Background: The 5-year follow-up of the Phase III POLARIX trial confirmed a sustained progression-free survival benefit of Pola-R-CHP over R-CHOP for patients with previously untreated DLBCL (Salles et al. ASH 2024). Pola-R-CHP has been accepted as a new standard of care, and data regarding potential treatment inequities in the first-line DLBCL setting are emerging. This real-world study aimed to identify the demographic and socioeconomic differences between patients with newly diagnosed DLBCL receiving Pola-R-CHP vs R-CHOP.

Methods: A claims-based analysis was conducted using the 100% Medicare Fee-for-Service database. This study included Medicare beneficiaries aged ≥66 years who had ≥1 claim for Pola-R-CHP or R-CHOP (classification of regimens adapted from Burke et al. CLML 2023) between April 23, 2023 and December 31, 2024, had a DLBCL diagnosis, were continuously enrolled in Medicare Parts A and B, and had not received treatment for DLBCL for 12 months prior to receiving Pola-R-CHP or R-CHOP.

Baseline demographics and socioeconomic factors, including race/ethnicity, gender, age, and dual eligibility for Medicare and Medicaid, were analyzed. In addition, county-level socioeconomic factors and data on healthcare resource availability from external data sources were included. United States (US) census regions were also included to examine differences in Pola-R-CHP utilization.

A descriptive bivariate analysis was conducted to evaluate the association of each independent variable with receipt of Pola-R-CHP vs R-CHOP. A logistic regression was performed to determine the likelihood of receiving Pola-R-CHP vs R-CHOP. The logistic regression model included patient-level socioeconomic factors, year of treatment administration, clinical comorbidity score, county-level socioeconomic factors, and US census regions.

Results: The study sample included 1,996 and 7,107 Medicare beneficiaries who received Pola-R-CHP and R-CHOP, respectively. Several differences were observed between the two cohorts: patients treated with Pola-R-CHP vs R-CHOP were likely to be younger (mean age: 75 vs 77 years, p<0.0001; 65–74 years: 44% vs 31%, p<0.0001), have a lower Charlson Comorbidity Index score (mean score: 2.5 vs 2.9, p<0.0001), and were less likely to be eligible for both Medicare and Medicaid (5% vs 7%, p=0.0025). Patients receiving Pola-R-CHP were more likely to live in areas with fewer veterans (p<0.0001) and in areas with less poverty (p=0.0026) compared with the R-CHOP cohort. There were regional differences in the receipt of Pola-R-CHP vs R-CHOP, including a higher percentage of patients receiving Pola-R-CHP in the Northeast (23% vs 19%, respectively; p<0.0001) and a lower percentage of patients receiving Pola-R-CHP in the West (18% vs 21%, respectively; p=0.0071). There were no differences in race/ethnicity, gender, or living in urban or rural areas between the Pola-R-CHP and R-CHOP cohorts.

The final logistic regression model identified several factors associated with influencing the odds of receiving Pola-R-CHP vs R-CHOP. Controlling for other variables, the model found that older patients (odds ratio [OR]: 0.94, 95% confidence interval [CI]: 0.93–0.95), patients with dual eligibility status for Medicare and Medicaid (OR: 0.71, 95% CI: 0.56–0.89), patients with a higher Charlson comorbidity score (OR: 0.95, 95% CI: 0.93–0.98), and patients living in counties with a proportion of veterans above the median (OR: 0.86, 95% CI: 0.76–0.97) were less likely to receive Pola-R-CHP vs R-CHOP. The likelihood of receiving Pola-R-CHP increased 1 year after Pola-R-CHP entered the US market (2024 vs 2023; OR: 1.76, 95% CI: 1.59–1.96) and was also higher in the Northeast vs the South (OR: 1.18, 95% CI: 1.02–1.37).

Conclusions: To our knowledge, this is the first real-world study examining the characteristics of Medicare beneficiaries receiving Pola-R-CHP or R-CHOP for newly diagnosed DLBCL. Treatment inequities relating to patient comorbidity status, socioeconomic status, and geographic location were observed. Future research is warranted to examine the trends and variation in Pola-R-CHP use, ensuring equitable access for Medicare beneficiaries with newly diagnosed DLBCL.

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2025
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