Infectious complications in relapsed/refractory multiple myeloma patients treated with bispecific antibodies: Meta-analysis.

Abstract

e19536 Background: Bispecific antibodies (BsABs) have emerged as promising therapeutic modalities for relapsed/refractory multiple myeloma (RRMM), with three FDA-approved drugs currently available: teclistamab, talquetamab, and elranatamab. However, treatment-related adverse events like infection-related complications, remain a significant concern. This meta-analysis evaluated the occurrence and severity of infection-related adverse events associated with BsABs. Methods: A systematic literature review was conducted with MEDLINE, Embase, and Cochrane, to identify trials evaluating infectious adverse events of BsABs in patients with RRMM. Data extracted included the number of patients, grade ≥ 3 infectious adverse events, and non-grade ≥ 3 infectious adverse events. Analyses were conducted using R software and the meta package. A random effect model was utilized. Results: 8 studies (6 RCTs, 2 retrospective) involving 1,013 patients (teclistamab: 461, talquetamab: 374, elranatamab: 178) were analyzed. For elranatamab, the pooled proportion (PP) of infections was 0.714 (CI [0.397–0.904]), with grade ≥ 3 infections at 0.344 (CI [0.015–0.948]). Common infections were adenovirus, CMV, COVID-19, and pneumocystis jirovecii. In the talquetamab group, infections had a PP of 0.636 (CI [0.305–0.874]), and grade ≥ 3 were 0.201 (CI [0.110–0.339]), with COVID-19 & pneumonia most reported. PP for teclistamab was 0.517 (CI [0.183–0.837]), and grade ≥ 3 were 0.233 (CI [0.058–0.598]). Common infections were pneumonia, COVID-19, pseudomonas, respiratory tract infections, and UTIs. Table 1 shows consistently reported AEs amongst the three bispecific antibodies for comparability. Conclusions: Various infection-related adverse events were observed in RRMM patients treated with BsABs. While these therapeutic modalities demonstrate promising efficacy, oncologists, infectious disease physicians, and pharmacists need awareness of potential toxicities to establish strategies for infectious disease prevention and management to provide quality care. Infection related complications of teclistamab, talquetamab, and elranatamab, abridged. Parameter Pooled Proportion 95% Confidence Interval (CI) p-value I² Elranatamab Infection Any Grade 0.713 [0.397;0.904] 0.5286 0.0% Elranatamab Infection Grade ≥3 0.344 [0.015; 0.948] 0.1086 61.2% Elranatamab COVID-19 Infection Any Grade 0.090 [0.000;1.000] 0.0313 78.4% Talquetamab Infection Any Grade 0.636 [0.305; 0.874] 0.3166 0.3% Talquetamab COVID-19 Infection 0.055 [0.000;1.000] 0.0008 9.1% Talquetamab Pneumonia 0.140 [0.004; 0.864] 0.1693 47.1% Teclistamab Infection, Any Grade 0.517 [0.183;0.837] 0.1874 95.1% Teclistamab Infection Grade ≥3 0.233 [0.058; 0.598] 0.0906 93.2% Teclistamab COVID-19 Infection 0.120 [0.006;0.752] 0.0001 92.2% Teclistamab Pneumonia Any Grade 0.136 [0.076;0.231] 0.1874 37.4%