Quality initiative in first-line chronic lymphocytic leukemia /small lymphocytic lymphoma assessing the use of 2nd generation BTKi therapy and impact on cardiac medical conditions patients experience on treatment

Abstract Background: Given the introduction of 2nd generation safer and more tolerable BTKis to treat first- line Chronic Lymphocytic Leukemia /Small Lymphocytic Lymphoma (CLL/SLL) patients, Integra Connect evaluated the use of these therapies among patients at practices who participated in its quality improvement (QI) program focusing on the use of 2nd generation BTKi drugs in the treatment of CLL/SLL compared to those practices who did not participate to assess the use of the 1st generation BTKi (ibrutinib) and the impact of CV-ME on treatment. Methods: The Integra Connect PrecisionQ real-world de-identified database was used to identify patients who initiated first- line treatment for CLL/SLL between January 1, 2023 and December 31, 2024. The analysis included practices who participated in the QI in 2023 (Group A) and those practices who did not participate (Group B). Descriptive statistics were used to assess proportions and chi-squared analysis were used to test for significance. Results: Among Group A practices, 802 patients received first-line treatment with 55.7% receiving a BTKi. Among Group B practices, 2,508 patients received first-line treatment with 59.3% receiving a BTKi. In Group A practices, the use of ibrutinib was 4.9% overall and 8.7% among patients treated with a BTKi, whereas among Group B practices the use of ibrutinib was 10% overall and 16.8% among the patients treated with a BTKi (p<0.01). Patients treated with ibrutinib in first-line experienced a CV-ME 9.7% of the time whereas those on a 2nd generation BTKi experienced a CV-ME 7.1% of the time (p>0.05). Conclusion: Those practices that participated in the CLL/SLL QI had increased guideline concordance per the NCCN of using 2nd generation BTKi drugs and had lower rates of CV-ME due to the lower use of ibrutinib in the treatment of CLL/SLL patients in the first-line.