Practical management of ibrutinib in the real life: Focus on atrial fibrillation and bleeding.

Abstract

The Bruton tyrosine kinase inhibitor ibrutinib (IB) has attained an important role in the treatment of patients with chronic lymphocytic leukaemia, mantle cell lymphoma, and Waldenström macroglobulinemia, significantly improving clinical outcomes. However, IB therapy has been associated with an increased risk of atrial fibrillation (AF) and bleeding. We report on the expert opinion that a group of Italian haematologists, cardiologists, and pharmacologists jointly released to improve the practical management of patients at risk for AF and bleeding during treatment with IB. A proper pretreatment assessment to identify patients who are at a higher risk, careful choice of concomitant drugs, regular monitoring, and multispecialist approach were characterized as the main principles of clinical management of these patients. For patients developing AF, anticoagulant and antiarrhythmic therapy must be guided by considerations about efficacy, safety, and risk of pharmacokinetic interactions with IB. For patients experiencing bleeding or requiring procedures that increase the risk of bleeding, considerations about platelet turnover, IB-related platelet dysfunctions, and bleeding worsening by concomitant anticoagulants or antiplatelet agents provide clues to manage bleeding. Overall, AF and bleeding are manageable clinical events in patients receiving IB, not requiring drug interruption in most cases. Preexisting AF should not represent an absolute contraindication to IB therapy. For each patient candidate for IB, strategies of risk assessment and mitigation may allow to exploit the life-saving effects of in chronic lymphocytic leukaemia and mantle cell lymphoma.

• Authors: Giuseppe Boriani, Paolo Corradini, Antonio Cuneo, Anna Falanga, Robin Foà, Gianluca Gaidano, Paolo Prospero Ghia, Maurizio Martelli, Roberto Marasca, Massimo Massaia, Francesca Romana Mauro, Giorgio Minotti, Stefano Molica, Marco Montillo, Antonio Pinto, Alessandra Tedeschi, Umberto Vitolo, Pier Luigi Zinzani
• Journal: Hematological oncology (Hematol Oncol) Vol. 36 Issue 4 Pg. 624-632 (Oct 2018) ISSN: 1099-1069 [Electronic] England
• PMID: 29512173 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2018 John Wiley & Sons, Ltd.

Chemical References

• Anti-Arrhythmia Agents
• Anticoagulants
• Piperidines
• Platelet Aggregation Inhibitors
• Pyrazoles
• Pyrimidines
• ibrutinib
• Adenine

Topics

• Adenine (analogs & derivatives)
• Anti-Arrhythmia Agents (administration & dosage)
• Anticoagulants (administration & dosage)
• Atrial Fibrillation (chemically induced, drug therapy)
• Clinical Trials as Topic
• Hematologic Neoplasms (drug therapy)
• Hemorrhage (chemically induced, drug therapy)
• Humans
• Piperidines
• Platelet Aggregation Inhibitors (administration & dosage)
• Pyrazoles (administration & dosage, adverse effects)
• Pyrimidines (administration & dosage, adverse effects)
• Randomized Controlled Trials as Topic
• Risk Factors