Abstract Ibrutinib and acalabrutinib are both associated with an increased risk of atrial fibrillation (AF) but AF comparative risk between these 2 BTK inhibitors remains largely unknown. Our aim was to examine the risk of developing incident AF in patients exposed to ibrutinib compared with those exposed to acalabrutinib. Using the TriNetX research network database, authors conducted a retrospective cohort analysis of deidentified, adult patients with B-cell malignancies and exposed to either ibrutinib or acalabrutinib between 1st January 2013 (first patient exposed to ibrutinib in TriNetX) and 1st July 2024. Patients were divided into 2 groups based on ibrutinib or acalabrutinib exposure. After propensity score matching (PSM) on 37 covariables, hazard ratios (HRs) and their associated 95% confidence intervals (CIs) were used to compare incident AF reporting risk during follow-up between the matched 2 groups. A cohort of 12,449 patients exposed to ibrutinib and 4,131 to acalabrutinib were included in the study. After PSM, 4,090 patients remained in each group (1:1). During a mean follow-up of 2.3±1.8 years, we found a higher risk of incident AF reporting in the ibrutinib group compared with the acalabrutinib group (HR 1.53, 95% CI 1.32–1.77; Log-Rank test p0.0001). This difference was seen in all subgroups of patients (age ≤ or 75, lower or higher baseline cardiovascular risk of developing AF). Patients with B-cell malignancies have a higher risk of developing incident AF when treated with ibrutinib compared to acalabrutinib.
Alexandre et al. (Fri,) studied this question.