@article{031de657b0894b0c975e69b8dad4fba4,
title = "Comparative clinical effectiveness of azacitidine versus decitabine in older patients with myelodysplastic syndromes",
abstract = "The hypomethylating agents (HMAs) azacitidine and decitabine are both approved for treatment of myelodysplastic syndromes (MDS) in the USA. In Europe, decitabine is not approved due to lack of survival advantage in randomized trials. The two drugs have not been compared in clinical trials. We identified patients diagnosed with MDS between 2004 and 2011 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in the USA who received ≥ 10 doses of either HMA. We estimated survival from HMA initiation with Kaplan–Meier methods and used multivariate Cox proportional hazards models to adjust for covariates. Analyses controlled for histological subtype and we conducted a subset analysis limited to patients with refractory anaemia with excess blasts (RAEB). In 2025 HMA-treated patients, median survival was 15 months with no difference in survival based on the HMA received in adjusted analysis (decitabine versus azacitidine, hazard ratio = 1·06, 95% confidence interval: 0·94–1·19, P = 0·37). For RAEB patients (n = 523), median survival was 12 months, with no significant difference based on HMA received. No significant survival difference was found between azacitidine and decitabine in patients with MDS, including RAEB. Importantly, population-based survival of azacitidine-treated RAEB patients was substantially shorter than in the AZA-001 clinical trial (11 versus 24·5 months).",
keywords = "azacitidine, comparative clinical effectiveness, decitabine, hypomethylating agents, myelodysplastic syndromes",
author = "Zeidan, {Amer M.} and Davidoff, {Amy J.} and Long, {Jessica B.} and Xin Hu and Rong Wang and Xiaomei Ma and Gross, {Cary P.} and Abel, {Gregory A.} and Huntington, {Scott F.} and Podoltsev, {Nikolai A.} and Uno Hajime and Thomas Prebet and Gore, {Steven D.}",
note = "Funding Information: The results of this study were presented in part at the American Society of Hematology (ASH) Annual Meeting in Orlando, FL, December 5–8, 2015. This research was partly funded by the Dennis Cooper Hematology Young Investigator Award (AZ), a P30 CA016359 from the National Cancer Institute (XM), and an American Cancer Society Research Scholar Award (GAA). The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the state-wide cancer reporting programme mandated by California Health and Safety Code Section 103885; the National Cancer Institute (NCI)'s Surveillance, Epidemiology and End Results (SEER) Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare and Medicaid Services; Information Management Services, Inc.; and the SEER Program tumor registries in the creation of the SEER-Medicare database. The interpretation and reporting of the SEER-Medicare data are the sole responsibility of the authors. Publisher Copyright: {\textcopyright} 2016 John Wiley & Sons Ltd",
year = "2016",
month = dec,
day = "1",
doi = "10.1111/bjh.14305",
language = "English (US)",
volume = "175",
pages = "829--840",
journal = "British Journal of Haematology",
issn = "0007-1048",
publisher = "Wiley-Blackwell",
number = "5",
}