Comprehensive analysis of adverse events associated with T-cell engagers using the FAERS database

T-cell engagers (TCEs) are transformative immunotherapies with significant potential in treating hematologic malignancies and solid tumors. However, their real-world safety profiles remain inadequately characterized.

Using the FDA Adverse Event Reporting System (FAERS) database (October 2019 - September 2024, 8,747,158 reports), we analyzed adverse events (AEs) associated with nine TCEs. Disproportionality analysis identified overreported AEs, with 11,963 unique reports analyzed after deduplication.

Blinatumomab was the most reported TCE (n = 4,950), and Tarlatamab the least (n = 185). Predominant AEs included immune system disorders, particularly cytokine release syndrome (IC₀₂₅ range: 6.08-7.47). Drug-specific signals included reproductive system and breast disorders (IC₀₂₅: 2.74) and vascular disorders (IC₀₂₅: 2.25) with Tebentafusp, renal and urinary disorders with Epcoritamab (IC₀₂₅: 1.84), and eye disorders with Elranatamab (IC₀₂₅: 1.81). Novel AEs were also uncovered, including second malignant neoplasms, vasogenic cerebral edema with Mosunetuzumab (IC₀₂₅: 5.77, ROR₀₂₅: 56.29), and hydronephrosis with Epcoritamab (IC₀₂₅: 7.50, ROR₀₂₅: 180.70). Early-onset events (0.5-9.5 days) were linked to four TCEs, while delayed-onset events (>20 days) were linked to five others.

This study highlights diverse AE profiles of TCEs, providing insights for clinicians to optimize their safe use in practice.