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June 4, 2026

Pharmacology-Guided venetoclax dose reduction with azacitidine in older or unfit acute myeloid leukemia: A North African experience from a Moroccan single-center cohort and exploratory hospital cost-effectiveness analysis

Key Points

This research assesses the efficacy and cost-effectiveness of pharmacology-guided azacitidine-venetoclax regimens in older or unfit acute myeloid leukemia patients in Morocco.
Retrospective single-center study at a military teaching hospital in Morocco (Dec 2019 - Dec 2025)
Inclusion of 15 older/unfit AML patients receiving dose-reduced venetoclax (100 mg/day) with azacitidine
Survival analysis using Kaplan-Meier and pharmacoeconomic analysis from the hospital perspective
Complete remission achieved in 78% of patients on azacitidine-venetoclax and 50% on azacitidine alone
Infection complications occurred in 73.3% of patients
Estimated survival probabilities were 76% at 12 months and 57% at 24 months; ICER for azacitidine-venetoclax was about 183,000 MAD/QALY gained.

Abstract

IntroductionAzacitidine-venetoclax has improved outcomes in older or intensive chemotherapy-ineligible acute myeloid leukemia (AML) patients. However, real-world experience and pharmacoeconomic evidence remain scarce in resource-limited settings, particularly in North Africa, where drug pricing and supportive care constraints significantly shape clinical practice.MethodsA retrospective single-center study was conducted at a tertiary military teaching hospital in Morocco (December 2019-December 2025). Fifteen older or unfit AML patients receiving azacitidine-based regimens were included. Venetoclax was dose-reduced to 100 mg/day under concomitant voriconazole prophylaxis based on CYP3A4 inhibition principles. Kaplan-Meier survival analysis was performed. An exploratory pharmacoeconomic analysis was conducted from a hospital perspective, incorporating drug acquisition costs, infection-related hospitalization expenses, and quality-adjusted life-years (QALYs) derived from the literature.ResultsComplete remission was achieved in 78% of first-line azacitidine-venetoclax recipients (n = 9) and 50% with azacitidine alone (n = 4). Infectious complications occurred in 73.3% of patients. Median overall survival was not reached; estimated survival probabilities were 76% at 12 months and 57% at 24 months. The incremental cost-effectiveness ratio (ICER) of azacitidine-venetoclax versus azacitidine alone was approximately 183,000 MAD per QALY gained (≈2× Morocco's GDP per capita) after incorporating infection-related costs. Venetoclax acquisition price was the primary cost-effectiveness driver on sensitivity analysis.ConclusionsPharmacology-guided azacitidine-venetoclax regimens are clinically feasible in resource-limited settings, with encouraging survival outcomes. Infection management, antifungal prophylaxis strategies, and targeted drug pricing negotiations are key determinants of cost-effectiveness. Prospective multicenter studies are warranted.

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Cite This Study

Youssef et al. (Tue,) studied this question.

synapsesocial.com/papers/6a2115d7d499ed480b16ed72 https://doi.org/https://doi.org/10.1177/10781552261456738

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