Comparative Renal Outcomes of CAR-T versus Bispecific Antibodies in Multiple Myeloma: A Propensity Score-Matched TriNetX Analysis
Materials and Methods/Case Presentation/Objective:
We conducted a retrospective propensity score-matched cohort study using the TriNetX Global Collaborative Network (178 healthcare organizations). Adults with MM (ICD-10 C90.0x) who received either CAR-T (ide-cel or cilta-cel) or a bispecific antibody (teclistamab or talquetamab) were identified. Index date was the first administration of the respective therapy. Outcomes included incident acute kidney injury (AKI; ICD-10 N17), new chronic kidney disease (CKD) stage 4 (N18.4), and any new CKD (N18), analyzed from day 1 after index with no upper time limit. Patients with the respective outcome (CKD) prior to the analysis window were excluded, so all CKD events represent newly diagnosed CKD after therapy initiation. 1:1 propensity score matching balanced demographics. Risk ratios (RR), odds ratios, Kaplan-Meier survival, log-rank tests, and hazard ratios (HR) were calculated.
Results/Description/Main Outcome Measure(s): After matching, 1,156 patients remained in each cohort. CAR-T was associated with significantly lower risk of AKI (12.1% vs 18.1%; RR 0.67, 95% CI 0.52-0.86; p=0.002; HR 0.60, 95% CI 0.46-0.80; log-rank p< 0.001), newly diagnosed CKD stage 4 (1.4% vs 2.7%; RR 0.50, 95% CI 0.27-0.92; p=0.023; HR 0.44, 95% CI 0.24-0.82; log-rank p=0.008), and any newly diagnosed CKD (6.3% vs 9.9%; RR 0.63, 95% CI 0.45-0.89; p=0.009; HR 0.57, 95% CI 0.40-0.82; log-rank p=0.002) compared with bispecific antibodies.
Conclusion(s).:
In this large real-world propensity-matched analysis that excluded patients with pre-existing CKD, CAR-T therapy was associated with a lower incidence of AKI and newly diagnosed CKD compared with bispecific antibodies in patients with MM. These findings support further evaluation of differential renal safety profiles when selecting between these modalities.
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