Teclistamab for treatment-refractory autoimmune diseases: a multicentre case series

OBJECTIVES: This study aimed to evaluate the safety and efficacy of teclistamab, a T cell-redirecting bispecific antibody targeting B-cell maturation antigen, in a case series of severe autoimmune diseases. METHODS: Data were retrospectively collected from patients with treatment-refractory systemic sclerosis (SSc), idiopathic inflammatory myopathies (IIMs), systemic lupus erythematosus (SLE), undifferentiated connective tissue disease (UCTD), or IgG4-related disease (IgG4-RD) who received 1 cycle of teclistamab at 5 European centres. RESULTS: Eighteen patients (72% women, median age 48.5 years, 10 SSc, 4 IIM, 2 SLE, 1 UCTD, and 1 IgG4-RD) with a median of 5 prior therapies and a median cumulative dose of 6.36 mg/kg teclistamab were included. The median follow-up was 5.1 months (range, 0.8-21.2 months). A total of 22 cytokine release syndrome episodes (16 grade 1 and 6 grade 2) occurred in 12 patients (67%). All patients developed severe hypogammaglobulinaemia, and 5 (28%) experienced severe infections. Two patients developed an inflammatory bowel disease-like colitis. Two patients with severe SSc-associated cardiac involvement died, 1 due to sudden cardiac death and the other following diffuse alveolar haemorrhage and heart failure. B-cell depletion was observed in all patients, accompanied by significant reductions in autoantibody levels. Teclistamab was associated with major clinical responses in 11 (61%) and minimal-to-moderate responses in 4 (22%) patients, despite discontinuation of immunosuppressive therapy. CONCLUSIONS: Teclistamab demonstrated the potential to induce treatment-free responses in refractory autoimmune disease, but clinically relevant safety events, including infections and fatal outcomes in patients with advanced cardiac involvement, highlight the need for careful patient selection and monitoring.