Time trends in frontline systemic therapy utilization for chronic lymphocytic leukemia in the United States
Goyal R, Nagar S, Davis KL, Kaye JA
Targeted treatments have emerged as frontline therapies for patients diagnosed with chronic lymphocytic leukemia or CLL. To better understand treatment trends, we undertook a retrospective cohort study of CLL patients using a commercial claims database in the US.
Our study includes nearly 1400 patients receiving their first treatment during July 2012 to June 2016. The combination of targeted agents bendamustine and rituximab increased to a peak of 31% in 2015, but its use had declined sharply by early 2016. Similarly, other rituximab-based combination immunochemotherapies declined during the study period. In contrast, the use of a first-in-class Bruton’s tyrosine kinase inhibitor, ibrutinib, increased sharply to 25.8% by early 2016. Its use increased among both younger patients and those over age 65.
This study demonstrates a substantial increase in the uptake of ibrutinib as the frontline therapy for CLL in the US. Additional novel agents are on the horizon for treatment of CLL, and treatment patterns are likely to continue shifting as treatment guidelines change.