Coagulation

No need to stop ibrutinib in patients who develop AF


Atrial fibrillation related to ibrutinib treatment can be managed with standard measures  and DOACs without patients having to stop cancer treatment, experience at an Australian centre suggests.

Ibrutinib-related AF was more common in real world practice than in the literature, according to a small cohort report by haematologists at the Hunter New England Health District.

In a review of all patients started on ibrutinib between 2015 and 2017 for conditions such as CLL  they found that AF developed after an average of nine months in four of 24 patients.

The incidence in this small group (17%) was higher than previously reported, which might be due to the ‘real world’ patient population having high rates of established risk factors for AF such as older age, hypertension and coronary heart disease, said the study authors form the John Hunter Hospital, Newcastle.

Ibrutinib was managed with rate control strategies such as beta blockers, and only one patient was hospitalised for symptomatic AF. Direct acting oral anticoagulants were used in all patients for thromboembolic protection.

Despite ibrutinib affecting platelet function and previously being associated with increased bleeding risk there were no bleeding or thromboembolic complications during 18 months of follow up.

The study authors said the findings showed that clinicians should be vigilant for AF in ibrutinib treated patients, particularly with longer duration of treatment.

Ibrutinib was thought to  cause AF through inhibition of Bruton’s tyrosine kinase (BTK) expressed in the heart, leading to inhibition of the phosphoinositide 3-kinase (P13K)-Akt pathway. Lower P13K-Akt activity has been associated with AF.

However they said their experience in a small cohort provided reassurance that anticoagulation was well tolerated in patients treated with ibrutinib.

“From a therapeutic perspective, patients developing AF in the context of ibrutinib therapy can appear to be safely treated using standard approaches without need to discontinue therapy,” they concluded in the Asia Pacific Journal of Clinical Oncology.

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