Efficacy and Safety of triplet versus doublet regimens in patients with multiple myeloma: A systematic review and meta-analysis

Background The efficacy and safety of various therapies for multiple myeloma (MM) remain a subject of ongoing debate, with inconsistent findings. This meta-analysis aimed to compare the efficacy and safety of triplet versus doublet regimens in the management of MM. This study followed the guidelines delineated in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 statement, with our protocol duly registered in PROSPERO (CRD42024527903). Methods An exhaustive literature search was performed across four databases, PubMed, EMBASE, Web of Science, and Cochrane Library, from their commencement to March 5, 2024. Data on overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), adverse events (AEs), and grade >= 3 AEs were synthesized using either random-effects or fixed-effects models. Results This analysis considered 29 studies, which cover approximately 11,230 MM patients in total. Triplet regimens were found to yield better PFS and OS for MM patients as compared to the doublet regimens. Although the incidence of serious AEs was higher under the triplet regimens, with pooled RRs of grade >= 3 AEs reaching 1.13. Besides, subgroup analysis demonstrated that patients with relapsed/refractory multiple myeloma (RRMM) tended to have better PFS and OS under triple therapy, in contrast to newly diagnosed multiple myeloma (NDMM) and older adults, who experienced little to no significant impact. Conclusions Triplet regimens demonstrate superior PFS and OS compared to doublet regimens in MM patients, but also have a higher likelihood of causing AEs of grade 3 or 4.