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Lu X, Emond B, Morrison L, Kinkead F, Lefebvre P, Lafeuille MH, Khan W, Wu LH, Qureshi ZP, Jacobs R. Real-World Comparison of First-Line Treatment Adherence Between Single-Agent Ibrutinib and Acalabrutinib in Patients with Chronic Lymphocytic Leukemia. Patient Prefer Adherence 2023; 17:2073-2084. [PMID: 37641660 PMCID: PMC10460580 DOI: 10.2147/ppa.s417180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose Increased dosing frequency adversely affects treatment adherence and outcomes in chronic diseases; however, such data related to treatment adherence is lacking in chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). This study compared adherence between patients treated with ibrutinib (once-daily) versus acalabrutinib (twice-daily) as first-line (1L) therapy for CLL/SLL. Patients and Methods Specialty pharmacy electronic medical records were used to identify adults with CLL/SLL initiating 1L ibrutinib or acalabrutinib between 01/01/2018 and 11/30/2020. Adherence was measured by the proportion of days covered (PDC) and medication possession ratio (MPR) and was compared between cohorts using odds ratios (ORs) obtained from logistic regression models adjusted for baseline characteristics. Results Between 01/01/2018 and 11/30/2020, 1374 and 140 patients initiated ibrutinib and acalabrutinib, respectively. Based on PDC/MPR ≥80%, patients treated with once-daily ibrutinib were more likely to be adherent than those treated with twice-daily acalabrutinib (OR ranges: PDC: 1.04-1.76; MPR: 1.03-1.58). At 6 months, patients on ibrutinib had a 58-76% higher likelihood of staying adherent compared to patients on acalabrutinib (PDC: 75.9% for ibrutinib vs 63.6% for acalabrutinib, OR: 1.76, P=0.008; MPR: 76.8% vs 66.9%, OR: 1.58, P=0.036) with a similar trend noted for the entire line of treatment (LOT) (PDC: 53.0% vs 41.4%, OR: 1.53, P=0.021; MPR: 58.7% vs 47.1%, OR: 1.50, P=0.027). Conclusion In this real-world analysis, CLL/SLL patients initiating 1L once-daily ibrutinib had >50% higher treatment adherence than those initiating twice-daily acalabrutinib during their LOT. Given the importance of sustained adherence for disease control in CLL/SLL, dosing frequency may be an important consideration for patients and physicians.
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Affiliation(s)
- Xiaoxiao Lu
- Real World Value and Evidence, Oncology, Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Bruno Emond
- Health Economics and Outcomes Research, Analysis Group, Inc, Montréal, Québec, Canada
| | - Laura Morrison
- Health Economics and Outcomes Research, Analysis Group, Inc, Montréal, Québec, Canada
| | - Frederic Kinkead
- Health Economics and Outcomes Research, Analysis Group, Inc, Montréal, Québec, Canada
| | - Patrick Lefebvre
- Health Economics and Outcomes Research, Analysis Group, Inc, Montréal, Québec, Canada
| | | | - Wasiulla Khan
- Real World Value and Evidence, Oncology, Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Linda H Wu
- Real World Value and Evidence, Oncology, Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Zaina P Qureshi
- Real World Value and Evidence, Oncology, Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Ryan Jacobs
- Hematology and Medical Oncology, Atrium Health Levine Cancer Institute, Charlotte, NC, USA
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Ito D, Feng C, Fu C, Kim C, Wu J, Epstein J, Snider JT, DuVall AS. Health resource utilization and costs of care for adult patients with relapsed or refractory mantle cell lymphoma in the United States: a retrospective claims analysis. Expert Rev Pharmacoecon Outcomes Res 2023; 23:773-787. [PMID: 37278284 DOI: 10.1080/14737167.2023.2216458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/05/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES We assessed real-world healthcare resource utilization (HRU) and costs among US patients with relapsed or refractory mantle cell lymphoma (R/R MCL) by line of therapy (LoT). METHODS We selected patients from MarketScan® (1/1/2016-12/31/2020): ≥1 claims of MCL-indicated first line (1L) therapies, ≥1 diagnoses of MCL pre-index date (1L initiation date), ≥6-month continuous enrollment pre-index date, second line (2L) therapy initiation, ≥18 years old at 2L, and no clinical trial enrollment. Outcomes included time to next treatment (TTNT), all-cause HRU, and costs. RESULTS The cohort (N = 142) was 77.5% male, aged 62 years (median). Sixty-six percent and 23% advanced to 3L and 4L+, respectively. Mean (median) TTNT was 9.7 (5.9), 9.3 (5.0), and 6.3 (4.2) months for 2L, 3L, and 4L+, respectively. Mean (median) per patient per month (PPPM) costs were $29,999 ($21,313), $29,352 ($20,033), and $30,633 ($23,662) for 2L, 3L, and 4L+, respectively. Among those who received Bruton tyrosine kinase inhibitors, mean (median) PPPM costs were $24,702 ($17,203), $31,801 ($20,363), and $36,710 ($25,899) for 2L, 3L, and 4L+, respectively. CONCLUSIONS During the period ending in 2020, patients relapsed frequently, incurring high HRU and costs across LoTs. More effective treatments with long-lasting remissions in R/R MCL may reduce healthcare burden.
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Affiliation(s)
| | | | | | | | - James Wu
- Kite, A Gilead Company, Santa Monica, CA, USA
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Penberthy LT, Rivera DR, Lund JL, Bruno MA, Meyer AM. An overview of real-world data sources for oncology and considerations for research. CA Cancer J Clin 2022; 72:287-300. [PMID: 34964981 DOI: 10.3322/caac.21714] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 12/11/2022] Open
Abstract
Generating evidence on the use, effectiveness, and safety of new cancer therapies is a priority for researchers, health care providers, payers, and regulators given the rapid pace of change in cancer diagnosis and treatments. The use of real-world data (RWD) is integral to understanding the utilization patterns and outcomes of these new treatments among patients with cancer who are treated in clinical practice and community settings. An initial step in the use of RWD is careful study design to assess the suitability of an RWD source. This pivotal process can be guided by using a conceptual model that encourages predesign conceptualization. The primary types of RWD included are electronic health records, administrative claims data, cancer registries, and specialty data providers and networks. Careful consideration of each data type is necessary because they are collected for a specific purpose, capturing a set of data elements within a certain population for that purpose, and they vary by population coverage and longitudinality. In this review, the authors provide a high-level assessment of the strengths and limitations of each data category to inform data source selection appropriate to the study question. Overall, the development and accessibility of RWD sources for cancer research are rapidly increasing, and the use of these data requires careful consideration of composition and utility to assess important questions in understanding the use and effectiveness of new therapies.
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Affiliation(s)
- Lynne T Penberthy
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Donna R Rivera
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Melissa A Bruno
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Anne-Marie Meyer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Rai S, Tanizawa Y, Cai Z, Huang YJ, Taipale K, Tajimi M. Outcomes for Recurrent Mantle Cell Lymphoma Post-Ibrutinib Therapy: A Retrospective Cohort Study from a Japanese Administrative Database. Adv Ther 2022; 39:4792-4807. [PMID: 35984628 PMCID: PMC9464745 DOI: 10.1007/s12325-022-02258-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/01/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Treatment options in patients with mantle cell lymphoma (MCL) failing ibrutinib are limited, with no standard therapies defined. This study aimed to investigate real-world treatment patterns and outcomes for patients with MCL following ibrutinib. METHODS This study utilized a de-identified hospital-based claims database (Medical Data Vision) in Japan. Eligible patients were adults who were diagnosed with MCL and had received antitumor drugs between December 2010 and July 2020. Patients were followed from the first antitumor drug treatment until the end of available data up to July 2021. Time-to-event analyses utilized the Kaplan-Meier method. Factors for receiving post-ibrutinib therapy were explored with logistic regression analysis. RESULTS Of the 1386 patients who started antitumor drug therapy, 247 patients received and discontinued ibrutinib at any line of therapy. Among them, 137 patients (55.5%) received subsequent therapy. The median age at the end of ibrutinib therapy was 77 (range 42-95), and 44 patients had a dependent activity of daily living (ADL). Factors negatively associated with receiving post-ibrutinib therapy after discontinuation of ibrutinib were age ≥ 75 years (odds ratio [95% CI] 0.46 [0.26-0.80]) and emergency hospital admissions (0.37 [0.17-0.84]). Immediate post-ibrutinib therapy regimens were highly diverse, with BR (bendamustine, rituximab) only prescribed in more than 10% of patients. The median duration of post-ibrutinib therapy was 1.5 months (95% CI 1.07-2.07). The median overall survival from the end of ibrutinib therapy in patients regardless of the receipt of post-ibrutinib therapy (n = 247), in those who did not receive post-ibrutinib therapy (n = 110), and in those who received post-ibrutinib therapy (n = 137) was 5.6 months (95% CI 3.8-8.7), 2.3 months (95% CI 1.2-3.9), and 8.7 months (95% CI 5.6-13.8), respectively. The most common adverse event during post-ibrutinib therapy was infection, with the use of anti-infectives (17%). CONCLUSIONS Patients with MCL previously treated with ibrutinib have poor ability to carry out ADL and experience very poor outcomes. New safe, effective therapies are needed.
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Affiliation(s)
- Shinya Rai
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osaka, Sayama, Japan.
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Ghosh N, Emond B, Lafeuille MH, Côté-Sergent A, Lefebvre P, Huang Q. Treatment patterns among patients with mantle cell lymphoma and comparison of healthcare resource utilization and costs among relapsed/refractory patients treated with ibrutinib or chemoimmunotherapy: A real-world retrospective study. Clin Ther 2021; 43:1285-1299. [PMID: 34332789 DOI: 10.1016/j.clinthera.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study assessed treatment patterns in patients with mantle cell lymphoma (MCL) and compared health care resource utilization (HRU) and costs of ibrutinib with or without rituximab (I ± R) versus chemoimmunotherapy (CIT) in patients with relapsed/refractory MCL. METHODS For this retrospective cohort study, adults with MCL observed between May 13, 2013, and June 30, 2019, were identified using Optum's de-identified Clinformatics Data Mart Database. Treatment patterns were described among patients who received ≥1 line of therapy (LOT). HRU and costs (payer's perspective) were compared between patients treated with I ± R and CIT in the second or later line (2L+) of therapy. To account for differences in baseline characteristics between the 2 cohorts, inverse probability of treatment weighting was used. Monthly HRU and costs starting from I ± R or CIT treatment initiation (index date) were compared during the first Oncology Care Model (OCM) episode (ie, first 6 months) postindex and during the observed duration of I ± R or CIT LOT (index LOT) using rate ratios (RRs) and mean monthly cost differences (MMCDs), respectively. FINDINGS Among 1346 patients with ≥1 LOT (median follow-up, 15.3 months), 870 (64.6%) were treated with CIT in the first line. Only 348 (25.9%) had a 2L of therapy, of whom 110 (31.6%) were treated with CIT and 98 (28.2%) with an ibrutinib-based therapy. A total of 300 patients were included for the comparison of HRU and costs between 2L+ I ± R and 2L+ CIT. The weighted cohorts (after inverse probability of treatment weighting) included 149 patients treated with I ± R (mean age, 71.6 years; 73.7% men) and 151 treated with CIT (mean age, 71.5 years; 76.2% men). During the first OCM episode and during the index LOT, the I ± R cohort had significantly fewer monthly days with outpatient services compared to the CIT cohort (OCM, RR = 0.63 [P < 0.001]; index LOT, RR = 0.73 [P = 0.004]). Compared to the CIT cohort, the I ± R cohort incurred significantly higher monthly pharmacy costs (MMCDs: OCM, 9938 US dollars [USD] [P < 0.001]; index LOT, 8920 USD [P < 0.001]) that were fully offset by lower monthly medical costs (MMCDs: OCM, -19,373 USD [P < 0.001]; index LOT, -13,548 USD [P < 0.001]), resulting in monthly total health care cost savings (MMCDs, OCM, -9435 USD [P < 0.001]; index LOT , -4628 USD [P = 0.01]). IMPLICATIONS Over a median follow-up of 15.3 months, most patients with MCL were treated with CIT in the first line, and only one fourth had a 2L therapy. Patients with relapsed/refractory MCL treated with I ± R had significantly fewer days with outpatient services and lower monthly total health care costs versus those treated with CIT during the first OCM episode and the index LOT.
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Affiliation(s)
- Nilanjan Ghosh
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Bruno Emond
- Analysis Group Inc, Montreal, Quebec, Canada.
| | | | | | | | - Qing Huang
- Janssen Scientific Affairs LLC, Horsham, Pennsylvania
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Izutsu K, Suzumiya J, Takizawa J, Fukase K, Nakamura M, Jinushi M, Nagai H. Real World Treatment Practices for Mantle Cell Lymphoma in Japan: An Observational Database Research Study (CLIMBER-DBR). J Clin Exp Hematop 2021; 61:135-144. [PMID: 34092722 PMCID: PMC8519241 DOI: 10.3960/jslrt.20056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Mantle cell lymphoma (MCL) accounts for approximately 3% of all cases of malignant
lymphoma in Japan. The CLIMBER-DBR (Treatment practices and patient burden in chronic
lymphocytic leukemia and mantle cell lymphoma patients in the real world: An observational
database research in Japan) study examined the clinical characteristics, treatment
patterns, and healthcare resource utilization of MCL in a real-world clinical setting in
Japan. Using the Japanese Medical Data Vision database, we extracted data for 1130
patients with MCL (ICD-10 code C83.1) registered between March 1, 2013 and February 28,
2018. The date of first MCL diagnosis was taken as the index date. The mean (standard
deviation) age, body weight, and modified Charlson Comorbidity Index were 71.4 (10.9)
years, 58.3 (11.7) kg, and 1.9 (1.6), respectively, and 24.6% were ≤65 years old. The
median follow-up period was 654 days (first–third quartile 290.5–1049 days). A total of
802 patients (71.0%) underwent first-line treatment. The most common first-line treatment
was bendamustine/rituximab (BR; 27.8%), followed by
rituximab/cyclophosphamide/doxorubicin/vincristine/prednisolone (R-CHOP; 15.6%) and
rituximab/tetrahydropyranyl-adriamycin/cyclophosphamide/vincristine/prednisolone
(R-THP-COP; 6.5%). The median (95% confidence interval) times to initial (first-line),
second-line, and third-line treatments were 45 (36–62), 687 (624–734), and 1188
(1099–1444) days, respectively. Treatment practices for MCL in Japan are consistent with
trends observed in Western countries. Our study can serve as a benchmark to assess future
MCL treatments in Japan.
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Affiliation(s)
- Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Junji Suzumiya
- Innovative Cancer Center, Shimane University Hospital, Izumo, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | | | | | | | - Hirokazu Nagai
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Goyal RK, Jain P, Nagar SP, Le H, Kabadi SM, Davis K, Kaye JA, Du XL, Wang M. Real-world evidence on survival, adverse events, and health care burden in Medicare patients with mantle cell lymphoma. Leuk Lymphoma 2021; 62:1325-1334. [PMID: 33966583 DOI: 10.1080/10428194.2021.1919662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Most data on overall survival (OS) and adverse events (AEs) in patients with mantle cell lymphoma (MCL) are from controlled trials; therefore, in this population-based study, we retrospectively assessed treatment patterns, OS, and AEs in MCL patients initiating systemic treatment during 2013-2015 using the United States Medicare claims database. Among 1390 eligible patients (median age = 74 years), chemoimmunotherapy with bendamustine/rituximab (BR) was the preferred choice in first-line (35.3%), followed by ibrutinib (33.5%), rituximab (9.1%), and rituximab/cyclophosphamide/doxorubicin/vincristine (R-CHOP) (6.8%). Twenty-four-month OS was 73% for BR; 47%, ibrutinib; 72%, rituximab; and 71%, R-CHOP. For the four most commonly used regimens, neutropenia, anemia, hypertension, and infection were the most frequent AEs. Patients with ≥3 AEs had nearly four times higher monthly costs than those with 0-2 AEs in the first observed therapy line. Findings demonstrate a substantial increase in the economic burden as the number of AEs increased among the Medicare MCL patients.
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Affiliation(s)
- Ravi K Goyal
- Department of Health Economics, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Preetesh Jain
- Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Saurabh P Nagar
- Department of Health Economics, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Hannah Le
- US HEOR Oncology, AstraZeneca, Gaithersburg, MD, USA
| | - Shaum M Kabadi
- Epidemiology and Real-World Evidence in Oncology, AstraZeneca, Gaithersburg, MD, USA
| | - Keith Davis
- Department of Health Economics, RTI Health Solutions, Research Triangle Park, NC, USA
| | - James A Kaye
- Department of Epidemiology, RTI Health Solutions, Waltham, MA, USA
| | - Xianglin L Du
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michael Wang
- Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX, USA
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Zhou Y, Chen H, Tao Y, Zhong Q, Shi Y. Minimal Residual Disease and Survival Outcomes in Patients with Mantle Cell Lymphoma: a systematic review and meta-analysis. J Cancer 2021; 12:553-561. [PMID: 33391451 PMCID: PMC7738989 DOI: 10.7150/jca.51959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/18/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Minimal residual disease (MRD) has shown the prognostic value in mantle cell lymphoma (MCL). To quantify the relationships between progression free survival (PFS) and overall survival (OS) with MRD status in MCL, we conducted this meta-analysis. Methods: We searched databases including Pubmed, Embase, Web of Science and the Cochrane Library up to July 15th, 2020. Data of patients' characteristics, MRD assessment and survival outcomes were extracted and analyzed. Results: Ten articles were included. For the impact of post-induction MRD status on survival outcomes, MRD positive status was associated with worse PFS (HR=1.44; 95%CI 1.27-1.62; P<0.00001) and OS (HR=1.30; 95%CI 1.03-1.64; P=0.03) compared with MRD negative status. Regarding the impact of post-consolidation MRD status on survival outcomes, MRD positivity predicted shorter PFS (HR=1.84; 95%CI 1.49-2.26; P<0.00001) and OS (HR=2.38; 95%CI 1.85-3.06; P<0.00001) than MRD negativity. Conclusions: This study indicated that MRD positivity after induction and consolidation treatments was associated with worse PFS and OS for MCL. MRD-based treatment strategies should be further explored in clinical trials and real-world practice.
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Affiliation(s)
| | | | | | | | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, China
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Waweru C, Kaur S, Sharma S, Mishra N. Health-related quality of life and economic burden of chronic lymphocytic leukemia in the era of novel targeted agents. Curr Med Res Opin 2020; 36:1481-1495. [PMID: 32634056 DOI: 10.1080/03007995.2020.1784120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To quantify the health-related quality of life (HRQoL) and economic burden of chronic lymphocytic leukemia (CLL). METHODS Studies were searched through Embase, MEDLINE, PubMed, and Cochrane Library, as well as conference abstracts (1 January 2000-2 June 2019). RESULTS Overall, 12 and 17 primary studies were included in the HRQoL and economic burden reviews, respectively. Patients with CLL reported impairment in various quality of life domains when compared with healthy controls, including fatigue, anxiety, physical functioning, social functioning, depression, sleep disturbance, and pain interference. Key factors associated with a negative impact on the HRQoL burden of CLL included female gender, increased disease severity, and the initiation of multiple lines of therapy. Economic burden was assessed for patients with CLL based on disease status and the treatment regimen received. The main cost drivers related to CLL were outpatient and hospitalization-related costs, primarily incurred as a result of chemo/chemoimmunotherapy, adverse events (AEs), and disease progression. Treatment with targeted agents, i.e. ibrutinib and venetoclax, was associated with lower medical costs than chemoimmunotherapy, although ibrutinib was associated with some increased AE costs related to cardiac toxicities. Cost studies of targeted agents were limited by short follow-up times that did not capture the full scope of treatment costs. CONCLUSIONS CLL imposes a significant HRQoL and economic burden. Our systematic review shows that an unmet need persists in CLL for treatments that delay progression while minimizing AEs. Studies suggest targeted therapies may reduce the economic burden of CLL, but longer follow-up data are needed.
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Affiliation(s)
| | - Simarjeet Kaur
- Parexel Access Consulting, Parexel International, Mohali, India
| | - Sheetal Sharma
- Parexel Access Consulting, Parexel International, Mohali, India
| | - Namita Mishra
- Parexel Access Consulting, Parexel International, Mohali, India
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Huang SJ, Gerrie AS, Young S, Tucker T, Bruyere H, Hrynchak M, Galbraith P, Al Tourah AJ, Dueck G, Noble MC, Ramadan KM, Tsang P, Hardy E, Sehn L, Toze CL. Comparison of real-world treatment patterns in chronic lymphocytic leukemia management before and after availability of ibrutinib in the province of British Columbia, Canada. Leuk Res 2020; 91:106335. [PMID: 32114372 DOI: 10.1016/j.leukres.2020.106335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
We performed a retrospective study comparing treatment patterns and overall survival (OS) in chronic lymphocytic leukemia (CLL) patients with the advent of ibrutinib to provide current real-world data. METHODS Using a provincial population-based database, we analyzed CLL patients who received upfront treatment in British Columbia before ibrutinib availability (1984-2014), during ibrutinib access for: relapse only (2014-2015) and for upfront treatment of patients (with 17p deletion or unfit for chemotherapy) (2015-2016). Analysis included up to third-line treatment. RESULTS Of 1729 patients meeting inclusion criteria (median age, 66 years; 1466, period 1; 140, period 2; 123, period 3), FR was the most common first-line therapy (35.8 %, 54.3 % and 40.7 %, periods 1-3, respectively) and 18.7 % received ibrutinib upfront in period 3. The most common therapies in relapse were chemoimmunotherapy (36.1 % and 55.6 %, periods 1 and 2, second-line; 29.2 %, period 1, third-line) and ibrutinib (69.8 %, period 3, second-line; 46.4 % and 70.3 %, periods 2 and 3, third-line). OS improved for patients treated in periods 2-3 over period 1 (median OS not reached vs. 11.9 years, p < 0.001; no difference in OS for periods 2-3, p = 0.385). CONCLUSION Ibrutinib has replaced chemoimmunotherapy as the preferred therapy in relapse. Overall survival has improved over time with access to ibrutinib.
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Affiliation(s)
- Steven J Huang
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada
| | - Alina S Gerrie
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada; British Columbia Cancer - Vancouver, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Young
- Pathology and Laboratory Medicine, British Columbia Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tracy Tucker
- Pathology and Laboratory Medicine, British Columbia Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helene Bruyere
- Division of Pathology and Laboratory Medicine, Cytogenetics Laboratory, Vancouver General Hospital, University of British Columbia, Canada
| | - Monica Hrynchak
- Molecular Cytogenetic Laboratory, Royal Columbian Hospital, University of British Columbia, New Westminster, British Columbia, Canada
| | - Paul Galbraith
- British Columbia Cancer - Abbotsford, University of British Columbia, Abbotsford, British Columbia, Canada
| | - Abdulwahab J Al Tourah
- British Columbia Cancer - Surrey, University of British Columbia, Surrey, British Columbia, Canada
| | - Gregory Dueck
- British Columbia Cancer - Kelowna, University of British Columbia, Kelowna, British Columbia, Canada
| | - Michael C Noble
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Khaled M Ramadan
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Tsang
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada; Richmond Hospital, Richmond, British Columbia, Canada
| | - Edward Hardy
- Tom McMurty & Peter Baerg Cancer Centre, Vernon Jubilee Hospital, Vernon, British Columbia, Canada
| | - Laurie Sehn
- British Columbia Cancer - Vancouver, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia L Toze
- Division of Hematology, Vancouver General Hospital, University of British Columbia, Canada; British Columbia Cancer - Vancouver, University of British Columbia, Vancouver, British Columbia, Canada.
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Kabadi SM, Near A, Wada K, Burudpakdee C. Treatment patterns, adverse events, healthcare resource use and costs among commercially insured patients with mantle cell lymphoma in the United States. Cancer Med 2019; 8:7174-7185. [PMID: 31595715 PMCID: PMC6885896 DOI: 10.1002/cam4.2559] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 08/26/2019] [Accepted: 09/03/2019] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION There are limited data on treatment patterns, adverse events (AEs), and economic burden in younger, commercially insured patients treated for mantle cell lymphoma (MCL). METHODS Adults with ≥1 treatment for MCL between 1 November 2013-31 December 2017 were identified from IQVIA Real-World Data Adjudicated Claims-US; index date was first treatment. Patients carried ≥1 MCL diagnosis, were newly treated, and were enrolled continuously for ≥12 months prior to and ≥30 days following index. Patients receiving the four most common MCL regimens were included. Measures included frequency of incident AEs, resource use, and costs overall and by number of AEs. Adjusted logistic regression and generalized linear modeling evaluated risk of hospitalization and all-cause costs per patient per month (PPPM). RESULTS Two thousand five hundred and nine treated patients had a drug-specific code and were classified to a specific treatment regimen. Of those patients, 1785 patients received at least one of the four most commonly used MCL regimens (R-CHOP, rituximab monotherapy, B-R, and ibrutinib) at some point over follow-up (median 23 months). R-CHOP was the most common regimen observed in the first line (26%), followed by rituximab monotherapy (19%), B-R (15%), and ibrutinib (5%). The median age was 57 years; median Charlson Comorbidity Index was 0. Among patients receiving the four most common regimens, 63% of patients experienced ≥1 incident AE (R-CHOP 77%, B-R 58%, and ibrutinib 52%). An increasing number of incident AEs was associated with increased hospitalization risk (odds ratio = 2.4; 95% Confidence Interval [CI] 2.1-2.7) and increased mean costs PPPM (cost ratio = 1.1; 95% CI 1.1-1.2). DISCUSSION This is the largest study describing treatment patterns and clinical and economic impact of MCL treatment. The most common regimens were R-CHOP, rituximab monotherapy, B-R, and ibrutinib. The majority of treated patients experienced at least one incident AE, with hospitalization risk and all-cause costs increasing as the number of AEs increased.
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