Department of Pharmacy, Atrium Health, Levine Cancer Institute, Concord, NC.
Specialty Pharmacy Services, Atrium Health, Charlotte, NC.
Clin Lymphoma Myeloma Leuk. 2020 Oct;20(10):e777-e781. doi: 10.1016/j.clml.2020.05.024. Epub 2020 Jun 7.
Daratumumab is an anti-CD38 monoclonal antibody indicated for the treatment of multiple myeloma. Infusion-related reactions (IRRs) are among the most common adverse events associated with daratumumab. IRRs are most common with the first infusion of daratumumab. Recommended premedications to be given prior to the daratumumab dose include acetaminophen, diphenhydramine, and a corticosteroid. There is emerging data to suggest that the addition of montelukast to this premedication regimen can lower the incidence of daratumumab-related IRRs.
This was a single-center, retrospective chart review conducted at a large, multistate health system with several different hematology/oncology practice sites. Eligible patients included those with a primary diagnosis of a plasma cell disorder who received at least 1 dose of daratumumab. The primary outcome was the incidence of IRRs with the first daratumumab infusion.
A total of 141 patients receiving daratumumab-based therapy were included in this study. All patients received acetaminophen, diphenhydramine, and a corticosteroid as premedications prior to the first infusion of daratumumab. Overall, 46 (33%) patients experienced an IRR with the first infusion of daratumumab. The incidence of IRR was lower in patients that received montelukast as a premedication compared with those that did not (montelukast, n = 25 [27%]; no montelukast, n = 21 [45%]; P = .0371). Patients in each arm experienced similar rates of overall, composite pulmonary, gastrointestinal, and systemic IRR manifestations.
The use of montelukast prior to the first daratumumab infusion led to a reduction in the incidence of IRRs in our experience.
达雷妥尤单抗是一种抗 CD38 单克隆抗体，用于治疗多发性骨髓瘤。输注相关反应（IRR）是与达雷妥尤单抗相关的最常见不良事件之一。IRR 最常发生在首次输注达雷妥尤单抗时。在给予达雷妥尤单抗剂量之前，建议给予对乙酰氨基酚、苯海拉明和皮质类固醇进行预先用药。有新的数据表明，将孟鲁司特加入该预先用药方案中可以降低达雷妥尤单抗相关 IRR 的发生率。
这是一项在一个拥有多个不同血液科/肿瘤科实践地点的大型多州卫生系统中进行的单中心、回顾性图表审查。符合条件的患者包括接受至少 1 剂达雷妥尤单抗治疗的原发性浆细胞疾病患者。主要结局是首次达雷妥尤单抗输注的 IRR 发生率。
本研究共纳入 141 例接受达雷妥尤单抗治疗的患者。所有患者在首次输注达雷妥尤单抗前均接受对乙酰氨基酚、苯海拉明和皮质类固醇作为预先用药。总体而言，46 例（33%）患者在首次输注达雷妥尤单抗时发生了 IRR。接受孟鲁司特作为预先用药的患者与未接受孟鲁司特的患者相比，IRR 的发生率较低（孟鲁司特组，n=25[27%]；无孟鲁司特组，n=21[45%]；P=0.0371）。每个治疗组的患者均发生了相似的总、复合肺部、胃肠道和全身 IRR 表现。
根据我们的经验，在首次输注达雷妥尤单抗前使用孟鲁司特可降低 IRR 的发生率。
