Management and prevention of adverse events associated with elotuzumab and CD38-targeting antibodies
| Adverse event . | Antibody . | Prevention and management . |
|---|---|---|
| General management of adverse events | CD38-targeting antibodies and elotuzumab | In general, dose-delay is the primary method for the management of side effects (and not dose-reductions) |
| Infections | CD38-targeting antibodies and elotuzumab | No formal recommendations can be made at the present time. Herpes zoster prophyaxis should be considered. It is recommended to screen patients for HIV, HBV, and HCV before start of therapy. |
| Infusion-related reactions | Infusion-related reactions occur more frequently with CD38-targeting antibodies than with elotuzumumab | Prevention Premedication, consisting of steroids, antihistamines and acetaminophen, 30-60 minutes prior to infusion.* For patients treated with CD38-targeting antibodies with higher risk of respiratory complications (eg, FEV1 <80%), postinfusion medication should be considered (eg, antihistamines, β-2 adrenergic receptor agonist by inhalation, or control medication for patients with asthma and COPD such as inhalation corticosteroids) For daratumumab: patients with known COPD with a FEV1 <50% of the predicted normal value, with moderate or severe persistent asthma within the past two years, or with uncontrolled asthma, were excluded from trials with daratumumab. Therefore, we recommend to perform FEV1 testing for patients with suspicion of having COPD, and it should be considered to exclude patients from daratumumab treatment if FEV1 <50% of predicted. Given similar pattern and frequency of infusion-related reactions, we also recommend FEV1 testing for patients planned to be treated with isatuximab. Treatment: Interrupt infusion, consider administration of corticosteroids, antihistamines, IV fluid, or β-2 adrenergic receptor agonist by inhalation; after infusion reaction is resolved, restart infusion at lower rate (e.g. half of that used before the interruption) Patients experiencing respiratory events, which occur more frequently with CD38-targeting antibodies, may benefit from pre- and postinfusion prophylaxis with a bronchodilator or in case patients have concomitant asthma or COPD additional medication such as inhalation corticosteroids to control lung disease |
| Adverse event . | Antibody . | Prevention and management . |
|---|---|---|
| General management of adverse events | CD38-targeting antibodies and elotuzumab | In general, dose-delay is the primary method for the management of side effects (and not dose-reductions) |
| Infections | CD38-targeting antibodies and elotuzumab | No formal recommendations can be made at the present time. Herpes zoster prophyaxis should be considered. It is recommended to screen patients for HIV, HBV, and HCV before start of therapy. |
| Infusion-related reactions | Infusion-related reactions occur more frequently with CD38-targeting antibodies than with elotuzumumab | Prevention Premedication, consisting of steroids, antihistamines and acetaminophen, 30-60 minutes prior to infusion.* For patients treated with CD38-targeting antibodies with higher risk of respiratory complications (eg, FEV1 <80%), postinfusion medication should be considered (eg, antihistamines, β-2 adrenergic receptor agonist by inhalation, or control medication for patients with asthma and COPD such as inhalation corticosteroids) For daratumumab: patients with known COPD with a FEV1 <50% of the predicted normal value, with moderate or severe persistent asthma within the past two years, or with uncontrolled asthma, were excluded from trials with daratumumab. Therefore, we recommend to perform FEV1 testing for patients with suspicion of having COPD, and it should be considered to exclude patients from daratumumab treatment if FEV1 <50% of predicted. Given similar pattern and frequency of infusion-related reactions, we also recommend FEV1 testing for patients planned to be treated with isatuximab. Treatment: Interrupt infusion, consider administration of corticosteroids, antihistamines, IV fluid, or β-2 adrenergic receptor agonist by inhalation; after infusion reaction is resolved, restart infusion at lower rate (e.g. half of that used before the interruption) Patients experiencing respiratory events, which occur more frequently with CD38-targeting antibodies, may benefit from pre- and postinfusion prophylaxis with a bronchodilator or in case patients have concomitant asthma or COPD additional medication such as inhalation corticosteroids to control lung disease |
FEV1, forced expiratory volume in 1 second.
Prophylactic treatment with the oral leukotriene antagonist montelukast 10 mg the day before and again on the morning of infusion is considered by some investigators to be a useful adjunct to the standard premedication with acetaminophen, antihistamine, and corticosteroid to prevent airway reactions following the administration of CD38-targeting antibodies.