Real-world analyses of bispecific antibodies and CAR-T cell therapy in relapsed or refractory multiple myeloma: a global TriNetX discovery and contemporary validation cohort.

Bispecific antibodies (BsAbs) and BCMA-directed CAR-T cell therapies have transformed late-line relapsed/refractory multiple myeloma (RRMM), yet real-world comparisons are confounded by treatment selection, line of therapy, and supportive care. We combined a global propensity-matched TriNetX discovery analysis with a contemporary, treatment-line-aware validation cohort. In TriNetX, 223,703 myeloma patients were identified up to 8 April 2026, matching yielded 822 BsAb- and 822 CAR-T-treated patients. BsAbs therapy showed inferior overall survival versus CAR-T (HR 2.015, 95% CI 1.592-2.551; p < 0.001), with similar signals in several biochemical risk subgroups. Cilta-cel outperformed ide-cel, whereas teclistamab and talquetamab were comparable. In the validation cohort (187 patients, 211 exposures), CAR-T therapy was used earlier and in fitter patients. After accounting for exposure and later-line disease, class-level OS and TTNT differences attenuated, while cilta-cel remained numerically favorable. Overall, treatment selection should be individualized rather than class-preferential.