Patient Preference and the Future of Home-Based Isatuximab Delivery

Sikander Ailawadhi, MD, of the Mayo Clinic Florida in Jacksonville, details compelling data regarding patient experience and the evolution of drug delivery for multiple myeloma, specifically focusing on the transition from intravenous (IV) to subcutaneous (SC) isatuximab (Sarclisa). By analyzing results from clinical trials such as IZALCO (NCT05704049) and IRAKLIA (NCT05405166), Ailawadhi highlights a significant shift toward patient-centric care that prioritizes convenience and satisfaction without compromising clinical efficacy.

The IZALCO Study: A Direct Comparison of Preference

In the IZALCO study, researchers utilized a crossover design to evaluate patient preference directly. Each participant received both the IV and the SC formulations of isatuximab at different stages of their treatment. By acting as their own controls, patients could make an informed comparison between the 2 delivery methods. Ailawadhi notes that the results were definitive: patients were overwhelmingly in favor of the subcutaneous version. This preference likely stems from the significantly reduced time required for administration compared to the multi-hour IV infusion process.

IRAKLIA and the Potential for Home Administration

The IRAKLIA trial expanded on this by exploring the feasibility of home-based treatment. After completing 6 cycles of therapy, patients were given the option to transition their subcutaneous administration from the clinical center to their own homes. Data from European participants showed that the success rate for home administration was identical to that of the clinical setting. Satisfaction scores were significantly higher among those receiving home-based care, and the drug was administered with the same level of precision and safety as in a traditional office setting.

A Groundbreaking Shift Toward Self-Administration

Although the home administrations in the IRAKLIA trial were conducted by visiting nurses, Dr Ailawadhi views this as a stepping stone toward an even more transformative model. He suggests that these findings open the door for patient self-administration using the on-body injector (OBI). Moving toward a self-care model would be a massive shift, as it would nearly eliminate the time toxicity associated with oncology visits, allowing patients to integrate life-saving therapy into their daily routines with minimal disruption. This evolution promises to redefine the standard of care, making highly effective monoclonal antibody treatments more accessible and less burdensome for the global myeloma community.