Real-world, population-based cohort study of toxicity and resource utilization of second-line ipilimumab for metastatic melanoma in Ontario, Canada

Menée au Canada dans un contexte de vie réelle à partir de données portant sur 329 patients atteints d'un mélanome métastatique traité sur la période 2005-2015, cette étude de cohorte analyse la toxicité d'un traitement de seconde ligne par ipilimumab, avant et après 2012, et l'utilisation des services de santé associée (visites hospitalières, visites avec des spécialistes, etc.)

Résumé en anglais

Second-line ipilimumab has been publicly funded in Ontario for metastatic melanoma (MM) since September 2012. We examined real-world toxicity of second-line ipilimumab compared to standard second-line treatments prior to funding. MM patients who received systemic treatment from April 2005 to March 2015 were included. Patients receiving second-line ipilimumab after September 2012 were considered as cases, and those who received second-line treatment prior to the funding date were included as historical controls. Outcomes assessed include treatment-related mortality, any-cause hospital visits, ipilimumab-related hospital visits, and specialist visits (e.g. endocrinologists, ophthalmologists, gastroenterologists, rheumatologists, and respirologists), which were captured from up to 30 and/or 90 days after end of second-line treatment. Inverse probability of treatment weighting was used to adjust for baseline differences between groups. Odds ratios (ORs) from logistic regressions and rate ratios (RRs) from rate regressions were used to assess differences between groups. We identified 329 MM patients who received second-line treatments (ipilimumab: 189; controls: 140). Ipilimumab was associated greater any-cause (60.1% vs 45.7%; OR = 1.81; p-value=0.019;) and ipilimumab-related (47.2% vs 31.9%; OR = 1.91; p-value=0.011;) hospital visits. Adjusting for different follow-up days, ipilimumab was associated with higher rates of all-cause (RR=1.56 [95%CI: 1.12 – 2.16]), and ipilimumab-related (RR=2.18 [95%CI: 1.45 – 3.27]) hospital visits. Patients receiving ipilimumab were more likely to visit specialist involved in immunotherapy toxicity management (23.5% vs 13.7%; p-value=0.04). Compared to historical second-line treatments, second-line ipilimumab was associated with more health service utilization (specifically hospital visits and specialist visits), suggestive of potentially increased toxicity in the real-world.