COMMANDS
COMMANDS showed that luspatercept freed more people with lower-risk myelodysplastic syndromes from blood transfusions than the erythropoietin injections that had been the first-line standard for decades.
Overview
COMMANDS was an open-label phase 3 trial of 363 patients with very low-, low- or intermediate-risk myelodysplastic syndromes who needed red cell transfusions and had not yet received an erythropoiesis-stimulating agent. They were randomised to luspatercept, which promotes late-stage red cell maturation by trapping TGF-beta superfamily ligands, or to epoetin alfa. The primary endpoint was transfusion independence for at least 12 weeks with a concurrent haemoglobin rise in the first 24 weeks.
More patients on luspatercept met the primary endpoint, with longer durations of transfusion independence, and the benefit was seen with and without ring sideroblasts. The result moved luspatercept into first-line use, with United States approval in August 2023.
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