Real-World Outcomes Among Medicare Beneficiaries Treated With First-Line Bruton Tyrosine Kinase Inhibitors for Chronic Lymphocytic Leukemia

In this OncLive Rapid Readout, Daniel A. Ermann, MD, discusses real-world outcomes among Medicare beneficiaries aged 65 years or older with chronic lymphocytic leukemia or small lymphocytic lymphoma who received first-line covalent Bruton tyrosine kinase inhibitor monotherapy. The retrospective Medicare Fee-for-Service analysis included 10,523 patients treated with zanubrutinib, acalabrutinib, or ibrutinib between 2020 and 2025, evaluating real-world time to treatment discontinuation or death, time to next treatment or death, and overall survival. Findings showed that zanubrutinib was associated with significantly longer treatment duration and delayed need for subsequent therapy compared with both acalabrutinib and ibrutinib. At 24 months, patients receiving zanubrutinib also had higher treatment-continuation, next-treatment-free, and survival probabilities. Similar outcome patterns were observed across age subgroups, including patients aged 85 years or older. Ermann highlights how these data may inform first-line BTK inhibitor selection for older patients with CLL in routine clinical practice and decision-making in the United States.