Fewer Black Patients Prescribed Novel Agents for CLL in the VA System

Black patients with chronic lymphocytic leukemia (CLL) treated in the Department of Veterans Affairs (VA) were less likely to receive novel agents for first-line therapy compared with White patients, according to a study published in the Journal of Managed Care and Specialty Pharmacy.

“Fortunately, health outcomes and most complications were similar for Black and White patients,” researchers wrote, “despite the difference in prescribing patterns.” 

The retrospective cohort study included 565 adults who received first-line treatment for CLL in the VA system between October 1, 2013, and September 30, 2017. Researchers were interested in whether novel agents—specifically, ibrutinib, idelalisib, and venetoclax—were used at similar rates among White and Black patients. Because the VA is the largest, equal-access health care system in the country, researchers hypothesized they would be.

However, just 14% of Black patients received novel agents overall compared with 26% of White patients, the study showed. 

“Notably, in our study, more Black patients received chemotherapy/chemoimmunotherapy and more White patients received novel agents as first-line therapy over the study period,” researchers wrote.

By year, the gap in use of novel agents between the groups slimmed, according to the study. In 2014, rates of novel agents were 4% among Black patients and 17% among White patients. By 2017, rates were 31% for Black patients and 33% for White patients. Multivariable analysis showed that Black race and fiscal year were the only variables significantly associated with novel agent use. 

“Further studies should explore other socioeconomic and cultural factors that may drive these racial disparities, as well as the safety and effectiveness of treatments by race, to better understand how racial disparities might impact patient outcomes,” the authors advised. “The VA should consider the findings of this study and other studies to design and implement programs and policies to eliminate this disparity.”

Reference:
Lucero KT, Obodozie-Ofoegbu OO, Nooruddin Z, et al. Health disparity in use of novel agents for first-line therapy in Black and White patients with chronic lymphocytic leukemia in the Department of Veterans Affairs. J Manag Care Spec Pharm. 2023;29(4):420-430. doi: 10.18553/jmcp.2023.29.4.420