Abstract
Introduction: Bispecific antibodies (BsAbs) including teclistamab (tec), talquetamab (talq), and elranatamab (elra) have emerged as treatment options for multiple myeloma (MM). Real-world data are needed to characterize patients who receive these treatments and their healthcare resource utilization (HCRU), which may help guide clinical decision making. Here we report the real-world demographics, administration-related HCRU, and post-administration HCRU of patients who received tec, talq, or elra.
Methods: This was a retrospective cohort study that used the IQVIA PharMetrics Plus® Enhanced Closed Claims database. Adults with MM were included if they were not participating in clinical trials and had a first observed claim for tec, talq, or elra starting with their respective FDA-approval month (tec, Oct 1, 2022; talq and elra, Aug 1, 2023). Continuous enrollment in medical and pharmacy benefits for ≥6 months before and ≥1 month after the step-up dosing index period (defined as the first 7 days of BsAb treatment administration, following label recommendation of 3 step-up doses) was required. Patient demographics were evaluated in the 6 months prior to or during the index period. Administration-related HCRU was evaluated during the index period and post-administration HCRU was evaluated during the 30 days following the index period. Study periods were from Apr 1, 2022 (tec)/Feb 1, 2023 (talq and elra) until Sep 30, 2024.
Results: The tec cohort included 405 patients, the talq cohort included 78 patients, and the elra cohort included 26 patients. Median (interquartile range) ages were 66 (59–74) years for tec, 62 (55–70) years for talq, and 67 (59–78) years for elra. Most patients were male (58.3/62.8/46.2% tec/talq/elra). During the step-up dosing index period, all-cause inpatient admissions were observed for 39.3/10.3/15.4% of patients treated with tec/talq/elra and lasted for a mean (standard deviation [SD]) of 10.1 (7.3)/10.6 (7.5)/5.1 (2.1) days. Emergency room (ER) visits were recorded for 2.5/1.3/19.2% of patients treated with tec/talq/elra. Intensive care unit (ICU) stays were observed for 8.9/7.7% of patients treated with tec/elra, lasting a mean (SD) of 8.3 (6.4)/5.5 (3.5) days, but did not occur in patients treated with talq. In the 30-day post-index period for tec/talq/elra, 19.8/23.1/34.6% of patients had ≥1 all-cause inpatient admission, with 8.4/10.3/11.5% having an ICU stay and 14.3/12.8/34.6% having an ER visit; lengths of stay for tec/talq/elra were a mean (SD) of 9.2 (6.1)/11.9 (9.2)/7.3 (6.9) days for inpatient stays and 10.7 (7.3)/15.9 (11.9)/9.3 (7.8) days for ICU stays. The most frequent diagnoses in the 30 days after tec/talq/elra administration were hypogammaglobulinemia (28.4/32.1/46.2%), hypertension (35.6/21.8/38.5%), and hematologic complications (35.8/41.0/30.8%), which included neutropenia, anemia, thrombocytopenia, and leukopenia. Inpatient admissions related to hypogammaglobulinemia occurred in 7.4/5.1/19.2% of patients receiving tec/talq/elra. Inpatient admissions related to hypertension occurred in 17.3/10.3/19.2% of patients receiving tec/talq/elra. Inpatient admissions related to hematologic complications occurred in 18.8/14.1/15.4% of patients receiving tec/talq/elra. Infections in the 30 days after tec/talq/elra step-up dosing occurred in 14.3/15.4/26.9%. In total, 36.0/52.6/38.5% of patients who received tec/talq/elra were administered intravenous immunoglobulin (IVIG) from 6 months before the index date to 30 days after administration, which increased to 67.9/65.4/50.0% during the full study period. Healthcare costs related to HCRU and HCRU rates over 6 months of follow-up will also be reported.
Conclusions: Inpatient visits and ICU stays were required for patients during step-up dosing and the subsequent 30 days, and these generally lasted >1 week. Approximately half of the patients who experienced hypertension or hematologic complications required inpatient admission during the 30 days following step-up dosing. The majority of patients had IVIG before, during, or after step-up dosing; however, a substantial percentage of patients had hypogammaglobulinemia and noticeable percentages of infections were still observed shortly after initiating the treatment.
