Luspatercept Provides Superior Long-Term Transfusion Independence Compared With Epoetin Alfa in Lower-Risk MDS.

The phase 3 COMMANDS trial compared luspatercept with epoetin alfa in patients with lower-risk myelodysplastic syndromes (LR-MDS), who were transfusion-dependent (TD) and naive to erythropoiesis-stimulating agents (ESAs). At data cutoff (September 22, 2023; median follow-up: luspatercept 21.4 months, epoetin alfa 20.3 months), luspatercept demonstrated significantly greater long-term efficacy.

• RBC transfusion independence (RBC-TI):
• ≥1 year: 44.5% with luspatercept vs. 27.6% with epoetin alfa (p=0.0003).
• ≥1.5 years: 30.2% vs. 13.8% (p<0.0001).
• Median cumulative duration of response: 154.7 weeks with luspatercept vs. 91.1 weeks with epoetin alfa.
• Subgroup findings: Benefits were consistent across clinically relevant groups, including patients with ring sideroblast–negative status, low baseline serum erythropoietin (≤200 U/L), and non-mutated SF3B1.
• Safety: Rates of treatment-emergent adverse events (TEAEs), including asthenia and hypertension, decreased over time in both arms. Progression to high-risk MDS or AML remained low and similar between treatments (<5%).

Conclusion

Extended follow-up confirms luspatercept as the treatment of choice for anemia in ESA-naive, TD LR-MDS, offering superior and durable transfusion independence with a consistent safety profile.

Editorial note: This content was developed with the support of artificial intelligence technologies to optimize the writing and structuring of the information. All material was carefully reviewed, validated, and supplemented by human experts prior to publication, ensuring scientific accuracy and adherence to good editorial practices.

#MDS #Luspatercept #COMMANDSTrial #TransfusionIndependence #Hematology