Introduction: Statins are drugs frequently used in patients with hypercholesterolaemia, and metformin is frequently used in patients with diabetes mellitus. The first one act by inhibiting the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, which functions in the same metabolic pathway as bisphosphonates. Some studies have suggested that statins may increase survival in patients with multiple myeloma, in addition to decreasing bone events. On the other hand, studies suggest that metformin stops the cell cycle of multiple myeloma cells, impairing mitochondrial function. The objective of this study is analyzing the impact of statins and oral antidiabetics treatment in a large cohort of patients with multiple myeloma. For the proposed analysis, we used data from TriNetx, a global federated health research platform that includes patients from Europe and US.
Methods: Patients had symptomatic multiple myeloma (ICD-10-CM code C90.0) diagnosed between 2007 and 2022. First of all, comparator cohorts included 16,852 MM patients from US and EMEA Collaborative Networks, 7529 were treated with statins. After propensity scoring matching by age, sex, and date of diagnosis we selected 5038 patients in each cohorts. In both groups, patients received the statin as a treatment for hypercholesterolemia. In relation to oral antidiabetics treatment, comparator cohorts included 13,972 MM patients from US and EMEA Collaborative Networks, 7094 were treated with oral antidiabetics. After propensity scoring matching by age, sex, and date of diagnosis we selected 6495 patients in each cohorts. Kaplan‒Meier analysis was used to estimate survival probabilities, and between-group differences were tested using the log-rank test and hazard ratio.
Results: Patients treated with statins had a longer overall survival (OS) than those who did not: HR 0.789 (0.740, 0.841; 95%) p< 0.001. (Figure 1). The median OS was 96.11 months vs. 74.25 months, respectively. Also, patients treated with oral antidiabetics had a longer overall survival (OS), the median OS was 110.66 months vs. 86.16 months, respectively (p < 0.001) (Figure 2).
Conclusions: This large-scale study based on real-world data confirms the statins and oral antidiabetics significantly prolongs survival in MM.
