elranatamab: clinical use

Prescribing considerations

• Initiate and supervise through clinicians experienced in multiple myeloma, with trained staff and facilities able to manage CRS and ICANS.
• Exclude active infection and verify pregnancy status before starting; do not initiate during an active infection.
• Consider antimicrobial and antiviral prophylaxis according to local institutional guidance.
• Review narrow-therapeutic-index CYP substrates and vaccination plans.
• Data are limited in severe renal impairment and unavailable in moderate or severe hepatic impairment.

Contraindications and cautions

• Hypersensitivity to elranatamab or any excipient.

Monitoring

• Baseline and periodic full blood count.
• Signs and symptoms of CRS, ICANS and other neurological toxicity.
• New, recurrent or reactivated infections, including possible PML.
• Immunoglobulin levels; consider replacement according to clinical status and local guidance.
• Transaminases and bilirubin at baseline and as clinically indicated.
• Record product name and batch number for biological traceability.

Clinical pharmacology

An IgG2 kappa bispecific T-cell engager that binds BCMA on plasma-lineage and myeloma cells and CD3-epsilon on T cells, causing T-cell activation, cytokine release and tumour-cell lysis.

Formulation and product differences

• Ready-to-use, single-use subcutaneous solution in vials; it does not require dilution and must not be shaken.
• Two vial fill sizes are available at the same concentration.

Injection

Route: Parenteral

Strengths: 40 mg/mL