elranatamab at a glance
Medicine class
Bispecific BCMA- and CD3-directed antibody
Main use
Relapsed and refractory multiple myeloma in previously treated adults
Administration
Subcutaneous injection given by a trained healthcare professional
Important risks
Cytokine release syndrome, neurological toxicity and serious infection
What is elranatamab used for?
Licensed as monotherapy for:
Adults with relapsed and refractory multiple myeloma who have received at least three previous therapies, including an immunomodulatory agent, a proteasome inhibitor and an anti-CD38 antibody, with progression on the most recent therapy.
How does elranatamab work?
Elranatamab binds BCMA on myeloma cells and CD3 on T cells, bringing them together. This activates the T cells and promotes destruction of myeloma cells.
elranatamab preparations and strengths
Injection
Route: Parenteral
Strengths: 40 mg/mL
How to take elranatamab
A healthcare professional gives elranatamab under the skin in a specialist setting equipped to manage severe immune reactions. It is injected into the abdomen or thigh, avoiding red, bruised, tender, hard or scarred skin. Follow the treatment centre's observation, proximity and pre-treatment instructions.
Do not inject it yourself.
Carry the patient alert card.
Report fever, neurological symptoms or signs of infection promptly.
elranatamab side effects
Common or expected effects
- Low red cells, white cells or platelets
- Tiredness
- Upper respiratory infection or pneumonia
- Cytokine release syndrome
- Diarrhoea or nausea
- Injection-site reaction
- Reduced appetite
- Fever
- Rash or dry skin
- Joint pain
- Low blood potassium
- Breathlessness
Get urgent medical advice
- Fever with breathlessness, low blood pressure, faintness or rapid heartbeat—possible cytokine release syndrome
- Confusion, difficulty speaking or writing, reduced consciousness, weakness or seizures—possible ICANS or other neurological toxicity
- Fever or other signs of severe infection, particularly with low white-cell counts
- Severe breathlessness, pneumonia or sepsis symptoms
- New or worsening neurological symptoms that could indicate progressive multifocal leukoencephalopathy
elranatamab in pregnancy
Pregnancy should be excluded before treatment. Elranatamab is not recommended during pregnancy because it may harm the fetus. Effective contraception is advised during treatment and for 6 months afterwards. Exposure requires specialist review, including consideration of the newborn's immunoglobulin levels.
elranatamab while breastfeeding
Breastfeeding is not recommended during treatment or for 6 months afterwards. It is unknown whether elranatamab enters human milk, and a risk to the child cannot be excluded.
elranatamab interactions
Formal interaction studies have not been performed. Clinicians should review all medicines and vaccines before treatment.
Sensitive CYP substrates with a narrow therapeutic index, including warfarin, phenytoin, ciclosporin and sirolimus
Cytokine release may temporarily suppress CYP enzymes and increase exposure or toxicity, so closer monitoring may be needed.
Live viral vaccines
Not recommended around treatment because safety has not been established and immune responses may be impaired.
Common questions about elranatamab
Answers are fully visible for fast scanning and source review.
Is elranatamab chemotherapy?
It is a targeted immunotherapy rather than conventional cytotoxic chemotherapy. This bispecific antibody directs T cells towards myeloma cells.
What are CRS and ICANS?
CRS is an immune reaction that may cause fever, chills, low blood pressure, rapid heartbeat or low oxygen. ICANS is an immune-related neurological reaction that may cause confusion, speech or writing difficulty, reduced alertness, weakness or seizures. Both require urgent assessment.
Does elranatamab increase infection risk?
Yes. It can reduce blood cells and antibody levels, and serious, reactivated or opportunistic infections have occurred.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.