In patients with lower-risk myelodysplastic syndromes (LR-MDS) who are receiving luspatercept, electronic medical record (EMR) alerts can help improve treatment dosing and enable more patients to attain and keep red blood cell transfusion independence (RBC-TI), according to a retrospective observational study presented at the Twelfth Annual Meeting of the Society of Hematologic Oncology in Houston, Texas.
“An EMR alert resulted in a higher proportion of patients being appropriately dosed with luspatercept and enabled more than 80% to reach maximum dose or achieve RBC-TI,” reported Nisha Singh, PharmD, of Bristol Myers Squibb, and colleagues.
The study population was 92 adults with LR-MDS from a multicenter community oncology network, all of whom had been prescribed at least one dose of luspatercept and had at least three months of follow-up.
One cohort of 38 patients received EMR alerts. They had a median age of 76.0 years, were 56.4% male, and were 53.8% transfusion dependent; 71.8% had ring sideroblasts. Another cohort of 54 patients did not receive EMR alerts. They had a median age of 81.0 years, were 53.7% male, and were 66.7% transfusion dependent; 77.8% had ring sideroblasts. Both cohorts had a median hemoglobin level of 8.4 g/dL.
By week 16 of the study, the percentage of patients who had either received the maximum luspatercept dose or achieved RBC-TI was 82.1% in the cohort that received EMR alerts and 66.7% in the cohort that did not receive alerts (P=0.0987). At the end of follow-up, RBC-TI had been achieved or maintained in 61.5% of the patients who received EMR alerts, as compared with 53.7% of patients who did not receive alerts (P=0.4514).
Dose escalation was necessary in 16 of the patients who received EMR alerts, and their median time to highest dose in the first 24 weeks was 12 weeks. Dose escalation was needed in 30 of the patients who did not receive EMR alerts, who had a median time to highest dose in the first 24 weeks of 15 weeks (P=0.5329).
Instances of inappropriate dosing occurred in 2.6% of the patients who received EMR alerts and in 33.3% of the patients who did not (P=0.0003). Dose rounding occurred in 53.8% of the cohort that received EMR alerts and in 75.9% of the cohort that did not receive alerts (P=0.0258).
Median drug waste among patients who received EMR alerts was 6.9 mg; in patients who did not receive alerts, it was 7.5 mg (P=0.9008). Therefore, the investigators concluded that dose rounding did not reduce drug waste.
“EMR interventions may enhance appropriateness of luspatercept treatment, improving patient outcomes,” the investigators concluded.
Reference
Singh N, Peters B, Chang M, et al. Evaluating the impact of an electronic medical record (EMR) alert on appropriate dosing of luspatercept in patients with lower-risk myelodysplastic syndromes (LR-MDS) in a community oncology network. Abstract #MDS-238. Presented at the Twelfth Annual Meeting of the Society of Hematologic Oncology; September 4-7, 2024; Houston, Texas.