Use of Beta-Blockers Improves Outcomes for Myeloma Patients on Pomalyst
Many of us myeloma patients may be familiar with the class of drugs called “beta-blockers.” The website of the Mayo Clinic posts “Beta-blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta-blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. Beta-blockers cause your heart to beat more slowly and with less force, which lowers blood pressure. Beta-blockers also help open up your veins and arteries to improve blood flow.”
There are several different kinds of beta-blockers marketed under names such as Acebutolol (Sectral), Atenolol (Tenormin), Bisoprolol (Zebeta), Metoprolol(Lopressor, Toprol XL), Nadolol (Corgard), Nebivolol (Bystolic), and Propranolol (Inderal, InnoPran XL).
A recent letter to the editor of the European Journal of Haematology summarizes the results of a retrospective observational study done at the Mayo Clinic. The investigational team analyzed the outcomes of 208 myeloma patients that had been enrolled in a previous study that studied the outcomes of pomalidomide (Pomalyst) + dexamethasone. These patients were treated for relapsed/refractory disease.
As it turned out, 77 patients had documented use of beta-blockers for more than 3 months at any time following their multiple myeloma diagnosis. There were no statistical differences between the beta-blocker and non-beta-blocker groups with respect to the year of diagnosis, sex, number of prior line therapies and presence of high-risk features [deletion of 17p, t(14;16), t(14;20); t(4:14) or 1q gain].
The only ‘large’ difference between the two groups was age: median of 68 years for the beta-blocker group compared to a median of 61 years for the non-beta-blocker group.
The results of this analysis are interesting, to say the least:
- Median progression free survival for the beta-blocker group was 10.9 months compared to 6.1 months for the others
- The overall survival from diagnosis of the 77 patients taking beta-blockers (median of 107 months), was significantly longer than for the patients not taking beta-blockers (median of 86 months)
- The response rates of the two groups of patients were also different, though not statistically so (due to the small sample size)
|Response Rate||Beta- Blockers||No Beta- Blockers|
|Very Good Partial Response or Better||28%||20%|
|Partial Response or Better||43%||34%|
The analysis also concluded that not only beta-blocker intake, but also the duration of the beta-blocker usage were two independent prognostic factors for progression free survival.
In addition, beta-blocker usage was even more prognostic for progression free survival compared to both the presence of high-risk myeloma features and the number or prior line treatments.
Please note that these results, in the absence of other studies, are valid only for those patients on a regimen of pomalidomide + dexamethasone. Happily, most of the beta-blockers are cheap when compared to typical myeloma therapy. For example, atenolol and metoprolol can be purchased at Wal-Mart for $4 for a 30-day prescription (without insurance). Other large drug store chains have similar discounted drug programs. For us, four bucks for a prescription is a treat for a class of drugs that could potentially improve our outcomes.
We look forward to more study using this simple class of drugs.