Effect of age and sex on cardiovascular outcomes among patients with chronic lymphocytic leukemia treated with Bruton tyrosine kinase inhibitors: a propensity matched analysis

The combined effect of age and sex on the risk of atrial fibrillation (AF) in patients receiving Bruton tyrosine kinase inhibitors (BTKi) is unclear. To address this knowledge gap, propensity score matching was applied to the TriNetX database to generate matched cohorts of males and females with chronic lymphocytic leukemia (CLL) who received ibrutinib (n = 5312) or acalabrutinib (n = 3110). AF events during the first three years of BTKi therapy increased with age and were more common in males compared to females. For ibrutinib, nearly one in three males aged ≥75 developed AF compared with fewer than one in ten females aged 18–74. The risk of AF with acalabrutinib also varied with age and sex, with older males appearing more vulnerable to this complication compared to younger females. These findings are relevant to decision-making about CLL therapy options and, for patients commencing BTKi, determining appropriate cardiovascular assessments before and during therapy.