Dr Jain on Results From the COMMANDS Trial in Lower-Risk MDS

Akriti Jain, MD, Department of Hematology and Medical Oncology, Cleveland Clinic, discusses results from the phase 3 COMMANDS trial (NCT03682536) in patients with transfusion-dependent lower-risk myelodysplastic syndromes (MDS), according to a presentation at the 2023 ASH Annual Meeting.

The COMMANDS study evaluated the use of luspatercept-aamt (Reblozyl) in low-risk patients with MDS. This study examined the efficacy and safety of luspatercept compared with epoetin alfa in patients with transfusion-dependent, low-risk MDS who had not been previously treated with an erythropoiesis-stimulating agent (ESA), Jain explains. Findings from this study were also recently published in the Lancet, she adds.

Data from the phase 3 trial also supported the regulatory approval of luspatercept in the United States for the management of anemia in ESA-naive low-risk MDS patients, Jain expands. The approval of this agent provides patients with an option that may enhance transfusion independence and overall responses among, she says. The primary end point of the study was sustained red blood cell (RBC) transfusion independence for more than 12 weeks, coupled with a simultaneous increase in hemoglobin levels by 1.5 grams per deciliter, Jain explains.

The results demonstrated a significant improvement in RBC transfusion independence compared with ESA in the intention-to-treat population, she continues. The luspatercept arm exhibited a robust and statistically significant response rate of 60.4%, surpassing the 34.8% response rate in the alternative arm (P < 0.0001), Jain explains. These findings have sparked considerable interest in luspatercept within MDS, as they mark an advancement in the understanding and management of MDS-related anemia in patients with ESA-naive, low-risk disease, Jain concludes.

Overall, findings from the COMMANDS trial are consistent with data from the prior interim analysis, affirming that the duration of red blood cell transfusion independence and the erythroid responses achieved with luspatercept are superior to those achieved with epoetin