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Real-world comparative effectiveness of acalabrutinib and ibrutinib in patients with chronic lymphocytic leukemia
Novel agents, including Bruton tyrosine kinase inhibitors (BTKis), have become the standard of care for patients with chronic lymphocytic leukemia (CLL). We conducted a real-world retrospective analysis of patients with CLL treated with acalabrutinib vs ibrutinib using the Flatiron Health database....
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The American Society of Hematology
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10424141/ https://www.ncbi.nlm.nih.gov/pubmed/37163361 http://dx.doi.org/10.1182/bloodadvances.2023009739 |
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author | Roeker, Lindsey E. DerSarkissian, Maral Ryan, Kellie Chen, Yan Duh, Mei Sheng Wahlstrom, Svea K. Hakre, Shweta Yu, Louise Guo, Helen Mato, Anthony R. |
author_facet | Roeker, Lindsey E. DerSarkissian, Maral Ryan, Kellie Chen, Yan Duh, Mei Sheng Wahlstrom, Svea K. Hakre, Shweta Yu, Louise Guo, Helen Mato, Anthony R. |
author_sort | Roeker, Lindsey E. |
collection | PubMed |
description | Novel agents, including Bruton tyrosine kinase inhibitors (BTKis), have become the standard of care for patients with chronic lymphocytic leukemia (CLL). We conducted a real-world retrospective analysis of patients with CLL treated with acalabrutinib vs ibrutinib using the Flatiron Health database. Patients with CLL were included if they initiated acalabrutinib or ibrutinib between 1 January 2018 and 28 February 2021. The primary outcome of interest was time to treatment discontinuation (TTD). Kaplan-Meier analysis was used to estimate unweighted and weighted median TTD. A weighted Cox proportional hazards model was used to compare the TTD between cohorts. Of the 2509 patients included in the analysis, 89.6% received ibrutinib, and 14.1% received acalabrutinib. TTD was not significantly different between cohorts in the unweighted analysis. After weighting, the cohorts were balanced on all baseline characteristics except cardiovascular risk factors and baseline medications use. The median (95% confidence interval [CI]) TTD was not reached (NR; 95% CI, 25.1 to NR) for the acalabrutinib cohort and was 23.4 months (95% CI, 18.1-28.7) for the ibrutinib cohort. The discontinuation rate at 12 months was 22% for the weighted acalabrutinib cohort vs 31% for the weighted ibrutinib cohort (P = .005). After additional adjustment for prior BTKi use, the acalabrutinib cohort had a 41% lower risk of discontinuation vs ibrutinib (hazard ratio, 0.59; 95% CI, 0.43-0.81; P = .001). In the largest available study comparing BTKis, patients with CLL receiving acalabrutinib demonstrated lower rates of discontinuation and a prolonged time to discontinuation vs those receiving ibrutinib. |
format | Online Article Text |
id | pubmed-10424141 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | The American Society of Hematology |
record_format | MEDLINE/PubMed |
spelling | pubmed-104241412023-08-15 Real-world comparative effectiveness of acalabrutinib and ibrutinib in patients with chronic lymphocytic leukemia Roeker, Lindsey E. DerSarkissian, Maral Ryan, Kellie Chen, Yan Duh, Mei Sheng Wahlstrom, Svea K. Hakre, Shweta Yu, Louise Guo, Helen Mato, Anthony R. Blood Adv Health Services and Outcomes Novel agents, including Bruton tyrosine kinase inhibitors (BTKis), have become the standard of care for patients with chronic lymphocytic leukemia (CLL). We conducted a real-world retrospective analysis of patients with CLL treated with acalabrutinib vs ibrutinib using the Flatiron Health database. Patients with CLL were included if they initiated acalabrutinib or ibrutinib between 1 January 2018 and 28 February 2021. The primary outcome of interest was time to treatment discontinuation (TTD). Kaplan-Meier analysis was used to estimate unweighted and weighted median TTD. A weighted Cox proportional hazards model was used to compare the TTD between cohorts. Of the 2509 patients included in the analysis, 89.6% received ibrutinib, and 14.1% received acalabrutinib. TTD was not significantly different between cohorts in the unweighted analysis. After weighting, the cohorts were balanced on all baseline characteristics except cardiovascular risk factors and baseline medications use. The median (95% confidence interval [CI]) TTD was not reached (NR; 95% CI, 25.1 to NR) for the acalabrutinib cohort and was 23.4 months (95% CI, 18.1-28.7) for the ibrutinib cohort. The discontinuation rate at 12 months was 22% for the weighted acalabrutinib cohort vs 31% for the weighted ibrutinib cohort (P = .005). After additional adjustment for prior BTKi use, the acalabrutinib cohort had a 41% lower risk of discontinuation vs ibrutinib (hazard ratio, 0.59; 95% CI, 0.43-0.81; P = .001). In the largest available study comparing BTKis, patients with CLL receiving acalabrutinib demonstrated lower rates of discontinuation and a prolonged time to discontinuation vs those receiving ibrutinib. The American Society of Hematology 2023-05-12 /pmc/articles/PMC10424141/ /pubmed/37163361 http://dx.doi.org/10.1182/bloodadvances.2023009739 Text en © 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Health Services and Outcomes Roeker, Lindsey E. DerSarkissian, Maral Ryan, Kellie Chen, Yan Duh, Mei Sheng Wahlstrom, Svea K. Hakre, Shweta Yu, Louise Guo, Helen Mato, Anthony R. Real-world comparative effectiveness of acalabrutinib and ibrutinib in patients with chronic lymphocytic leukemia |
title | Real-world comparative effectiveness of acalabrutinib and ibrutinib in patients with chronic lymphocytic leukemia |
title_full | Real-world comparative effectiveness of acalabrutinib and ibrutinib in patients with chronic lymphocytic leukemia |
title_fullStr | Real-world comparative effectiveness of acalabrutinib and ibrutinib in patients with chronic lymphocytic leukemia |
title_full_unstemmed | Real-world comparative effectiveness of acalabrutinib and ibrutinib in patients with chronic lymphocytic leukemia |
title_short | Real-world comparative effectiveness of acalabrutinib and ibrutinib in patients with chronic lymphocytic leukemia |
title_sort | real-world comparative effectiveness of acalabrutinib and ibrutinib in patients with chronic lymphocytic leukemia |
topic | Health Services and Outcomes |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10424141/ https://www.ncbi.nlm.nih.gov/pubmed/37163361 http://dx.doi.org/10.1182/bloodadvances.2023009739 |
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