Network Meta-Analysis Compares Efficacy of BTK Inhibitors for CLL

Mazyar Shadman, MD, MPH, an Assistant Professor at the Fred Hutchinson Cancer Center, discusses a network meta-analysis comparing the efficacy of covalent Bruton’s tyrosine kinase (BTK) inhibitors for relapsed or refractory chronic lymphocytic leukemia (CLL) presented at the 2024 American Society of Clinical Oncology Annual Meeting in Chicago.

“This is a methodology that uses more than three clinical trials and utilizes direct and indirect comparisons,” Dr. Shadman explained.

Dr. Shadman and colleagues utilized three studies: ELEVATE-RR comparing acalabrutinib versus ibrutinib, ALPINE comparing zanubrutinib versus ibrutinib, and ASCEND comparing acalabrutinib versus bendamustine plus rituximab or idelalisib plus rituximab.

Zanubrutinib led to statistically significant improvements in progression-free survival compared with ibrutinib, acalabrutinib, and bendamustine plus rituximab. While there was also a trend in favor of zanubrutinib versus ibrutinib for complete response, it did not reach statistical significance.

“The gold standard for comparing drugs is head-to-head trials. However, these indirect comparisons could help investigators, physicians, and patients have a good understanding of the relative efficacy of these drugs,” Dr. Shadman concluded.