Real-World Study Explores BTK Inhibitor Trends for CLL, SLL

By Andrew Moreno - Last Updated: September 30, 2024

A real-world study examined trends in Bruton tyrosine kinase (BTK) inhibitor use for chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) in the United States. The findings were presented at the Society of Hematologic Oncology 2024 Annual Meeting in Houston, Texas.

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The retrospective study examined medical records from the US Oncology Network of 2,082 adults with CLL or SLL who were prescribed BTK inhibitors over the January 2020 to April 2023 study period. The cohort had a median age of 73 years and a median follow-up of 14.1 months.

In these patients, the investigators accounted for social determinants of health (SDOHs) through Area Deprivation Index (ADI) scores based on socioeconomic status (SES). They defined “low” SES as the top 20% of state and national ADI scores.

Over the study period, 1,159 patients in the cohort received acalabrutinib and 628 received ibrutinib as their sole BTK inhibitor. One hundred eighty-two patients reported receiving additional BTK inhibitors beyond their initial agent.

Over the study period, ibrutinib use decreased but zanubrutinib and acalabrutinib use increased. In 2020, of 597 patients who were treated with a BTK inhibitor, 372 received ibrutinib and only one received zanubrutinib. In 2023, of 206 patients treated with a BTK inhibitor, 14 received ibrutinib and 59 received zanubrutinib.

“SDOH were similar across BTK inhibitor sequence subgroups, although rural/urban status, and not SES or Medicaid, was associated with differences in prescribing patterns,” wrote lead study author David J. Andorsky, MD, of Rocky Mountain Cancer Centers in Boulder, Colorado.

Of the total study cohort, 17.3% had low SES according to state indicators and 6% by national indicators. In addition, 42.1% of the cohort had Medicare and 24.4% had Managed Medicare plans. The investigators observed a statistical difference between treatments by rural versus urban status (P<0.01) but not by state ADI status (P=0.52), national ADI status (P=0.36), or Medicaid versus other medical insurance (P=0.18).

“Further real-world research and longitudinal follow-up are needed to examine the impact of SDOH on BTK inhibitor choice, switching, reasons for switching, and outcomes,” Dr. Andorsky concluded.

Reference

Andorsky DJ, Wilson TW, Aguilar KM, et al. Recent patterns of care with BTK inhibitors and distribution of social determinants of health among patients with CLL/SLL in the US community setting. Abstract #CLL-103. Presented at the Society of Hematologic Oncology 2024 Annual Meeting; September 4-7, 2024; Houston, Texas.

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