Elranatamab Versus Teclistamab in Relapsed and Refractory Multiple Myeloma: A Real-World Propensity Score-Matched Study

BACKGROUND: Relapsed and refractory multiple myeloma treatment is challenging. Bispecific antibodies targeting B-cell maturation antigens, including elranatamab and teclistamab, have demonstrated encouraging responses in heavily pretreated diseases. Nonetheless, comparative data from real-world practice are limited. OBJECTIVE: This study aimed to compare the time to the next treatment, overall survival, and adverse events in patients with refractory multiple myeloma receiving elranatamab or teclistamab monotherapy in real-world practice. METHODS: We conducted a multinational retrospective cohort study using deidentified electronic health records from the TriNetX Global Research Network. Adults with refractory multiple myeloma receiving elranatamab or teclistamab as monotherapy after one or more prior systemic regimen were included. Propensity score matching (1:1) was performed based on demographics, comorbidities, and baseline laboratory values. The primary endpoint was the time to the next treatment. Secondary endpoints were overall survival and safety outcomes, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, cytopenia, and infections. RESULTS: Following matching, 188 patients were included in each group. The median time to the next treatment did not differ significantly between elranatamab and teclistamab (11.0 vs 12.3 months; p = 0.394), and the 3-year overall survival rates were similar (58.8% vs 59.7%; p = 0.077). Subgroup analyses indicated a longer time to the next treatment with teclistamab in patients with baseline thrombocytopenia and in those receiving more than five prior lines of treatment. Grade ≥ 3 neutropenia was more frequent with teclistamab (84.6% vs 74.5%; p = 0.015), whereas cytokine release syndrome occurred more often with elranatamab (45.2% vs 27.1%; p < 0.001). The immune effector cell-associated neurotoxicity syndrome and infection rates were comparable. Both agents demonstrated comparable real-world effectiveness but different toxicity profiles. CONCLUSIONS: These findings support individualized treatment selection; prospective comparative trials are warranted.