Elrexfio is a brand-name injectable solution that’s prescribed for multiple myeloma in certain situations. Elrexfio contains the active ingredient elranatamab-bcmm and is a type of immunotherapy.

Elrexfio is FDA-approved to treat multiple myeloma in adults in certain situations. For this use, the cancer must be relapsed or refractory after treatment with at least four other therapies in the past.

Drug details

You’ll find key information about Elrexfio below.

Elrexfio is a brand-name medication containing the active drug elranatamab-bcmm.*

Elrexfio is a biologic drug that isn’t available in biosimilar form. While traditional drugs are made using chemicals, biologics are made using parts of living cells. Traditional drugs have generics that are exact copies of the active drug in the brand-name form. However, biologics have biosimilars because they cannot be copied exactly.

Like generics, biosimilars are considered to be as safe and effective as the original brand-name drug.

* The “-bcmm” at the end of the drug’s name indicates that it’s distinct from similar medications that may be created in the future.

Your doctor may adapt the Elrexfio dosage they prescribe based on the side effects you have.

The following information describes dosages that are commonly used or recommended. However, your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Elrexfio comes as a solution in a single-use vial. It’s available in two strengths:

  • 44 milligrams per 1.1 milliliters of solution (44 mg/1.1 mL)
  • 76 mg/1.9 mL

Dosage for multiple myeloma

Elrexfio is prescribed to treat multiple myeloma in adults in certain situations. To learn when doctors prescribe Elrexfio, see the “Elrexfio uses” section below.

If your doctor prescribes Elrexfio, you’ll typically start with two step-up doses of Elrexfio. This means you’ll get two lower doses of the drug before receiving the first treatment dose to see how your body responds to the drug.

The usual step-up dosing schedule for Elrexfio is to receive 12 mg on the first day, followed by 32 mg on day 4. On day 8, you’ll receive the first treatment dose of 76 mg of Elrexfio. After that, you’ll continue to receive 76 mg once per week.

After 24 weeks of treatment, your doctor may adjust your dosage to 76 mg of Elrexfio every other week. This depends on how your cancer is responding to treatment.

Your doctor may also adjust your dosage based on whether you have certain side effects with Elrexfio. If you have questions about the dosage that’s right for you, talk with your doctor.

How it’s given

Your doctor or another healthcare professional will administer Elrexfio as a subcutaneous injection. They’ll inject the drug under the skin of your abdomen or thigh.

Elrexfio may cause serious side effects.* For this reason, the drug is only given in a facility certified by the Elrexfio risk evaluation and mitigation strategy (REMS) program. The Elrexfio REMS program helps ensure your doctor understands how to give Elrexfio. They’re also trained on how to recognize and treat serious side effects that may occur.

After your first dose of Elrexfio, you’ll likely stay in the facility where you received the drug for at least 48 hours. After your second dose, you’ll likely stay in the facility for at least 24 hours. These extended stays allow your doctor to closely monitor you for serious side effects.

If you have other questions about receiving Elrexfio treatment, talk with your doctor or visit the drug manufacturer’s website.

* Elrexfio has boxed warnings for certain serious side effects. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Elrexfio precautions” section below.

About receiving Elrexfio

Below, you’ll find information about key dosage issues.

  • When it’s given: Depending on the situation, you’ll receive one injection of Elrexfio every 1 or 2 weeks.
  • If you miss a dose: If you miss an appointment for your Elrexfio injection, call your doctor’s office right away to reschedule.
  • Length of treatment: Elrexfio may be used as a long-term treatment. The length of time you’ll receive the drug depends on whether your condition is improving and any side effects you have. If you and your doctor determine that Elrexfio is safe and effective for you, you’ll likely receive it long term.
  • Length of time to work: Elrexfio starts to work after your first dose. Your doctor will monitor you during treatment to check whether the drug is working for your condition.

Elrexfio can cause mild or serious side effects. The following lists contain some of the key side effects that may occur during Elrexfio treatment. These lists do not include all possible side effects.

For more information about the possible side effects of Elrexfio, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may concern or bother you.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Elrexfio, you can do so through MedWatch.

Mild side effects

Below is a partial list of mild side effects of Elrexfio. To learn about other mild side effects, talk with your doctor or pharmacist or view Elrexfio’s prescribing information.

Mild side effects of Elrexfio can include:

Most of these side effects may go away within a few days to a couple of weeks. However, if they become more severe or don’t go away, talk with your doctor or pharmacist.

* For more information about allergic reaction and Elrexfio, see “Allergic reaction” below.

Serious side effects

Serious side effects from Elrexfio aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

* Elrexfio has a boxed warning for this side effect. This is the most serious warning from the FDA. To learn more, see the “Elrexfio precautions” section below.
† For details about allergic reaction and Elrexfio, see “Allergic reaction” below.

ALLERGIC REACTION

As with most drugs, some people can have an allergic reaction after receiving Elrexfio. This side effect wasn’t reported in clinical trials of this drug but can still occur.

Symptoms of a mild allergic reaction can include:

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have an allergic reaction to Elrexfio, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

The Food and Drug Administration (FDA) approves prescription drugs such as Elrexfio to treat certain conditions.

Elrexfio for multiple myeloma

Elrexfio is FDA-approved to treat multiple myeloma in adults in certain situations. Multiple myeloma is a type of blood cancer. It affects plasma cells (a type of white blood cell), which help your immune system fight infection.

For this purpose, the multiple myeloma must be either relapsed or refractory. “Relapsed” means the cancer came back after other treatments. “Refractory” means the cancer did not respond to other treatments.

In addition, the multiple myeloma must have been treated with at least at least four other therapies in the past, including:

You can learn more about multiple myeloma by visiting our cancer hub.

Elrexfio and children

Elrexfio is not FDA-approved for use in children. It’s not known for sure whether the drug is safe or effective for children.

Elrexfio is not known to interact with other medications, herbs, supplements, foods, or alcohol. The manufacturer of Elrexfio didn’t look at interactions in clinical trials of the drug.

However, this does not mean that interactions won’t be recognized in the future. For example, new drugs could be approved that interact with Elrexfio.

Before starting Elrexfio treatment, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also, tell them about any vitamins, herbs, and supplements you take. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

As with all medications, the cost of Elrexfio can vary. The actual price you’ll pay depends on your insurance plan and your location.

Financial and insurance assistance: If you need financial support to pay for Elrexfio, or if you need help understanding your insurance coverage, help is available.

A program called Pfizer Oncology Together is available for Elrexfio. For more information and to find out your eligibility for support, visit the program website.

To learn more about saving money on prescriptions, check out this article.

Biosimilar version: Elrexfio is a biologic drug that is not available in a biosimilar form. While traditional drugs are made using chemicals, biologics are made using parts of living cells. Traditional drugs have generics that are exact copies of the active drug in the brand-name form. However, biologics have biosimilars because they cannot be copied exactly.

Like generics, biosimilars are considered to be as safe and effective as the original brand-name drug. And they may cost less than brand-name drugs.

If you have questions or concerns about the price of Elrexfio, talk with your doctor.

Other drugs that can treat multiple myeloma are available. Some may be a better fit for you than others. If you’re interested in finding an alternative to Elrexfio, talk with your doctor. They can tell you about other medications that may work well for you.

The following drugs are similar to Elrexfio:

If you can become pregnant, consider the following information about pregnancy and breastfeeding.

Elrexfio and pregnancy

You should not receive Elrexfio treatment during pregnancy. If you’re planning a pregnancy or can become pregnant, talk with your doctor before using this medication.

Your doctor may suggest birth control options to help prevent pregnancy during treatment with Elrexfio. They’ll likely advise you to use birth control while receiving the drug and for at least 4 months after your final dose.

Elrexfio and breastfeeding

You should not receive Elrexfio treatment while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before using this medication.

Your doctor may recommend other ways to feed your child during treatment with Elrexfio. They’ll likely advise you not to breastfeed while receiving the drug and for at least 4 months after your final dose.

If you have questions about Elrexfio and pregnancy or breastfeeding, contact your doctor for more information.

Here are answers to some frequently asked questions about Elrexfio.

How does Elrexfio work?

Elrexfio is a type of immunotherapy. It works by helping your immune system fight cancer cells.

Specifically, Elrexfio is a B cell maturation antigen (BCMA)-targeted immunotherapy. The drug works by attaching to two proteins: the BCMA protein found on multiple myeloma cells and a protein found on certain cells in your immune system.

By attaching to both proteins, Elrexfio brings your immune system cells to the multiple myeloma cells. This helps your immune system destroy the cancer cells.

If you have other questions about how Elrexfio works, talk with your doctor or pharmacist. You can also view the drug manufacturer’s website.

Is Elrexfio similar to Tecvayli?

Elrexfio and Tecvayli have many similarities, but they also have important differences.

Elrexfio and Tecvayli are BCMA-targeted immunotherapies.* They’re both approved to treat multiple myeloma. Both drugs are given as subcutaneous injections by a healthcare professional.

Elrexfio and Tecvayli also have similar side effects. In fact, both drugs have boxed warnings for the risks of cytokine release syndrome and neurologic toxicity.†

Elrexfio and Tecvayli contain different active ingredients and have different dosages. Elrexfio’s active ingredient is elranatamab-bcmm, while Tecvayli’s active ingredient is teclistamab-cqyv. Unlike Elrexfio, the dosage of Tecvayli is dependent on a person’s body weight.

To learn more about how Elrexfio compares with Tecvayli, talk with your doctor.

* To learn how this type of drug works, see “How does Elrexfio work?” directly above.
† A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Elrexfio precautions” section below and the Tecvayli prescribing information.

Does Elrexfio cause long-term side effects?

It’s possible. Elrexfio treatment may cause side effects that start while you’re receiving the drug but continue after treatment ends. Examples of these side effects include liver damage and neurologic toxicity.*

If you have other questions about the long-term side effects of Elrexfio, talk with your doctor.

* Elrexfio has a boxed warning for this side effect. To learn more, see the “Elrexfio precautions” section just below.

This drug comes with several precautions.

FDA warnings

This drug has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Risk of cytokine release syndrome: Elrexfio may cause cytokine release syndrome (CRS). This condition results in the rapid release of certain proteins into your blood, which can make your immune system overactive.

Mild CRS was common in clinical trials of Elrexfio. With mild CRS, you may have symptoms such as fever, chills, body aches, and diarrhea.

Severe CRS was less common in clinical trials. However, it can be life threatening for some people. With severe CRS, you may have symptoms that include:

Due to this risk, Elrexfio is only given in a facility that has been certified by the Elrexfio risk evaluation and mitigation strategy (REMS) program. The REMS program helps ensure that your doctor (or other healthcare professional) understands how to give Elrexfio. They’ll also know how to recognize and treat serious side effects that may occur.

After the first dose of Elrexfio, you’ll likely stay in the facility for at least 48 hours. After the second dose, you’ll likely stay for at least 24 hours. These extended stays allow your doctor to closely monitor you for any serious side effects, including CRS. (For details about the dosing schedule for Elrexfio, see the “Elrexfio dosage” section above.)

To help reduce your risk of CRS, your doctor may prescribe other medications along with Elrexfio. These include acetaminophen (Tylenol), dexamethasone (Hemady), and diphenhydramine (Benadryl).

If you have symptoms of CRS after receiving Elrexfio injections, tell your doctor right away. They’ll likely stop Elrexfio injections and give you treatments for CRS.

Risk of neurologic toxicity: Elrexfio may cause neurologic toxicity. This means the drug may damage your nervous system, which includes your brain and spinal cord.

Mild neurologic toxicity was common in clinical trials of Elrexfio. With mild toxicity, you may have symptoms such as headache and tingling or numbness in your arms and legs.

Severe neurologic toxicity was less common in these trials. This includes a potentially life threatening condition called immune effector cell-associated neurotoxicity syndrome (ICANS).

Symptoms of severe neurologic toxicity or ICANS may include:

  • feeling agitated, disoriented, or confused
  • muscle spasms
  • difficulty writing, such as being unable to write a complete sentence
  • loss of consciousness

Due to this risk, Elrexfio is only given in a facility that has been certified by the Elrexfio REMS program. (For details about this program, see “Risk of cytokine release syndrome” just above.) In addition, you’ll likely stay in the facility after your first and second doses of the drug. This allows your doctor to closely monitor you for neurologic toxicity or other negative effects from the drug.

It’s important to avoid any activities that require alertness, such as driving, for at least 48 hours after receiving the first three doses of Elrexfio. This is because neurologic toxicity can affect coordination and memory. If you have symptoms of neurologic toxicity, you should avoid these activities until your symptoms have resolved.

Tell your doctor immediately if you have symptoms of neurologic toxicity after Elrexfio injections. They’ll likely discontinue your Elrexfio injections and treat this condition right away.

Other precautions

Before receiving Elrexfio, discuss your health history with your doctor. Elrexfio may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you:

  • current infection
  • previous allergic reaction to this or a similar drug
  • pregnancy
  • breastfeeding

Note: For more information about the potential negative effects of Elrexfio, see the “Elrexfio side effects” section above.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.