Derman Benjamin A, Roach Meaghan, Lin Dee, Wu Bingcao, Murphy Richard, Kim Nina, Doyle Margaret, Prood Nadya, Fowler Jessica, Marshall Alexander, Jamaleddine Amal, Paner-Straseviciute Agne
University of Chicago Medical Center, Chicago, IL, USA.
PRECISIONheor, New York, NY, USA.
Curr Med Res Opin. 2024 May 16:1-6. doi: 10.1080/03007995.2024.2352856.
To understand clinicians' current teclistamab step-up dosing (SUD) model and how they envision future administration models, as well as perceived barriers and facilitators to these models in day-to-day clinical practice.
Interviews of clinicians with RW experience administering teclistamab, with a subsequent roundtable discussion to discuss interview findings. Topics of interest included managing adverse events (AE), and handling logistics of SUD and transition of care (ToC).
20 clinicians representing 19 practices participated. Of 14 practices administering inpatient teclistamab SUD, 12 (86%) utilized a single admission. A day 1-3-5 dosing schedule with a 7-day length of stay was planned in 10/14 (71%). The remaining 5 practices employed outpatient or hybrid SUD. SUD models depended on cellular therapy experience, patient volume, and monitoring capabilities. Clinicians desired to administer SUD outpatient for convenience and reduced healthcare resource use. 11% of practices reported using tocilizumab for cytokine release syndrome (CRS) prophylaxis, whilst it was uniformly used to treat grade 2+ CRS. Corticosteroids were the preferred treatment for neurotoxicity. Infection prophylaxis with intravenous immunoglobulin was reported by 89% of practices. Patient- and institution-level factors affected decision-making of transitioning patients back to referring sites after SUD.
The results consolidated practice-based experiences and indicated diverse RW SUD models and patient management strategies in practices with familiarity with teclistamab AE management and ToC protocols. Inpatient SUD is common, with expectations that approaches will evolve toward outpatient or community-based administration. Further research is needed to investigate outcomes of different care models and AE management strategies.
了解临床医生当前的替雷利珠单抗逐步递增给药（SUD）模式，以及他们对未来给药模式的设想，以及在日常临床实践中这些模式的感知障碍和促进因素。
对有替雷利珠单抗给药经验的临床医生进行访谈，随后进行圆桌讨论以讨论访谈结果。感兴趣的主题包括管理不良事件（AE），以及处理SUD的后勤工作和护理过渡（ToC）。
代表19家医疗机构的20名临床医生参与。在14家进行住院替雷利珠单抗SUD给药的医疗机构中，12家（86%）采用单次住院。10/14（71%）计划采用第1 - 3 - 5天给药方案，住院时长为7天。其余5家医疗机构采用门诊或混合SUD模式。SUD模式取决于细胞治疗经验、患者数量和监测能力。临床医生希望在门诊进行SUD给药，以方便患者并减少医疗资源的使用。11%的医疗机构报告使用托珠单抗预防细胞因子释放综合征（CRS），而它被统一用于治疗2级及以上CRS。皮质类固醇是治疗神经毒性的首选药物。89%的医疗机构报告使用静脉注射免疫球蛋白进行感染预防。患者和机构层面的因素影响了SUD后将患者转回转诊机构的决策。
研究结果整合了基于实践的经验，并表明在熟悉替雷利珠单抗AE管理和ToC方案的实践中，存在多样化的真实世界SUD模式和患者管理策略。住院SUD很常见，预计给药方式将朝着门诊或社区给药方向发展。需要进一步研究来调查不同护理模式和AE管理策略的结果。
