HealthTree Research: Patient Perspectives on Bispecifics

Bispecific antibodies are a treatment for relapsed/refractory multiple myeloma. These drugs carry the risk of cytokine release syndrome and neurotoxicity. These side effects are often mild, but they can be severe and life-threatening. 

Step-up dosing is one strategy to reduce the risk of cytokine release syndrome. This is when a small amount of medication is given on the first day. The amount given is increased (“stepped up”) every few days to evaluate if the medications cause side effects. 

Researchers at the HealthTree Foundation are conducting an ongoing survey of multiple myeloma patients who have been prescribed bispecific antibodies. At the 2025 American Society of Hematology annual meeting, HealthTree researchers presented some results of the data gathered so far. 

Take the Bispecific Antibody Survey

Multiple myeloma patient opinions on step-up dosing of bispecific antibodies

There were 32 patients who completed the survey on step-up dosing. Of those, 24 had been treated with the bispecific antibody teclistamab (Tecvayli, Janssen Biotech, Inc.), and 8 had been treated with talquetamab (Talvey, Janssen Biotech, Inc.). The median age of the patients was 70 years. Half of the patients were male, and 84% were white. 

Currently, step-up dosing is most often done in an inpatient setting. This means that patients need to stay at the hospital. Some clinics have moved to completing the step-up dosing in an outpatient setting. 

In this study, 21 patients (66%) received their entire step-up dosing during a single hospital stay. There were 6 who had separate hospitalizations (19%). Four were treated in an outpatient setting (13%) and 1 was treated in a hybrid inpatient and outpatient setting. 

Patients were surveyed about their experiences and preferences. Of those who received step-up dosing in an inpatient setting (27), 15% would have preferred an outpatient setting and 7% would have preferred a hybrid setting. A majority (78%) also preferred only one inpatient hospitalization for step-up dosing. 

When patients who had inpatient step-up dosing had to choose factors that influenced their choice, they reported: 

• Feeling more secure with the level of monitoring inpatient (78%)
• Convenience (26%)
• Less worry about staying near healthcare centers (15%)
• Being able to stay with their local physician (11%)
• Staying closer to home (7%)
• Lower costs to the patient (4%)

In the smaller subgroup of patients who received outpatient step-up dosing, 3 (75%) preferred fully outpatient step-up dosing and 1 (25%) preferred hybrid step-up dosing. The factors influencing these preferences included: 

• Convenience (50%)
• Lower costs to the patient (25%)
• Flexible dosing schedule (25%)
• Feeling more secure with the level of monitoring inpatient (25%)

The one patient who received hybrid step-up dosing would have preferred outpatient.

Other preferences and challenges for multiple myeloma patients on bispecific antibodies

Patients were also asked about their preferences for how the medications were administered. Bispecific antibodies can be given as a subcutaneous injection or as an infusion. Twenty-two patients (69%) favored the subcutaneous injection while only 3 (9%) preferred the infusion. Seven patients (22%) had no preference. 

Patients were also asked to share some of the challenges they faced while taking bispecific antibodies. The most common challenge was treatment side effects. Six patients treated with talquetamab (75%) and 9 patients treated with teclistamab (38%) reported treatment side effects as a challenge. Two patients treated with talquetamab (25%) and 4 patients treated with teclistamab (17%) reported travel time to the treatment facility as another challenge.

Other challenges mentioned by patients during the survey included: 

• Caring for others
• Continuing to work
• Cost and insurance
• Lack of caregiver or care partner
• Being away from home
• Unavailability of the therapy in community setting near home
• Eligibility criteria

Study conclusions

This study is an important step in understanding patient experiences and preferences during treatment decision-making. By expanding options for treatment methods (inpatient vs outpatient and treatment administration, patients can have more options for their treatments that may improve quality of life. 

This study was funded by Johnson & Johnson. 

What’s next for HealthTree’s bispecific antibody research

HealthTree’s bispecific antibody survey is ongoing. If you have multiple myeloma and you have been treated with teclistamab, talquetamab, or elrantamab (Elrexfio) for at least 4 months, we want to hear from you! We are researching: 

• How patients make treatment decisions
• Side effects and patient outcomes
• Step-up dosing challenges
• Differences in care between academic and community centers
• Caregiver burden and financial impact
• Quality of life during and after treatment

This is critical information that will help doctors and researchers. 

Participate in a research survey today!