Real-World Talquetamab Utilization Patterns and Dose Schedules in the United States: An Analysis Using Claims Data

Introduction:Talquetamab (Tal) is the first-in-class GPRC5D-targeting bispecific antibody recently approved in the United States (US) for treating patients with multiple myeloma (MM) after ≥4 prior lines of therapy (LOTs). Tal initiation includes step-up dosing (SUD) prior to establishment of either a weekly (QW) or biweekly (Q2W) treatment schedule based on prescribing information. Recently, Q4W talquetamab dosing was described (Chari et al, ASH 2023). However, there are limited data regarding real-world patterns of Tal administration and patient characteristics for those receiving Tal in real-world settings. This study describes patterns of Tal administration in real-world settings among US patients. Methods: This analysis queried the Komodo Healthcare MapTM for data from adult patients with ≥1 diagnosis code for multiple myeloma between October 1, 2015 and June 8, 2024 and ≥1 medical claim for commercial Tal between Aug 9, 2023 [US approval date] and June 8, 2024 [latest data cut]. The index date was defined as either the date of the first outpatient Tal SUD (3mg/1.5mL) or the date of an inpatient Tal encounter. Patient demographics and clinical characteristics were described for the baseline period of 6 months prior to index date. Tal utilization patterns and patient characteristics were reported descriptively. Results: Overall, 141 MM patients treated with Tal were identified, with a median follow-up of 3.3 months and a median (interquartile range [IQR]) age at index of 67 years (59, 74). Among these, 53.9% were male, 63.2% were white, and 63.8% had Medicare. Baseline comorbidities prior to Tal treatment were common, including recent infections (47.5%) and pre-existing hypogammaglobulinemia (44.0%). The median (IQR) time from MM diagnosis to index date was 5.9 (4.0, 7.9) years and number of prior LOTs was 5 (4, 6). Overall, 44.7% were naïve to prior T-cell redirection therapies, and prior exposure to commercial BCMA-targeted therapy was reported in 84 (59.6%) patients: 7.8% of patients received ciltacabtagene autoleucel, 17.7% idecabtagene vicleucel, 35.5% teclistamab (Tec), 2.1% elranatamab, and 14.2% belantamab mafodotin. Tal monotherapy was administered for a majority of the patients (n=127, 90.1%), and 3 (2.1%) patients received commercial Tal+Tec. Following SUD, 26.6% of patients were receiving QW dosing, and 61.7% were receiving Q2W dosing. Of patients who received ≥3 treatment doses (not including SUD) before data cutoff, 15 of the 25 patients receiving QW dosing had switched to ≥Q2W and 12 of the 58 patients receiving Q2W dosing had switched to ≥Q3W. At data cutoff, 14 (14.9%), 62 (66.0%), and 9 (9.6%) patients were on QW, Q2W, and Q4W dosing, respectively. Conclusion: This study reports the largest real-world analysis of Tal dosing and patient characteristics since its US approval. As expected, the patients identified as receiving Tal were heavily pretreated, although approximately 40% of patients had not received a prior commercial BCMA therapy. The majority of patients received Tal as monotherapy, while a small number received Tal in combination with Tec. Q2W was the most common dosing schedule, and some patients de-escalated to less frequent dosing. Further real-world research into Tal clinical outcomes is ongoing to provide insights into long-term use practices for this novel treatment option.