Related Experiment Video
Updated: Jul 1, 2026
Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
Published on: September 18, 2013
Real-world comparative effectiveness of first-line BTK inhibitors in chronic lymphocytic leukemia
Jing-Zhou Hou1, Rushir Choksi1, Gregory A Maglinte2
1Division of Malignant Hematology and Medical Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Introduction:
Second-generation covalent Bruton tyrosine kinase inhibitors (cBTKi), acalabrutinib and zanubrutinib, are standard-of-care for treatment-naïve adults with chronic lymphocytic leukemia (CLL). However, real-world evidence remains limited.
Methods:
This real-world analysis compared acalabrutinib and zanubrutinib using the IntegraConnect PrecisionQ de-identified electronic health record database, representing >3 million cancer patients across 500+ US sites. Patients initiated cBTKi between January 2020 and November 2023, with follow-up through 3 July 2024.
Results:
This study included 473 patients; 184 zanubrutinib-treated patients matched to 289 acalabrutinib-treated patients by age and sex. Baseline characteristics were similar. Median time to discontinuation (TTD) for acalabrutinib was 29.5 months (95% confidence interval [CI] 21.2, not reached [NR]). Median TTD for zanubrutinib was NR, with significantly longer duration of treatment than acalabrutinib (adjusted hazard ratio [aHR]: 0.50, 95% CI 0.3-0.7; p < .01). The 12-month probability of remaining on treatment with zanubrutinib (83.3%) was higher than acalabrutinib (69.5%). Toxicity-related discontinuation was higher with acalabrutinib (10.7%) than zanubrutinib (5.4%). Median time to next treatment was 42.5 months for acalabrutinib (95% CI 33.2-NR) and NR for zanubrutinib (aHR 0.82; 95% CI 0.5-1.4).
Conclusion:
Zanubrutinib demonstrated longer treatment persistence and fewer discontinuations attributed to toxicity during chart abstraction than acalabrutinib in treatment-naïve CLL.
