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Real-World Cardiovascular Risks for Patients With CLL Receiving Ibrutinib
According to a recent study, ibrutinib is associated with higher risk of atrial fibrillation, bleeding, and heart failure, but not acute myocardial infarction or stroke among patients with chronic lymphocytic leukemia (CLL; J Clin Oncol. 2021; JCO2100693. doi:10.1200/JCO.21.00693).
“Ibrutinib reduces mortality in CLL. It increases the risk of atrial fibrillation (AF) and bleeding and there are concerns about heart failure (HF) and central nervous system ischemic events.,” wrote Husam Abdel-Qadir, MD, PhD, Division of Cardiology and Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada, and colleagues.
Aiming to measure the risks of atrial fibrillation and bleeding associated with ibrutinib in patients with CLL, Dr Abdel-Qadir and colleagues used linked administrative databases to identify Ontario patients with CLL who were diagnosed between 2007 and 2019, and treated. Patients treated with ibrutinib were matched with controls treated with chemotherapy but unexposed to ibrutinib on prior atrial fibrillation, aged at least 66 years, anticoagulant exposure, and propensity for receiving ibrutinib.
Data on atrial fibrillation-related health care contact, hospital-diagnosed bleeding, new diagnoses of HF, and hospitalizations for stroke and acute myocardial infarction were examined.
All 1156 patients with CLL were matched and put into 778 pairs, consisting of one patient treated with ibrutinib, and one unexposed patient.
In patients treated with ibrutinib compared with those in controls, the 3-year incidence of atrial fibrillation-related health care contact was 22.7% vs 11.7%, the 3-year risk of hospital-diagnosed bleeding was 8.8% vs 3.1%, and the 3-year risk of heart failure was 7.7% vs 3.6%, respectively.
Patients treated with ibrutinib were associated with bleeding. Data showed no significant difference in the risk of ischemic stroke or acute myocardial infarction.
“Ibrutinib is associated with higher risk of AF [atrial fibrillation], bleeding, and HF [heart failure], but not AMI [acute myocardial infarction] or stroke,” Dr Abdel-Qadir and colleagues concluded.—Marta Rybczynski
