Breakthrough Insights from UAE Researchers on Heart Medications in Myeloma Care

Multiple myeloma (MM), a type of blood cancer characterized by the uncontrolled growth of plasma cells in the bone marrow, poses significant challenges for patients, particularly those over 65 who often battle concurrent heart conditions. A groundbreaking study led by scientists at the University of Sharjah in the United Arab Emirates has provided crucial evidence that commonly prescribed heart drugs do not compromise MM treatment outcomes and may even offer survival benefits for certain classes. Published in Scientific Reports, this international collaboration analyzed data from major phase III clinical trials, offering reassurance to clinicians managing the dual burdens of cancer and cardiovascular disease.

The research highlights how antihypertensive agents like angiotensin-converting enzyme inhibitors (ACE inhibitors, ACEi) and angiotensin II receptor blockers (ARBs) were linked to improved progression-free survival (PFS), despite some increased risks of side effects. This finding is especially relevant in the UAE, where diabetes and cardiovascular comorbidities affect up to 88% of MM patients, complicating standard therapies like daratumumab-based regimens.

Understanding Multiple Myeloma: Prevalence and Challenges in the UAE

Multiple myeloma accounts for about 10% of hematologic malignancies worldwide and is increasingly diagnosed in the Gulf region, including the UAE, due to an aging population and rising diabetes rates. In Dubai alone, real-world data shows a growing disease burden, with high rates of anemia (50%), renal impairment, and bone disease at diagnosis. Survival rates have improved globally with novel agents, but comorbidities like hypertension and heart disease—prevalent in 88% of UAE cases—often force treatment adjustments.

UAE's healthcare system, bolstered by advanced centers like Tawam Hospital and Burjeel Cancer Institute, has reported promising early responses to induction therapies, with overall response rates around 80% in initial cohorts. However, long-term survival data remains limited, making studies like this essential for tailoring care to local demographics.

The Intersection of Heart Disease and Myeloma Treatment

Patients with MM face heightened cardiovascular risks from the disease itself—through amyloidosis, hyperviscosity, or anemia—and from treatments like proteasome inhibitors (e.g., bortezomib) or immunomodulators (e.g., lenalidomide), which can exacerbate heart strain. In the UAE, where cardiovascular diseases are a leading cause of death, up to 31% of MM patients use ACEi/ARBs at baseline, 23% beta-blockers, and 21% statins. Prior observational data hinted at potential benefits from drug repurposing, but phase III trial evidence was lacking until now.

This comorbidity overlap underscores the need for evidence on whether essential heart medications interfere with anti-myeloma therapies, particularly daratumumab combinations that have revolutionized care for newly diagnosed and relapsed/refractory cases.

Delving into the University of Sharjah-Led Study Design

The study pooled individual patient data from 1,804 adults across three landmark phase III trials: MAIA (daratumumab-lenalidomide-dexamethasone vs. lenalidomide-dexamethasone for transplant-ineligible newly diagnosed MM), POLLUX (daratumumab-lenalidomide-dexamethasone for relapsed/refractory MM), and CASTOR (daratumumab-bortezomib-dexamethasone for relapsed/refractory MM). Researchers assessed baseline use of five cardiovascular classes: beta-blockers, calcium channel blockers (CCBs), ACEi/ARBs, statins, and diuretics.

• Primary Endpoints: Progression-free survival (PFS) and overall survival (OS).
• Safety Endpoint: Grade ≥3 adverse events (AEs) per Medical Dictionary for Regulatory Activities (MedDRA).
• Analysis: Cox proportional hazards models (adjusted for age, sex, ISS stage, etc.) and logistic regression.

Missing data was imputed, ensuring robust statistics. Funded by a University of Sharjah grant, this work exemplifies UAE's push in pharmacoepidemiology.

Key Findings: Beta-Blockers and Calcium Channel Blockers Show No Harm

Among the drugs examined, beta-blockers (used by 23% of patients) and CCBs (17%) demonstrated no significant impact on OS, PFS, or grade ≥3 AEs. Univariate analysis hinted at worse OS with CCBs (HR 1.40), but adjustments nullified this, providing clear safety signals.

These results alleviate concerns for UAE clinicians prescribing these for hypertension control alongside myeloma regimens.

Statins and Diuretics: Safety Profile with Nuances

Statins (21% usage) showed neutral effects across all outcomes, aligning with prior Swedish data suggesting potential survival gains but not confirmed here. Diuretics (16%) raised flags for higher grade ≥3 AEs (aOR 1.53), particularly renal failure (aOR 2.54) and electrolyte imbalances (aOR 2.14), likely due to MM's kidney impact—"myeloma kidney." No survival detriment observed.

For UAE patients, where renal comorbidities hit 28%, vigilant monitoring is advised for diuretic users on daratumumab therapy.

ACE Inhibitors/ARBs: Promising PFS Benefit Amid Safety Concerns

The standout: ACEi/ARBs (31%) linked to 16% better PFS (aHR 0.84, P=0.034), possibly via anti-angiogenic or immunomodulatory effects. However, elevated grade ≥3 AEs (aOR 1.45), including renal issues (aOR 1.64) and hyperglycemia (aOR 2.58), warrant caution. No OS impact.

• Mechanisms: Renin-angiotensin system blockade may curb myeloma cell proliferation.
• Clinical Tip: Dose adjustments and renal function tracking essential in high-risk UAE cohorts.

Read the full study for detailed Kaplan-Meier curves.

Spotlight on University of Sharjah's Role in Global Oncology Research

Lead investigator Ahmad Y. Abuhelwa and team from Sharjah's College of Pharmacy and Research Institute spearheaded this analysis, supported by a university grant. Collaborators include Humaid O. Al-Shamsi (Burjeel Cancer Institute, Abu Dhabi) and international experts from Australia and Qatar. This underscores UAE universities' ascent in pharmacotherapy research, aligning with national visions like UAE Centennial 2071 for health innovation.

Sharjah's contributions extend to prior MM reports from Tawam Hospital (Al Ain, affiliated with UAEU), building a robust regional evidence base. For aspiring researchers, explore higher ed jobs in UAE pharmacy and oncology programs.

Implications for UAE Clinicians and Patients

In the UAE, where MM market is projected to hit $500 million by 2030 amid rising incidence, these findings enable confident polypharmacy. Avoid routine diuretic/ACEi/ARB cessation; prioritize monitoring. Tailored approaches could boost PFS in comorbid patients, enhancing quality of life.

Real-world registries like Gulf MM studies reinforce need for localized data, positioning UAE as a hub for personalized myeloma care.

Future Outlook: Drug Repurposing and UAE Research Horizons

Prospective trials are urged to validate PFS benefits and mitigate AEs. UAE's investments in AI-driven drug discovery at Khalifa University and MBZUAI could accelerate repurposing. Ongoing registries will track long-term survival, vital as UAE's elderly population grows.

Stakeholders: Patients gain optimized care; researchers, new hypotheses; policymakers, evidence for funding. Explore UAE university jobs in medical research.

Photo by Earl Wilcox on Unsplash

Why This Matters for UAE Higher Education and Careers

University of Sharjah's leadership exemplifies how UAE institutions foster impactful science amid global challenges. With MM research surging, opportunities abound in clinical pharmacology, oncology nursing, and data science. Aspiring professionals can leverage platforms like Rate My Professor, higher ed jobs, and career advice to join this vital field. Internal links to university jobs and recruitment connect talent to roles driving UAE's health future.