Thalidomide and lenalidomide are equivalent with respect to survival outcomes in patients with multiple myeloma, but thalidomide is associated with higher rates of neurotoxicity in clinical practice settings, a study published in the European Journal of Cancer has shown.1

To compare the effectiveness of thalidomide and lenalidomide and their associated rates of neurotoxicity in the treatment of multiple myeloma, researchers designed an observational cohort study of patients with multiple myeloma receiving either thalidomide or lenalidomide in routine care in the United States.

For the study, investigators analyzed data from 1264 patients who initiated lenalidomide or thalidomide between 2004 and 2013. Data was obtained from administrative claims from UnitedHealth, a large national health insurance provider.

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The study showed that there was no significant difference in the rates of death between the 2 groups (hazard ratio [HR], 1.00; 95% CI, 0.71-1.41).

However, researchers found that 35% of the 406 new users of thalidomide developed peripheral neuropathy during an average of 499 person-days of follow-up compared with 29% of the 858 new lenalidomide users during 587 person-days.

The study demonstrated that lenalidomide treatment was associated with 29% reduced risk for developing peripheral neuropathy vs thalidomide treatment (HR, 0.71; 95% CI, 0.56-0.92).

These findings ultimately support previously reported studies that showed thalidomide and lenalidomide are associated with similar survival outcomes and demonstrate that thalidomide is associated with a higher risk for peripheral neuropathy in clinical practice settings.


  1. Luo J, Gagne JJ, Landon J, Avorn J, Kesselheim AS. Comparative effectiveness and safety of thalidomide and lenalidomide in patients with multiple myeloma in the United States of America: a population-based cohort study. Eur J Cancer. 2017;70:22-33. doi: 10.1016/j.ejca.2016.10.018. [epub ahead of print]