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Examining Uptake of Therapy Options for Patients With CLL Among Veteran Population

June 03, 2020

Researchers of a recent study examined a significant shift in the treatment patterns for patients with chronic lymphocytic leukemia (CLL) in the Veterans Health Administration (VHA) but note that more research is needed to understand the impact on health care resource utilization rates and costs.

Zohra Nooruddin, MD, University of Colorado Denver, Denver, CO, and colleagues, in a study funded by AstraZeneca conducted research that described the pharmacoepidemiology of three novel agents (ibrutinib, idelalisib, venetoclax), and traditional chemotherapies/chemoimmunotherapies (CT/CIT) in the VHA. As background, the researchers explained that the first novel agent for CLL was approved in 2014 but little data on the uptake of specific treatments in the VHA is unknown.

The retrospective study consisted of 26,879 adult patients with CLL in the VHA between October 1, 2013 and May 31, 2018. For a period of six months, the researchers extracted data from the VHA electronic health record. Dr Nooruddin and colleagues used descriptive statistics to summarize patients’ baseline characteristics, CLL treatments, next therapies, and secondary complications.

The final examined cohort of patients who received at least one of the 12 CLL therapies observed totaled 3670 adult patients with a median age of 69 years (47% were 65+ and 26% were 75+). Further, the median age-adjusted Charlson comorbidity score was 6, and 6% had a history of exposure to Agent Orange.

“Ibrutinib accounted for 89% of the novel agent use,” explained the researchers. “Ibrutinib use across all lines of therapy (LOTs) increased sevenfold over the study period.”

The next most common therapy was Venetoclax (42%), followed by idelalisib (30%).

“Across all LOTs, traditional CT/CIT use declined steadily over the study period,” explained Dr Nooruddin and colleagues. “However, in fiscal year 2018, there were still 17% of patients receiving CT/CIT.”

For the next LOT, ibrutinib remained the most common therapy for 43% to 74% of patients. The  incidence of diffuse large B cell lymphoma post-index was 2 to 6 times higher in patients on CT/CIT than those on ibrutinib, noted the researchers, and any other secondary complications were similar between the ibrutinib and CT/CIT arms.

“To our knowledge, this is the largest study looking at CLL treatment patterns among VHA patients in the real world,” said researchers, noting that the period of 2013 to 2018 saw the most significant shift, however, “The impact of this shift on healthcare resource use and cost burden in the VHA will need to be examined.”

—Edan Stanley


Nooruddin Z, Le H, McHugh D, et al. The shift in therapies for the treatment of chronic lymphocytic leukemia (CLL) patients in the US Veterans Health Administration (VHA) from 2013-2018. J Clin Oncol. 38:2020; suppl;abstr: e19339. doi:10.1200/JCO.2020.38.15_suppl.e19339

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