Stakeholder Perspective: Step-Up Dosing for Bispecific Antibodies in Multiple Myeloma

Opinion
Video

Experts discuss their institution’s implementation of step-up dosing for bispecific antibodies and share their best practices.

This is a video synopsis/summary of a Practice Pearls involving Ryan Haumschild, PharmD, MS, MBA; Matthew Pianko, MD; and Anthony Perissinotti, PharmD, BCOP.

Perissinotti discusses his institution’s approach to implementing step-up dosing for bispecific antibodies. Unlike therapies with weekly dosing that allow for observation admissions between doses, the frequent dosing schedule of myeloma bispecifics makes this challenging. Admitting patients for the full step-up dosing duration was determined to be less taxing for patients than frequent inpatient/outpatient transitions.

They initially followed the exact schedule listed in the prescribing information for teclistamab’s day 1, 4, and 7 schedule. However, they found day 1, 3, and 5 dosing allowed for shorter admissions of approximately 6 to 7 days. For elranatamab, some patients are discharged after 24 hours instead of 48 hours after the day 4 dose if no cytokine release syndrome (CRS) symptoms occur, shortening admission to around 6 days.

Perissinotti agrees outpatient administration is ideal but highlights barriers like staffing shortages and the infrastructure needed beyond guidelines and education. Interesting American Society of Hematologyabstracts suggest tocilizumab premedication almost eliminates CRS risk, enabling outpatient dosing, but he is hesitant to adopt this given the high cost and potential impact on efficacy if T-cell activation is reduced.

Haumschild emphasizes ensuring appropriate frameworks for success before widespread adoption. Key priorities should focus on staff training, monitoring, and avoiding negative outcomes rather than institutional cost savings or improved experience alone. He envisions increased bispecific antibody availability in the community through partnerships enabling access beyond academic centers.

 

Video synopsis is AI-generated and reviewed by Pharmacy Times® editorial staff.

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