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December 8, 2025Blood

Incidence of cardiac events associated with next-generation bruton tyrosine kinase (BTK) inhibitors compared to control in hematologic malignancies: A meta-analysis of randomized trials

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Authors

JTJason TaSASalman AhmadSASamir A. Afifi

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Overview

Meta-analysis reveals next-generation BTK inhibitors increase atrial fibrillation risk in hematologic malignancies, indicating potential cardiotoxicity.

Key Points

  • To evaluate the incidence of cardiac events associated with next-generation BTK inhibitors compared to control in patients with hematologic malignancies.
  • Systematic literature search through MEDLINE and EMBASE up to July 2025
  • Included Phase II/III RCTs with adults receiving acalabrutinib, zanubrutinib, or pirtobrutinib
  • Cardiac outcomes included any-grade and high-grade cardiac events, atrial fibrillation, and myocardial infarctions
  • Pooled risk ratios and confidence intervals calculated using a random-effects model
  • Heterogeneity assessed with the I² statistic and risk of bias using Cochrane Risk of Bias 2.0 tool.
  • Seven RCTs with 3,278 patients were included in the analysis
  • BTK inhibitors associated with higher any-grade cardiac events (15.2% vs 8.9%; RR 1.90; p=0.0004)
  • Atrial fibrillation or flutter was more common in BTKi group (3.7% vs 1.6%; RR 2.11; p=0.003)
  • High-grade cardiac events not significantly different (4.0% vs 3.3%; RR 1.29; p=0.19)
  • Low incidence of myocardial infarction did not differ significantly between groups.

Cite This Study

Ta et al. (2025) studied this question.

synapsesocial.com/papers/69362f6e4fa91c937236e0d2https://doi.org/10.1182/blood-2025-8067
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardiotoxicity from bruton tyrosine kinase inhibitors (BTKi)—an analysis of an administrative health claims database2024 · 7 citations
  2. 2Cardiotoxicity from Bruton tyrosine kinase inhibitors (BTKi) – an analysis of an administrative health claims database2024
  3. 3Cardiovascular Risk of First and Second Generation Bruton’s Tyrosine Kinase Inhibitors: A Systematic Review and Network Meta-Analysis2026
  4. 4Incidence of bleeding and hypertension in patients with hematologic malignancies treated with next-generation Bruton tyrosine kinase (BTK) inhibitors: A meta-analysis of randomized controlled trials2025
  5. 5Risk assessment of cardiovascular adverse events with BTK inhibitors in hematological malignancies: Insights from FAERS.2024 · 3 citations