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. 2020 Feb;132(3-4):97-109.
doi: 10.1007/s00508-019-1534-1. Epub 2019 Aug 14.

Recommendations for ibrutinib treatment in patients with atrial fibrillation and/or elevated cardiovascular risk

Markus C Stühlinger  1 , Ansgar Weltermann  2 , Philipp Staber  3 , Daniel Heintel  4 , Thomas Nösslinger  5 , Michael Steurer  6
Affiliations

Recommendations for ibrutinib treatment in patients with atrial fibrillation and/or elevated cardiovascular risk

Markus C Stühlinger et al. Wien Klin Wochenschr. 2020 Feb.

Abstract
in English, German

Ibrutinib is the first clinically approved inhibitor of Bruton's tyrosine kinase, an enzyme that is essential for survival and proliferation of B‑cells by activating the B‑cell receptor signalling pathway. Ibrutinib has been shown to be highly effective in B‑cell malignancies in clinical trials and is recommended in current international guidelines as a first and/or second line treatment of chronic lymphocytic leukemia. The drug has a favorable tolerability and safety profile but the occurrence of specific side effects (e.g. atrial fibrillation, bleeding and hypertension) may complicate or be of concern for doctors and patients considering the use of this treatment. In many cases, however, it is not necessary to withhold this effective therapy. In contrast, ibrutinib treatment can be initiated or continued, if certain recommendations are followed. The possibilities of prevention, diagnosis and management of specific clinical situations are discussed in detail and recommendations are derived, which should facilitate ibrutinib use.

Ibrutinib ist der erste zum klinischen Einsatz zugelassene Inhibitor der Bruton-Tyrosinkinase, eines Enzyms, das durch Aktivierung des B‑Zell-Rezeptor-Signalwegs für das Überleben und die Proliferation der B‑Zellen von wesentlicher Bedeutung ist. Ibrutinib hat in klinischen Studien hohe Wirksamkeit bei B‑Zell-Malignomen gezeigt und wird in aktuellen internationalen Leitlinien als Erst- und/oder Nachfolgetherapie zur Behandlung der chronischen lymphatischen Leukämie empfohlen. Grundsätzlich mit günstigem Verträglichkeits- und Sicherheitsprofil ausgestattet, kann jedoch das mögliche Auftreten spezifischer Nebenwirkungen (Vorhofflimmern, Blutungen und Hypertonie) den Einsatz dieser effektiven Therapie erschweren oder verhindern. In vielen Fällen ist es aber nicht notwendig, auf die Ibrutinib-Therapie zu verzichten – unter Berücksichtigung bestimmter Vorgaben kann diese fortgesetzt werden. Die Möglichkeiten von Prävention, Diagnose und Umgang mit konkreten Situationen werden in der Folge ausführlich behandelt, und es werden daraus Empfehlungen abgeleitet, welche die Entscheidung für das jeweilige Vorgehen erleichtern sollen.

Keywords: Anticoagulation; BCR inhibitor; Bleeding; CLL; Chronic lymphocytic leukemia.

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Conflict of interest statement

M. Stühlinger, A. Weltermann, P. Staber, D. Heintel, T. Nösslinger, and M. Steurer declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Ibrutinib dosing scheme. aResolution to grade 1 or baseline. Note: dose shown is for chronic lymphocytic leukemia (CLL); mantle cell lymphoma (MCL) dosing is 560 mg (4 capsules) daily. Source: Imbruvica®. Summary of product characteristics, 2017 [17]
Fig. 2
Fig. 2
Basic and additional patient assessments before and during ibrutinib therapy
Fig. 3
Fig. 3
Ibrutinib-related adverse event management. Source: Heidbuchel et al. [57]
See this image and copyright information in PMC

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