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COMMANDS showed that luspatercept freed more people with lower-risk myelodysplastic syndromes from blood transfusions than the erythropoietin injections that had been the first-line standard for decades.
COMMANDS was an open-label phase 3 trial of 363 patients with very low-, low- or intermediate-risk myelodysplastic syndromes who needed red cell transfusions and had not yet received an erythropoiesis-stimulating agent. They were randomised to luspatercept, which promotes late-stage red cell maturation by trapping TGF-beta superfamily ligands, or to epoetin alfa. The primary endpoint was transfusion independence for at least 12 weeks with a concurrent haemoglobin rise in the first 24 weeks.
More patients on luspatercept met the primary endpoint, with longer durations of transfusion independence, and the benefit was seen with and without ring sideroblasts. The result moved luspatercept into first-line use, with United States approval in August 2023.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
363 enrolled.
Common risk difference 26.6 (95% CI 15.8 to 37.4)
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Transfusion independence >=12 weeks with haemoglobin rise >=1.5 g/dL, weeks 1-24 (interim analysis)primary | Luspatercept | 147 | 59% | - | <0.0001 | link |
| Epoetin alfa | 154 | 31% |
Shares Luspatercept, Lower-risk myelodysplastic syndromes, Transfusion support and anaemia management, Myelodysplastic syndromes / neoplasms (MDS) and the tag subtype-trials.
Shares Uwe Platzbecker, Lower-risk myelodysplastic syndromes, Myelodysplastic syndromes / neoplasms (MDS) and the tag subtype-trials.
Shares Myelodysplastic syndromes / neoplasms (MDS), Bristol Myers Squibb and the tag subtype-trials.
Shares Bristol Myers Squibb and the tag subtype-trials.
Shares Bristol Myers Squibb and the tag subtype-trials.
Shares Bristol Myers Squibb and the tag subtype-trials.
Shares Myelodysplastic syndromes / neoplasms (MDS) and the tag subtype-trials.
Shares Bristol Myers Squibb and the tag subtype-trials.