Goyal R, Nagar S, Davis KL, Kaye JA. Time trends in frontline systemic therapy utilization for chronic lymphocytic leukemia in the United States. Poster presented at the ISPOR 21st Annual European Congress; November 14, 2018. Barcelona, Spain.

OBJECTIVES: Introduction of next-generation targeted therapies, such as ibrutinib, a first-in-class Bruton’s tyrosine kinase inhibitor, for treatment of chronic lymphocytic leukemia (CLL) is expected to redefine the therapeutic landscape. In this study, we aimed to explore and benchmark recent trends in utilization of frontline systemic therapies for CLL in the United States (US).

METHODS: Using a population-level commercial claims database, this retrospective cohort study included patients (aged ≥18 years) initiating systemic therapy after the first CLL diagnosis during July 2012 through June 2016. Percentage of patients treated with first-line therapy regimens was assessed by calendar year and stratified by age group (<65 years and ≥65 years). All analyses were descriptive in nature.

RESULTS: 1,379 patients met the selection criteria. The number of patients with any systemic therapy by calendar year were 143 (2012 [Jul-Dec]), 360 (2013), 470 (2014), 309 (2015), and 97 (2016 [Jan-Jun]). The utilization of bendamustine/rituximab as the frontline therapy increased from 23.1% in 2012 to 31.4% in 2015 but declined sharply to 13.4% in early 2016, with a corresponding increase in the use of ibrutinib from 11.7% in 2015 to 25.8% in early 2016. Use of fludarabine/cyclophosphamide/rituximab and other rituximab-based immunochemotherapies declined during the study period; use of R-monotherapy remained stable but increased slightly towards the later years (20.1% in 2015 to 23.7% in 2016). Ibrutinib and R-monotherapy were the preferred options for patients aged ≥65 years, although, their use among patients aged <65 years increased considerably from 2015 to early 2016 (ibrutinib: 7% to 24%; R-monotherapy: 17.5% to 22%).

This study demonstrates a substantial increase in the uptake of ibrutinib as the frontline therapy for CLL in the US. As novel agents are approved or included in the treatment guidelines for CLL (e.g. venetoclax, acalabrutinib), further research should evaluate post-2016 utilization trends overall and by therapy line.

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