Darzalex vs. Sarclisa: How Does Darzalex Compare With Other Multiple Myeloma Drugs?

Multiple myeloma, or myeloma for short, is a type of blood cancer that develops in the bone marrow. There isn’t a cure for myeloma, but many medications can help manage the condition over the long run.

If you aren’t experiencing any myeloma symptoms, you may not need to start treatment right away. But if you are, your oncologist will likely recommend three types of medications: a targeted therapy, an immunomodulator, and a corticosteroid. These medications work better together than on their own.

Of these, targeted therapies are medications that target specific characteristics found on cancer cells. There are many types of targeted therapies for myeloma. These include monoclonal antibodies, proteasome inhibitors, and chimeric antigen receptor (CAR) T-cell therapies.

Monoclonal antibodies are often one of the first targeted therapy options used to treat myeloma. Below, we’ll explore how these medications fight cancer, how they’re administered, and how they stack up against other myeloma medications.

What is Darzalex (and Darzalex Faspro)?

Darzalex (daratumumab) and Darzalex Faspro (daratumumab / hyaluronidase-fihj) are monoclonal antibodies that treat myeloma. They contain the same active ingredient, but they’re administered differently.

Darzalex is given intravenously, directly into the vein. But Darzalex Faspro is administered subcutaneously, just under the skin. This difference affects how long it takes to receive treatment. The first infusion of Darzalex takes about 7 hours. The second takes about 4 hours. Every infusion after that takes close to 3 hours.

Darzalex Faspro takes only a few minutes per administration. But your first injection of Darzalex Faspro may still take several hours. Your oncologist will likely want to monitor you for a few hours to make sure your body responds smoothly to the injection.

Both medications have similar dosing schedules. You’ll start with weekly doses that are gradually given less often. Once you’ve completed a certain amount of doses, you’ll receive Darzalex once a month until it stops working.

How do monoclonal antibodies like Darzalex work for multiple myeloma?

Monoclonal antibodies attach to proteins on cancer cells. This alerts the immune system to attack the cell. Many times, cancer cells hide from the immune system to keep growing. When a monoclonal antibody attaches to these cells, it acts like a red flag. This lets your immune system see and kill the cancer cell.

Darzalex and Darzalex Faspro target a protein on myeloma cells called CD38. This protein is found in much higher levels on myeloma cells compared with healthy cells. By focusing on CD38, monoclonal antibodies help the immune system fight myeloma more effectively.

Darzalex vs. Sarclisa: What are the main differences between these two multiple myeloma medications?

Darzalex and Sarclisa (isatuximab-irfc) are both monoclonal antibodies that target CD38. But they do have some key differences. Darzalex is available as an intravenous (IV) and a subcutaneous injection. Sarclisa is available only as an IV injection.

Their FDA-approved uses for myeloma are also different. Darzalex can be a first-choice treatment in combination with other myeloma medications. It can be used even if you’re not eligible for a stem cell transplant. It can be used by itself or in combination with other myeloma medications later in treatment. By comparison, Sarclisa is used with other medications if you’ve had at least one to three prior myeloma treatments.

Dosages are also different. Once you get past the weekly doses, you’ll receive Sarclisa every 2 weeks. Darzalex is once a month. But infusion times are shorter with Sarclisa than with Darzalex. The first infusion of Sarclisa takes 3 to 4 hours. The second is 2 hours. Infusions after that last a little over 1 hour.

Darzalex and Sarclisa are different from Empliciti

Darzalex and Sarclisa attach to the CD38 protein on myeloma cells. Empliciti (elotuzumab) is another monoclonal antibody approved to treat myeloma. But it targets a different protein, called SLAMF7. This protein is found at high levels on myeloma cells.

Other multiple myeloma medications your oncologist may prescribe

The most effective myeloma treatment often includes several medications used in combination. Monoclonal antibodies like Daralex are one example of the types of medications used.

Below are other treatments used for myeloma. Your oncologist may recommend one or more of these medications.

Chemotherapy for multiple myeloma

Chemotherapy works by killing fast-growing cells throughout the body. This works because cancer cells generally grow much faster than normal, healthy cells. Chemotherapy is often used with other multiple myeloma medications before a stem cell transplant. But it can also be given if other medications have stopped working.

Examples of IV chemotherapies used for myeloma treatment include:

• Doxorubicin (Adriamycin)

• Melphalan (Evomela)

• Bendamustine (Bendeka, Treanda)

• Cyclophosphamide (Cytoxan)

• Etoposide (Toposar)

• Cisplatin

Corticosteroids for multiple myeloma

Corticosteroids are often used to reduce swelling and inflammation in the body. But some steroids have anticancer effects too. When used to treat myeloma, they’re often given in combination with other medications.

Corticosteroids are available as tablets and IV injections. Common corticosteroids used for myeloma treatment are dexamethasone and prednisone.

Immunomodulators for multiple myeloma

Immunomodulators are a type of immunotherapy. They work with your immune system to recognize and fight cancer. Immunomodulators can also block substances called growth factors, which stop cancer cells. They’re available as tablets or capsules and taken with other myeloma medications.

The two most common immunomodulators used to treat myeloma are Pomalyst (pomalidomide) and Revlimid (lenalidomide).

Proteasome inhibitors for multiple myeloma

Proteasome inhibitors are another type of targeted therapy. They block a group of proteins called proteasomes. This protein helps myeloma cells grow and survive by getting rid of damaged or unnecessary proteins.

Proteasome inhibitors are usually given along with other myeloma medications. They’re available by IV injection or as an oral tablet. They include:

• Kyprolis (carfilzomib)

• Ninlaro (ixazomib)

• Velcade (bortezomib)

Bispecific antibodies for multiple myeloma

Bispecific antibodies are targeted therapies that are similar to monoclonal antibodies. Except they attach to myeloma cells and immune cells, bringing them closer together. This helps immune cells attack and destroy the cancer cells more effectively.

All bispecific antibodies approved for myeloma are given by a subcutaneous injection. And they can be given only to people who have already received at least four previous treatments, including three myeloma medications:

• Tecvayli (teclistamab-cqyv)

• Elrexfio (elranatamab-bcmm)

• Talvey (talquetamab-tgvs)

Nuclear export inhibitors for multiple myeloma

Cancer cells need certain proteins to be able to grow and survive. Nuclear export inhibitors are targeted medications that block cancer cells’ ability to use these proteins. This eventually causes cancer cells to stop growing and die.

Xpovio (selinexor) is the only nuclear export inhibitor approved for myeloma. It’s an oral tablet used in combination with other medications after trying at least one other myeloma treatment.

CAR T-cell therapies for multiple myeloma

CAR T-cell therapy is a type of targeted therapy made from your own T cells, a type of immune cell. Your T cells are taken from your body and modified in a lab to better recognize and attack myeloma cells. After they’re modified, they’re infused back into your body to fight the cancer.

Abecma (idecabtagene vicleucel) and Carvykti (ciltacabtagene autoleucel) are CAR T-cell therapies that are approved for use in myeloma. But they’re considered only after you’ve tried one to two other myeloma treatments that didn’t work.

CAR T-cell therapies like these are a one-time treatment.

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Written by:

Vanessa Carranza, PharmD

Vanessa Carranza, PharmD, is a pharmacist who has dedicated her career to the advancement of medical education for healthcare providers, patients, and caregivers, most notably in the oncology space.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

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