Myeloma: A Focus On South and Southeast Asia

Introduction: Despite advances in research and treatment modalities, disparities persist in research priorities and the geographical distribution of clinical trials in multiple myeloma (MM). This scoping review aims to classify clinical trials in MM and identify research gaps present in the South and Southeast Asia region.

Methods: The scoping review included all clinical trials in MM undertaken in 15 South and Southeast Asian countries, from 1 Jan 2008 to 1 May 2025 as registered on ClinicalTrials.gov and relevant national registries, which were our primary sources of data. Trials were classified based on their country, epidemiological characteristics, patient population involved (newly diagnosed MM [NDMM] vs. relapsed/refractory MM [RRMM]) and type of intervention. The data was presented using choropleths and hierarchical charts.

Results: 746 trials across 15 countries were classified based on their characteristics. China was found to have the highest number of trials (345) followed by Japan (142), South Korea (131), India (83), Singapore (32), Thailand (6), Malaysia (5), and the Philippines (2) while seven South and Southeast Asian countries, i.e., Sri Lanka, Nepal, Indonesia, Bhutan, Pakistan, Myanmar and Bangladesh had no registered trials in the last 17 years. Interventional trials comprised 90.1% (n=672) of all the trials, with the majority focusing on pharmacotherapy (55.9%, n=376), followed by cellular therapies (31.5%, n=212), while a smaller proportion (4.5%, n=30) employed both cellular and pharmacotherapy and a few concerned supportive therapy (8.03%, n=54). 22.4% (n=167) of all interventional trials were comparative in their design and trials involving RRMM patients dominated the landscape. In NDMM patients 20.9% (n=9) of the comparative trials assessed a single agent while the remaining comparative trials involved a combination of drugs. In RRMM patients 7.69% (n=8) of the comparative trials assessed a single agent while 92.3% (n=96) involved a combination of drugs. 
Observational trials formed 9.9% (n=74) of all registered trials and focused on the prevalence (n=12), diagnosis (n=11), risk factors (n=5), and outcomes (n=41) of the disease. There was also a consistent increase in the number of trials from this region over the years with 6 trials registered in 2008, 12 in 2010, 27 in 2012, 28 in 2014, 30 in 2016, 46 in 2018, 57 in 2020, 89 in 2022 and 91 in 2024. 

Conclusions: There is a marked disparity that exists in the regional distribution of clinical trials in MM, with only a limited number conducted in resource constrained settings involving novel therapeutic agents. This scoping review can serve as a guiding tool for future research to bridge these gaps, thereby championing equity in MM research and improving patient outcomes.