On-Body Isatuximab Eases Myeloma Care: Mateo Mejia Saldarriaga, MD

A new on-body delivery device for isatuximab could improve the patient experience and free up nursing time in busy myeloma clinics, according to Mateo Mejia Saldarriaga, MD, hematologist/oncologist at Weill Cornell Medicine and NewYork-Presbyterian. In an interview with The American Journal of Managed Care^® following his participation in the panel discussion, “Patient-Centered Innovation in Multiple Myeloma Therapy,” at the August 20 Institute for Value-Based Medicine® event in New York City, Mejia Saldarriaga discussed CD38 monoclonal antibody administration and treatment sequencing in multiple myeloma.

How Isatuximab On-Body Device Differs From Daratumumab

Daratumumab has been used more widely in clinical practice because it can be given as a subcutaneous (SubQ) injection, while isatuximab has been delivered intravenously, Mejia Saldarriaga explained. The newly developed on-body device for isatuximab is also SubQ, but it is an automated system that delivers the drug over 10 to 20 minutes.

SubQ daratumumab takes about 20 minutes, and a nurse must stay with the patient to push the needle the whole time. With the on-body device, the nurse prepares it, applies it, presses a button, and can walk away until the device clicks to signal that delivery is complete.

In the IZALCO (NCT05704049) and IRAKLIA (NCT05405166) trials, which evaluated the device against intravenous or standard SubQ administration, more than 70% of patients preferred the on-body device. Because patients in the studies rotated between administration methods, each could compare the experiences directly, Mejia Saldarriaga noted. The device also uses a smaller needle, about 31 gauge compared with 24 gauge.

Patients who have received SubQ injections for 10 years may not switch, Mejia Saldarriaga said, but newly diagnosed patients could start with a better-tolerated option.

Why Chair Time Matters for Myeloma Centers

At high-volume myeloma centers, a single nurse may administer 20 to 25 doses of a CD38 monoclonal antibody per day. Saving even 10 minutes per patient across 20 patients frees significant nursing time and can improve patient flow, according to Mejia Saldarriaga. The first on-body dose of isatuximab also does not require the extended monitoring needed with other approaches, which makes starting therapy easier.

"The main thing I care [about] is the efficacy," Mejia Saldarriaga said. "The second thing I care [about] is the patient experience...if we can also improve the workflow of the institution, why not? I think the on-body device seems to be at least equivalent or favorable in all these aspects."

How to Sequence CAR T and Bispecific Antibodies

Chimeric antigen receptor (CAR) T-cell therapy has not been formally compared with bispecific antibodies, but myeloma treatment planning requires thinking 2 or 3 lines ahead, Mejia Saldarriaga said. The largest body of evidence supports using CAR T-cell therapy first and bispecifics afterward. Data exist for the reverse order, but there are concerns about slightly lower efficacy and about CAR T manufacturing.

"What I often speak with patients is we're trying to have a plan not for the next year, but rather like 5, 6, [or] 7 years, down the line," Mejia Saldarriaga said.

Patient preferences still guide the final decision. Some patients decline CAR T-cell therapy because they do not want to be hospitalized when outpatient administration is not possible, while others view the toxicity profile as an unacceptable risk. Mejia Saldarriaga called both positions fair and said the goal is to choose the best path based on each patient's values. If CAR T-cell therapy is not an option, moving forward with a bispecific is preferable to spending 2 or 3 months debating while the disease progresses.

"My first priority is that we make the best decision for the patient, knowing all the available data, regardless of which path it is," Mejia Saldarriaga said.