WolverHeme Happy Hour Dex and the Cytokine City: Managing CRS with Bispecifics
Apr 7, 2025
Joining the discussion are Victoria Nachar, an outpatient hematology pharmacist from the University of Michigan with expertise in lymphoma and myeloma, and James Davis, a malignant hematology pharmacist and assistant professor at MUSC, known for his deep knowledge in multiple myeloma. They explore the management of cytokine release syndrome (CRS) in patients receiving bispecific antibodies, comparing it to CAR-T therapies. They discuss current treatment strategies, the role of prophylactic tocilizumab, and the importance of tailored approaches in patient care.
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Real-World CRS Outpatient Management
- Victoria Nachar explained practical outpatient management of CRS mimicking their clinical trial experiences.
- Patients often develop fever on their drive home and manage symptoms with Tylenol and steroids as needed.
Dexamethasone Works for Grade One CRS
- James Davis and Victoria Nachar found dexamethasone effective for treating grade one CRS.
- Early tocilizumab usage is overkill, often unnecessary, and more costly than steroids.
Most CRS Is Mild and Manageable
- Majority of CRS events occurring with bispecifics are low grade (grade 1-2) fevers.
- Using tocilizumab quickly treats many patients unnecessarily, driving up cost and overtreatment.