Risk of adverse events in elotuzumab-treated patients with multiple myeloma: a systematic review and meta-analysis

TL;DR

This study reviews and combines data from clinical trials to assess the safety of elotuzumab in treating multiple myeloma, finding specific patterns of side effects.

Contribution

The paper provides the first meta-analysis of adverse events associated with elotuzumab in multiple myeloma patients.

Findings

Elotuzumab reduces neutropenia risk but increases risks of cough, pneumonia, diarrhea, pyrexia, and infections.

Grade 3–4 events show higher risks of lymphopenia, diarrhea, pneumonia, cataracts, and infections with elotuzumab.

No significant differences were observed for anemia, thrombocytopenia, or several other common adverse events.

Abstract

Elotuzumab, an anti-SLAMF7 monoclonal antibody for multiple myeloma (MM), lacks a comprehensive safety profile from meta-analysis.

We systematically searched PubMed, Web of Science, EMBASE and CENTRAL through February 13, 2025 for randomized controlled trials (RCTs) evaluating elotuzumab in MM. Pooled relative risks(RRs) of adverse events observed in elotuzumab-containing regimens versus control therapies.

6 RCTs (N=1,736) were included. Elotuzumabsignificantly reduced incidence of neutropenia (RR = 0.86, 95% CI: 0.76–0.98), but increased risks of cough (RR = 1.41, 95% CI: 0.96–2.09), pneumonia (RR = 1.30, 95% CI: 1.07–1.59), diarrhea (RR = 1.16, 95% CI: 1.05–1.30), pyrexia (RR = 1.47, 95% CI: 1.10–1.96) and infections (RR = 1.09, 95% CI: 1.03–1.15). No significant differences were observed for anemia, thrombocytopenia, respiratory infections, nausea, appetite loss, back pain, muscle spasms, peripheral edema, insomnia, rash, pruritus, fatigue, or hypokalemia. For grade 3–4 events, elotuzumab was associated with higher risks of lymphopenia (RR = 1.86, 95% CI: 1.31–2.64, p = 0.0005, I2 = 9%), diarrhea (RR = 1.47, 95% CI: 1.00–2.17), pneumonia (RR = 1.57, 95% CI: 1.11–2.23), cataracts (RR = 2.87, 95% CI: 1.15–7.21) and infections (RR = 1.30, 95% CI: 1.04–1.62).

Elotuzumab in MM appears safe but with a specific adverse events pattern : lower neutropenia, but higher respiratory, gastrointestinal, metabolic, and infectious events. Differences may be influenced by longer treatment and corticosteroid use; therefore, interpretation of outcomes such as hyperglycemia and cataracts requires particular caution.

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