{"entity":{"id":"btki-ibrutinib-cardiac-caution","kind":"pairing","name":"Caution: ibrutinib in patients with cardiac risk","aka":[],"tldr":"Ibrutinib raises the risk of irregular heart rhythm, high blood pressure, and sudden cardiac events; second-generation BTK inhibitors are safer choices for patients with heart disease.","summary":"This caution pairs ibrutinib with cardio-oncology: the first-generation BTK inhibitor raises the risk of atrial fibrillation, hypertension and ventricular arrhythmia or sudden cardiac death in chronic lymphocytic leukaemia patients, through off-target inhibition of CSK and TEC kinases in cardiomyocytes and the vasculature. Long-term ibrutinib data carry these signals, and the head-to-head phase 3 trials ELEVATE-RR and ALPINE showed markedly less atrial fibrillation with the second-generation inhibitors acalabrutinib and zanubrutinib, which are therefore safer choices for patients with heart disease; pharmacovigilance data agree. Anticoagulation for atrial fibrillation adds bleeding risk with any BTK inhibitor, so the cardiac and bleeding risks have to be weighed together.","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT03734016: ALPINE","url":"https://clinicaltrials.gov/study/NCT03734016"}],"tags":[],"related":[],"cancers":["cll"],"sections":[],"technologies":["cardio-oncology"],"targets":[],"drugs":["ibrutinib","acalabrutinib","zanubrutinib"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["alpine"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"a":"ibrutinib","b":"cardio-oncology","rationale":"Off-target inhibition of CSK and TEC in cardiomyocytes and vasculature.","evidence":"Head-to-head phase 3 (ELEVATE-RR, ALPINE); pharmacovigilance.","pairingType":"caution"},"route":"/pairings/btki-ibrutinib-cardiac-caution/","neighbours":{"cancer":[{"id":"cll","kind":"cancer","name":"Chronic lymphocytic leukaemia","route":"/cancers/cll/"},{"id":"cll-treatment-naive","kind":"cancer","name":"Chronic lymphocytic leukaemia, first treatment","route":"/cancers/cll-treatment-naive/"}],"technology":[{"id":"cardio-oncology","kind":"technology","name":"Cardio-oncology","route":"/technologies/cardio-oncology/"}],"drug":[{"id":"acalabrutinib","kind":"drug","name":"Acalabrutinib","route":"/drugs/acalabrutinib/"},{"id":"ibrutinib","kind":"drug","name":"Ibrutinib","route":"/drugs/ibrutinib/"},{"id":"zanubrutinib","kind":"drug","name":"Zanubrutinib","route":"/drugs/zanubrutinib/"}],"trial":[{"id":"alpine","kind":"trial","name":"ALPINE","route":"/trials/alpine/"}]}}