Abstract
The first-in-class Bruton's tyrosine kinase inhibitor ibrutinib has proven clinical benefit in B-cell malignancies; however, atrial fibrillation (AF) has been reported in 6-16% of ibrutinib patients. We pooled data from 1505 chronic lymphocytic leukemia and mantle cell lymphoma patients enrolled in four large, randomized, controlled studies to characterize AF with ibrutinib and its management. AF incidence was 6.5% [95% Confidence Interval (CI): 4.8, 8.5] for ibrutinib at 16.6-months versus 1.6% (95%CI: 0.8, 2.8) for comparator and 10.4% (95%CI: 8.4, 12.9) at the 36-month follow up; estimated cumulative incidence: 13.8% (95%CI: 11.2, 16.8). Ibrutinib treatment, prior history of AF and age 65 years or over were independent risk factors for AF. Multiple AF events were more common with ibrutinib (44.9%; comparator, 16.7%) among patients with AF. Most (85.7%) patients with AF did not discontinue ibrutinib, and more than half received common anticoagulant/antiplatelet medications on study. Low-grade bleeds were more frequent with ibrutinib, but serious bleeds were uncommon (ibrutinib, 2.9%; comparator, 2.0%). Although the AF rate among older non-trial patients with comorbidities is likely underestimated by this dataset, these results suggest that AF among clinical trial patients is generally manageable without ibrutinib discontinuation (clinicaltrials.gov identifier: 01578707, 01722487, 01611090, 01646021).
DOI
10.3324/haematol.2017.171041
Publication Date
2017-10-01
Publication Title
Haematologica
Volume
102
Issue
10
Publisher
Ferrata Storti Foundation (Haematologica)
ISSN
1592-8721
Embargo Period
2024-11-19
First Page
1796
Last Page
1805
Recommended Citation
Brown, J., Moslehi, J., O’Brien, S., Ghia, P., & et al. (2017) 'Characterization of atrial fibrillation adverse events reported in ibrutinib randomized controlled registration trials', Haematologica, 102(10), pp. 1796-1805. Ferrata Storti Foundation (Haematologica): Available at: https://doi.org/10.3324/haematol.2017.171041
