Real-World Study Evaluating Drug Tolerability and Health Care Resource Use (HCRU) With Acalabrutinib vs. Ibrutinib in Treatment-Naïve Patients With Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL)
Author(s)
Daniel Ermann, MD1, George Dranitsaris, PhD2, Sibel Blau, MD2, Aaron Peevyhouse, MBA2, Heather Neuhalfen, MBA2, Vikram Shetty, MD3, Dipen Patel, PhD3, Samantha L. Thompson, PhD4, Anna Teschemaker, PhD3, Mayur Narkhede, MD5.
1University of Utah, Salt Lake City, UT, USA, 2ONCare Alliance, Tacoma, WA, USA, 3AstraZeneca, Gaithersburg, MD, USA, 4AstraZeneca, Cambridge, United Kingdom, 5The University of Alabama at Birmingham, Birmingham, AL, USA.
1University of Utah, Salt Lake City, UT, USA, 2ONCare Alliance, Tacoma, WA, USA, 3AstraZeneca, Gaithersburg, MD, USA, 4AstraZeneca, Cambridge, United Kingdom, 5The University of Alabama at Birmingham, Birmingham, AL, USA.
Presentation Documents
OBJECTIVES: Bruton tyrosine kinase inhibitors, acalabrutinib and ibrutinib, are standard of care in CLL/SLL but associated cardiovascular toxicities may increase HCRU. This study compared the tolerability, cardiovascular adverse events of interest, and HCRU between acalabrutinib and ibrutinib monotherapy in treatment-naïve patients with CLL/SLL in the USA.
METHODS: A large retrospective study was conducted using electronic medical record data from the ONCare Alliance Network, an alliance of 32 community practices. Data were analyzed from treatment-naïve patients receiving acalabrutinib or ibrutinib from 1/1/2017 to 12/31/2023. Data collected included patient and disease characteristics, medical events of interest (MEOI), tolerability (i.e., discontinuation due to MEOI), and HCRU, including clinic visits, emergency department (ED) visits, hospital admissions, and specialist consultations. The primary endpoint, hypertension, was evaluated using propensity score weighted multivariate logistic regression analysis.
RESULTS: 454 patients (227 per group) were included. Baseline characteristics were comparable between acalabrutinib and ibrutinib, including median age (72 vs 73 years), ECOG performance status (≥2: 8.4% vs 11.4%), and median Charlson comorbidity score (3 vs 3). After a median follow-up of 28 months, fewer MEOI occurred with acalabrutinib versus ibrutinib (20.3% vs 45.8%; p<0.001), including hypertension (4.4% vs 18.5%), atrial fibrillation (4.4% vs 15.9%), and bleeding events (7.9% vs 11.4%). Fewer patients receiving acalabrutinib versus ibrutinib discontinued owing to MEOIs (19.4% vs 46.7%; p<0.001). The median number of clinic visits was higher with acalabrutinib than ibrutinib (12 vs 9), but the total number of ED visits for MEOI (5 vs 17), hospital admissions for MEOI (34 vs 42), and specialist consultations (39 vs 48) was lower with acalabrutinib, as was the median hospitalization length (3.0 vs 7.5 days per admission).
CONCLUSIONS: In treatment-naïve patients with CLL/SLL, acalabrutinib monotherapy showed better tolerability than ibrutinib with reduced HCRU, which may translate to a lower economic burden with acalabrutinib in CLL/SLL.
METHODS: A large retrospective study was conducted using electronic medical record data from the ONCare Alliance Network, an alliance of 32 community practices. Data were analyzed from treatment-naïve patients receiving acalabrutinib or ibrutinib from 1/1/2017 to 12/31/2023. Data collected included patient and disease characteristics, medical events of interest (MEOI), tolerability (i.e., discontinuation due to MEOI), and HCRU, including clinic visits, emergency department (ED) visits, hospital admissions, and specialist consultations. The primary endpoint, hypertension, was evaluated using propensity score weighted multivariate logistic regression analysis.
RESULTS: 454 patients (227 per group) were included. Baseline characteristics were comparable between acalabrutinib and ibrutinib, including median age (72 vs 73 years), ECOG performance status (≥2: 8.4% vs 11.4%), and median Charlson comorbidity score (3 vs 3). After a median follow-up of 28 months, fewer MEOI occurred with acalabrutinib versus ibrutinib (20.3% vs 45.8%; p<0.001), including hypertension (4.4% vs 18.5%), atrial fibrillation (4.4% vs 15.9%), and bleeding events (7.9% vs 11.4%). Fewer patients receiving acalabrutinib versus ibrutinib discontinued owing to MEOIs (19.4% vs 46.7%; p<0.001). The median number of clinic visits was higher with acalabrutinib than ibrutinib (12 vs 9), but the total number of ED visits for MEOI (5 vs 17), hospital admissions for MEOI (34 vs 42), and specialist consultations (39 vs 48) was lower with acalabrutinib, as was the median hospitalization length (3.0 vs 7.5 days per admission).
CONCLUSIONS: In treatment-naïve patients with CLL/SLL, acalabrutinib monotherapy showed better tolerability than ibrutinib with reduced HCRU, which may translate to a lower economic burden with acalabrutinib in CLL/SLL.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE457
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology