Mezigdomide for Adult Relapsed or Refractory Multiple Myeloma

As of August 2026, MARA’s assessment finds Mezigdomide’s reimbursement risk concentrated in safety and adverse effects, with clinical effectiveness a strength; the current MARA Rating and full rationale are available in the report.

The assessment also weighs care pathway integration: how the drug fits into the way care is organised today; a treatment that demands new infrastructure or displaces an established pathway faces extra scrutiny. The strength recorded in clinical effectiveness carries weight because that domain asks how much additional benefit the drug demonstrated over the care patients already receive — the first question every payer asks.

Oncology

This rating sits within MARA’s Oncology coverage, alongside 165 other independently assessed treatments in the same area.

What payers will ask

Is the clinical benefit the kind payers reward? — Clinical effectiveness

The SUCCESSOR-2 trial demonstrated a significant improvement in progression-free survival (PFS) and overall response rate (ORR) for MeziKd compared to Kd, with a hazard ratio for PFS of 0.48 (95% CI 0.36–0.63; p<0.0001). However, overall survival (OS) benefit is not yet established, and follow-up is short.

Does the economic case hold at the expected price? — Cost effectiveness

No economic model, ICER, or cost-utility analysis is available for mezigdomide. NICE’s appraisal is still in development.

Is there quality-of-life evidence payers weigh? — Quality of life

No HRQoL data is available as the registered HRQoL endpoints have not yet yielded publicly reported outcome data.

Does the safety profile hold up for payers? — Safety and Adverse Effects

MeziKd showed increased grade 3/4 adverse events compared to Kd, including neutropenia and infections. The safety profile is characterized by higher short-term toxicity.

Was the drug compared against what payers expect? — Comparator Selection

Kd is a relevant comparator for the studied population, but the trial does not include comparisons with other modern RRMM treatments like CAR-T or bispecific antibodies.

Is the population defined the way payers need it? — Patient Population and Subgroups

The trial population is representative of a contemporary post-anti-CD38/lenalidomide population, but generalizability to frailer patients is limited.

Does the drug fit how care is delivered and paid for? — Care Pathway Integration

The regimen includes oral mezigdomide but retains IV carfilzomib, requiring significant monitoring and supportive care.

Are the wider system costs understood? — Resource Use and Cost Implications

No budget-impact or resource information is presented. Resource categories are identifiable, but costs cannot be quantified.

Would the evidence survive payer scrutiny? — Evidence Quality and Robustness

The SUCCESSOR-2 trial is a well-designed, randomized, active-controlled phase 3 study with high-quality evidence for PFS, but lacks replication and long-term data.

How exposed is the case to uncertainty? — Uncertainty, Sensitivity, and Broader Impacts

There is high uncertainty regarding long-term OS, HRQoL, and cost-effectiveness. The evidence is robust for PFS but lacks broader system impact analysis.

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