What is step-up dosing for bispecific antibody therapy?

Before the start of your bispecific treatment regimen, your treating physician will communicate with you about a “step-up” dosing schedule. 

Bispecific antibodies are very potent drugs that have the potential for serious side effects like cytokine release syndrome (CRS) and neurotoxicity. These symptoms usually present early when a patient is given bispecific antibody therapy. 

These doses are increased (“stepped up”) every few days to evaluate how well the patient tolerates the drugs before the first full-strength dose is administered. Step-up dosing is a smaller first dose. The next dose, which is the step-up dose No. 2, is going to be slightly larger and is typically given on days 2-4.

During the step-up dosing, patients need to be hospitalized for 1-2 days after each dose to closely monitor and treat any side effects. 

Before each administration, your medical team will give you prophylactic (proactive and preventative) medication to keep you from having severe side effects or immune reactions. They will administer tests to evaluate your neurologic abilities and provide reactive side effect solutions if any issues or complications occur. 

After receiving a full dose with no complications, hospitalization for following treatments won't be necessary. However, if your treatment is delayed for any reason, you may need to repeat the step-up dosing procedure.

To continue reading about the frequency and duration of the treatment with bispecific antibodies go to Treatment Course.