The Changing Landscape of Multiple Myeloma Therapies Market

Multiple Myeloma, the second most common type of blood cancer after non-Hodgkin lymphoma, is characterized by the presence of malignant plasma cells in the bone marrow. The diagnosis involves identifying these highly abnormal and unstable cells, which proliferate aggressively and spread through the bloodstream and lymph nodes. This results in an overwhelming presence of cancer cells in the bone marrow, outnumbering healthy blood cells and immunoglobulins. Consequently, the body’s ability to function normally and fight infections is severely compromised, making timely diagnosis and treatment crucial. Multiple Myeloma can present in various forms, including symptomatic multiple myeloma (an active disease with symptoms such as bone pain and anemia), asymptomatic (smoldering) multiple myeloma (with abnormal cells but no symptoms), solitary plasmacytoma (a single tumor of plasma cells), and plasma cell leukemia (a rare form with malignant plasma cells in the blood). Each type requires tailored diagnostic and treatment approaches.

The prevalence of multiple myeloma in the elderly population has contributed to the multiple myeloma drug market. It could be due to the demographic burden as the proportion of the geriatric population in the country will be greater than that of the millennials.

Myeloma incidence is strongly related to age, with the highest incidence rates being in older people. Additionally, over 50% of multiple myeloma cases are diagnosed in males  In the United States.

Data suggests that roughly half of newly diagnosed multiple myeloma patients are ineligible for transplant, and around a third of eligible patients do not receive the transplant. In the US, there were around 23,600 frontline transplant-ineligible patients and 9,200 transplant-eligible patients of multiple myeloma patients in 2023.

At present, the market holds a diverse range of therapeutic alternatives for treatment, which includes Proteasome Inhibitors, Immunomodulating Agents, Histone Deacetylase (HDAC) inhibitors, Monoclonal Antibodies, Chemotherapy, Corticosteroids, Nuclear export inhibitors, CAR-T cell therapy, and Bispecific antibody in different lines of treatment. For several decades, the standard therapy for multiple myeloma included a combination of alkylating agents, primarily melphalan and cyclophosphamide, together with corticosteroids, such as dexamethasone and prednisone, all of which were augmented in the mid-1980s by the introduction of autologous stem cell transplantation.

The advent of therapies and their augmented efficacy of prevalent therapies helps in increasing the life span of the patients thus making them dependable on those therapies for the rest of their lives.

Current Therapies for Multiple Myeloma Treatment

The advancements in the multiple myeloma drugs market are happening at a good pace. There has been an increase in research in chemotherapy, non-chemotherapy, corticosteroids, and stem cell transplantation. However, the recent drug approvals and advancements have proven to be a relief to healthcare systems and patients. The multiple myeloma Pipeline is the most diverse when it comes to oncology. 

Recent advances in drugs for multiple myeloma treatment include BLENREP (approved in 2020), an anti-BCMA immunoconjugate, and NINLARO (approved in 2015), the first oral proteasome inhibitor with lenalidomide and dexamethasone. EMPLICITI (approved in 2015) enhances immune response, TECVAYLI (approved in 2022) redirects T-cells, SARCLISA (approved in 2020), and DARZALEX (approved in 2015) targets CD38 for cell death, and TALVEY (approved in 2023) addresses refractory cases. These innovations expand treatment options and improve outcomes for patients with multiple myeloma. 

Moreover, the treatment landscape for relapsed or refractory multiple myeloma is rapidly evolving with the FDA approvals of ABECMA and CARVYKTI (CAR-T therapies) and TECVAYLI (a bispecific antibody). Key players like Pfizer, Johnson & Johnson, and GSK are intensifying competition in the fourth-line and above-treatment market. Johnson & Johnson’s DARZALEX and the newly approved TECVAYLI, along with the upcoming talquetamab, are setting high standards. GSK’s relaunch of BLENREP targets a second-line niche, and Pfizer’s elranatamab faces stiff competition from other bispecific antibodies. CAR-T therapies, despite their effectiveness, face challenges in safety, cost, and manufacturing, but ongoing improvements may enhance their adoption.

Nevertheless, recent technological advances have dramatically changed the treatment patterns for treating Multiple myeloma. The entry of novel pharmaceutical entities has substantially progressed, and a lot more are in the pipeline. Looking at the current scenario, the multiple myeloma treatment market majorly revolves around chemotherapies in conjunction with proteasome inhibitors, monoclonal antibodies, anti-resorptive agents such as bisphosphonates along with NSAIDs or narcotics, corticosteroids, and bone marrow transplantation.

Dominant Players in Multiple Myeloma Treatment

Over the past several years, multiple myeloma treatment options have expanded widely for patients, resulting in significantly improved outcomes. The FDA approved around 16 new agents and 30 treatment regimens, transforming the multiple myeloma treatment paradigm for patients with newly diagnosed and relapsed/refractory multiple myeloma. Bristol Myers Squibb and Janssen, a subsidiary of Johnson & Johnson, are the two titans dominating the multiple myeloma treatment market with around nine FDA-approved products for multiple myeloma in different settings.

Janssen and Bristol Myers Squibb are both pivotal players in the evolving multiple myeloma treatment landscape. Janssen’s robust portfolio, highlighted by the successes of DARZALEX, TECVAYLI, and CARVYKTI, positions it strongly for leadership in the coming decade. Conversely, BMS continues to leverage its significant assets, including its pioneering CAR-T therapy ABECMA and emerging CELMoDs. Despite challenges, BMS remains a key competitor. It is likely that Janssen and BMS will be dominant players in the multiple myeloma treatment market this decade.

Multiple Myeloma Market Trends and Future Outlook

Celgene Corp.’s REVLIMID (lenalidomide) currently leads as the highest-selling drug approved for multiple myeloma and is expected to maintain this position for the foreseeable future. REVLIMID, an immunomodulatory agent, along with Takeda Pharmaceutical Co. Ltd.’s proteasome inhibitor VELCADE (bortezomib), partnered with J&J, are considered backbone therapies in the field. In June 2006, the FDA approved REVLIMID in combination with dexamethasone for use in multiple myeloma patients who have received at least one prior therapy. Regulatory authorities have approved several immunomodulatory agents (IMiDs) for multiple myeloma treatment, including THALOMID (thalidomide), REVLIMID (lenalidomide), and POMALYST (pomalidomide). 

“As REVLIMID’s patent expired in 2022, ushering in generic competition from low-cost rivals like Teva and Natco, Bristol Myers Squibb faced a significant decline in sales. This decline, exacerbated by generic erosion and increased patient access to free drug programs, prompted BMS to pivot towards developing new therapies. In response to REVLIMID’s waning market dominance, BMS introduced CELMoDs—specifically Iberdomide and Mezigdomide—as potential successors. Unlike REVLIMID, these CELMoDs bind more tightly to cereblon and exhibit greater potency, offering enhanced tumoricidal activity and improved efficacy in treating relapsed/refractory multiple myeloma, thus positioning BMS for a strong comeback in the multiple myeloma treatment arena.”

Chimeric antigen receptor (CAR)-T cell therapies were also being investigated for heavily pretreated relapsed or refractory multiple myeloma. In February 2022, Johnson & Johnson Innovative Medicine announced FDA approval of CARVYKTI (ciltacabtagene autoleucel) for adults with relapsed or refractory multiple myeloma after four or more prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.

Immunomodulators (IMiDs) like THALOMID, REVLIMID, and POMALYST play a crucial role in multiple myeloma treatment. Thalomid initially faced hesitation from the FDA but eventually gained approval. REVLIMID, similar to Thalomid, was approved in 2006 with dexamethasone for patients who had received prior therapy.

Proteasome inhibitors (PIs) such as VELCADE (bortezomib), KYPROLIS (carfilzomib), and NINLARO (ixazomib) are also widely utilized. VELCADE was approved for relapsed myeloma resistant to previous treatments. Carfilzomib and ixazomib are newer PIs approved for managing multiple myeloma.

Anti-CD38 therapies, including DARZALEX (daratumumab), a CD38 inhibitor, and SARCLISA (isatuximab), are monoclonal antibodies used in myeloma treatment. DARZALEX is often preferred due to its broader use and effectiveness, including combinations with Kyprolis and dexamethasone.

Newest treatment, such as CAR-T cell therapies for multiple myeloma, represents a promising frontier in addressing heavily pretreated cases of relapsed or refractory multiple myeloma.

According to DelveInsight’s report, the multiple myeloma treatment market size in the 7MM was valued at USD 21,300 million in 2023. The market is anticipated to grow positively through 2034, driven by factors such as increased incident cases, label expansions of existing therapies, improved penetration of therapies in earlier treatment lines, high adoption rates of newer treatments like CAR-T cell therapies and anti-BCMA therapies, a robust pipeline of emerging therapies, and expected growth in R&D investments. 

Conclusion

To conclude, the multiple myeloma treatment landscape is rapidly evolving, driven by significant advancements in therapeutic options and a deeper understanding of the disease. The market is set for robust growth due to rising incidence rates, expanding treatment labels, and increasing adoption of novel therapies like CAR-T cell treatments and anti-BCMA therapies. Continuous investment in research and development will be pivotal in introducing more effective treatments and improving patient outcomes. Addressing the needs of a growing elderly population and ensuring access to innovative therapies will be critical in the fight against multiple myeloma.