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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.
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.
Shares Zanubrutinib, Acalabrutinib, Chronic lymphocytic leukaemia, first treatment, Chronic lymphocytic leukaemia.
Shares Acalabrutinib, Chronic lymphocytic leukaemia, first treatment, Ibrutinib, Chronic lymphocytic leukaemia.
Shares Zanubrutinib, Acalabrutinib, Ibrutinib.
Shares Zanubrutinib, Acalabrutinib, Chronic lymphocytic leukaemia, first treatment, Ibrutinib.
Shares Acalabrutinib, Ibrutinib, Chronic lymphocytic leukaemia.
Shares Chronic lymphocytic leukaemia, first treatment, Ibrutinib, Chronic lymphocytic leukaemia.
Shares Chronic lymphocytic leukaemia, first treatment, Ibrutinib, Chronic lymphocytic leukaemia.
Shares ALPINE, Zanubrutinib.