Opinion|Videos|July 11, 2025
Real-World Evidence in Treatment Selection: Luspatercept vs ESAs in Clinical Practice
Author(s)Saeed Sadeghi, MD
A panelist emphasizes that recent real-world retrospective data from 103 first-line luspatercept-treated patients closely align with, and even slightly exceed, COMMANDS trial results—demonstrating significant hemoglobin improvements and transfusion independence—thereby reinforcing luspatercept’s effectiveness and practical value in routine clinical care for erythropoiesis-stimulating agent–naïve, low-risk patients with myelodysplastic syndrome.
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While randomized phase 3 clinical trial data remains the gold standard for evaluating treatment efficacy, real-world data can offer valuable insights to support clinical decisions. Recently presented retrospective real-world data from 103 patients treated with luspatercept in the first-line setting closely mirrored results seen in the COMMANDS trial. In fact, the real-world outcomes were somewhat more favorable, with 89% of patients achieving a hemoglobin increase of at least 1.5 g/dL within the first 6 months.
Additionally, 27% of these patients became transfusion independent within the first 3 months of treatment, reinforcing the benefits observed in controlled trial settings. This consistency between trial and real-world data is important because it suggests that the effectiveness of luspatercept in improving anemia and reducing transfusion burden translates well into routine clinical practice.
These findings provide further support for considering luspatercept as a first-line treatment option for patients with low-risk myelodysplastic syndromes who are erythropoiesis-stimulating agent naive. They help build confidence in the treatment’s real-world applicability and reinforce its role in improving patient outcomes outside of the controlled environment of clinical trials.
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