Real-world treatment utilization patterns, discontinuation and healthcare resource utilization of first-line Bruton tyrosine kinase inhibitors among elderly patients ≥65 years in chronic lymphocytic leukemia

Background Chronic lymphocytic leukemia (CLL) commonly affects older patients, who often endure greater health disparities and treatment burdens. This study assessed treatment utilization patterns, discontinuation, and healthcare resource utilization (HCRU) of first-line (1 L) use of Bruton tyrosine kinase inhibitors (BTKis) in elderly patients with CLL.Research design and methods A retrospective observational study using Symphony Integrated Dataverse identified CLL patients aged ≥65 years initiating a 1 L BTKi (zanubrutinib, acalabrutinib, ibrutinib; 01/2022-11/2024). Baseline characteristics and outcomes were reported for each BTKi. Treatment discontinuation rate was estimated at 3, 4, 5, 6, 12, 18, and 24 months, and by time to discontinuation (TTD), using Kaplan-Meier method. HCRU (outpatient, inpatient, and other services) was evaluated as per-patient-per-year (PPPY).Results A total of 5344 patients ≥65 years were included (acalabrutinib = 2,662; zanubrutinib = 1,577; ibrutinib = 1,105). Baseline characteristics were similar across each BTKi. Zanubrutinib had the longest median TTD overall (zanubrutinib: 22.8 months, acalabrutinib: 17.4 months, ibrutinib: 14.3 months; p < .0001). Average outpatient visits PPPY were lowest for zanubrutinib (zanubrutinib: 9.7, acalabrutinib: 10.9, ibrutinib: 11.5; p = .0018).Conclusions This real-world study demonstrated that zanubrutinib was associated with longer TTD, lower discontinuation rates, and less HCRU compared to acalabrutinib or ibrutinib in older CLL patients aged ≥65 years.