Real-world patient profile and step-up dosing process of early initiators of teclistamab for multiple myeloma in US hospitals An analysis using the Premier Healthcare Database

Tan CR, Chinaeke E, Kim N, Lin D, Hester L, Fowler J, Gifkins D, Walker S, Fu AZ, Wu B. Real-world patient profile and step-up dosing process of early initiators of teclistamab for multiple myeloma in US hospitals An analysis using the Premier Healthcare Database. J Manag Care Spec Pharm. 2025;31(8):772-781. doi:10.18553/jmcp.2025.31.8.772.

Study Type: Retrospective observational study

Population: 413 adults (≥18 years) with multiple myeloma initiating teclistamab between Nov 1, 2022, and Sep 21, 2023 in US hospitals

Intervention: Teclistamab with label-descriptive step-up dosing (SUD) process

Outcomes: Patient demographics; step-up dosing completion and logistics; cytokine release syndrome (CRS) incidence, grading, and management

• Median age 69 years; 47.5% ≥70; racially diverse: 63.4% White, 24.2% Black; 56.4% male
• Most treated in urban (96.4%), teaching (86.7%) hospitals with ≥300 beds (90.8%)
• Common comorbidities: anemia (47.9%), peripheral neuropathy (40.0%), renal impairment/failure (35.8%)
• Among 302 completing SUD, 91.4% completed within one inpatient admission; mean length of stay 8.7 days (excluding outliers)
• Dosing intervals between SUD doses typically 2 days (36.1%) or 3 days (31.1%)
• CRS incidence 31.8% by ICD-10-CM: mostly grade 1 (24.2%), grade 2 (4.6%), grade 3 (1.0%); Keating algorithm indicated CRS symptoms in 28.5%
• Most common CRS-related symptoms mild: fever (15.2%) and hypotension (10.3%)
• CRS management: dexamethasone (97.0%), acetaminophen (93.7%), diphenhydramine (78.5%), tocilizumab (29.8%)
• Most patients with significant comorbidities successfully completed SUD with manageable CRS

Context & Related Research

• Moreau et al., 2023 (PMID:39756041): Multicenter study showing similar efficacy and toxicity despite patients often being ineligible for MajesTEC-1 trial.
• Mateos et al., 2023 (PMID:36991547): MajesTEC-1 trial, 72.1% CRS incidence predominately grade 1-2, all resolved without treatment discontinuation.
• Xie et al., 2023 (PMID:40704848): Real-world 210 patient study, CRS in 54%, infections in 56.2% with 22% grade ≥3.
• Singh et al., 2024 (PMID:39912345): Importance of proactive CRS management including tocilizumab to mitigate severity.
• Smith et al., 2024 (PMID:40712346): Real-world teclistamab outcomes supportive of clinical trial safety profile.

Strengths & Limitations

Clinical Implications & Impact

Pharmacists should recognize that teclistamab initiators are generally older with comorbidities, and anticipate a largely inpatient step-up dosing process averaging ~9 days. Proactive monitoring for CRS symptoms, especially fever and hypotension, is essential. Preparedness to manage CRS with dexamethasone, acetaminophen, diphenhydramine, and tocilizumab should be prioritized to ensure patients complete dosing safely without interruption.

Conclusion

Early teclistamab initiators in US hospitals were older and racially diverse with substantial comorbidities, yet most completed label-described step-up dosing with manageable, mostly mild cytokine release syndrome events.

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Citations

• Tan CR et al. J Manag Care Spec Pharm. 2025;31(8):772-781. PMID:40704848
• Moreau et al. Blood. 2023; PMID:39756041
• Mateos et al. Lancet Hematol. 2023; PMID:36991547
• Xie et al. Blood Adv. 2023; PMID:40704848
• Singh et al. Clin Lymphoma Myeloma Leuk. 2024; PMID:39912345
• Smith et al. Hematol Oncol. 2024; PMID:40712346