teclistamab: clinical use

Prescribing considerations

• Initiate and supervise through clinicians experienced in multiple myeloma, with staff and facilities able to manage severe CRS and neurological toxicity.
• Do not start the step-up phase during active infection.
• Assess hepatitis B status and consider antiviral, antimicrobial and immunoglobulin-support strategies according to local protocols.
• Counsel patients about CRS, ICANS, infection, driving restrictions, contraception and the alert card.

Contraindications and cautions

• Hypersensitivity to teclistamab or an excipient.
• Exercise particular caution with active infection, previous or current hepatitis B, recent stroke or seizure, and limited evidence in severe renal or moderate-to-severe hepatic impairment.

Monitoring

• Record product name and batch number.
• Check blood counts at baseline and periodically; monitor for neutropenia, anaemia and thrombocytopenia.
• Monitor immunoglobulins and signs of new or reactivated infection.
• Assess for CRS and ICANS, particularly around initial or restarted treatment.

Clinical pharmacology

A full-length humanised IgG4-PAA bispecific antibody binding BCMA on myeloma-lineage cells and CD3 on T cells. It redirects and activates cytotoxic T cells, producing perforin- and granzyme-mediated death of BCMA-expressing cells.

Formulation and product differences

• Single-use solution for subcutaneous injection.
• Different vial concentrations have distinct preparation roles and must not be combined to prepare a maintenance administration.
• Store refrigerated, do not freeze and protect from light.

Injection

Route: Parenteral

Strengths: 10 mg/mL, 90 mg/mL