Hypertension and incident cardiovascular events following ibrutinib initiation

• Published in: Blood Vol. 134; no. 22; pp. 1919 - 1928
• Main Authors: Dickerson, Tyler, Wiczer, Tracy, Waller, Allyson, Philippon, Jennifer, Porter, Kyle, Haddad, Devin, Guha, Avirup, Rogers, Kerry A., Bhat, Seema, Byrd, John C., Woyach, Jennifer A., Awan, Farrukh, Addison, Daniel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 28-11-2019; American Society of Hematology
• Subjects: Aged; Antihypertensive Agents - administration & dosage; Clinical Trials and Observations; Female; Heart Diseases - chemically induced; Heart Diseases - drug therapy; Heart Diseases - mortality; Hematologic Neoplasms - diet therapy; Hematologic Neoplasms - mortality; Humans; Hypertension - chemically induced; Hypertension - drug therapy; Hypertension - mortality; Incidence; Male; Middle Aged; Pyrazoles - administration & dosage; Pyrazoles - adverse effects; Pyrimidines - administration & dosage; Pyrimidines - adverse effects; Stroke - chemically induced; Stroke - drug therapy; Stroke - mortality
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.2019000840

Ibrutinib is associated with dramatic efficacy against B-cell malignancies. Yet, it has been linked with potentially limiting cardiotoxicity, including emerging reports of profound hypertension (HTN). The long-term incidence, severity, and impact of HTN development with ibrutinib are unknown. Therefore, in 562 consecutive patients treated with ibrutinib for B-cell malignancies from 2009 through 2016, we assessed the new/incident or worsened HTN (systolic blood pressure [BP] cutoff, 130 mm Hg). Observed incident HTN rates were compared with Framingham-heart–predicted incident HTN rates. We also evaluated the relationship of HTN to the development of other major adverse cardiovascular events (MACEs), including arrhythmia, myocardial infarction, stroke, heart failure, and cardiovascular death. Further, we assessed the effects of different antihypertensive classes on ibrutinib-related HTN. Overall, 78.3% of ibrutinib users developed new or worsened HTN over a median of 30 months. New HTN developed in 71.6% of ibrutinib users, with a time to 50% cumulative incidence of 4.2 months. Among those without preceding HTN, 17.7% developed high-grade HTN (BP >160/100 mm Hg). In multivariate regression, new or worsened HTN was associated with increased MACEs (hazard ratio [HR], 2.17; 95% confidence interval [CI], 1.08-4.38). No single antihypertensive class was associated with prevention or control of ibrutinib-related HTN. However, antihypertensive initiation was associated with a lower risk of a MACE (HR, 0.40; 95% CI, 0.24-0.66). Collectively, these data suggest that ibrutinib is associated with a substantial increase in the incidence and severity of HTN, and that HTN development carries a higher risk of subsequent cardiotoxic events.
•Among lymphoid malignancy patients treated with ibrutinib, the subsequent incidence of new hypertension is nearly 72%.•Development of new or worsened HTN after ibrutinib initiation associates with a more than twofold increased risk of other cardiac events.
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