Adverse events among chronic myelogenous leukemia patients treated with tyrosine kinase inhibitors: a real-world analysis of health plan enrollees

Abstract

With tyrosine kinase inhibitor (TKI) therapy, chronic myelogenous leukemia (CML) is now a chronic disease. CML patients treated with TKIs (n = 1200) were identified from the OptumLabs^® Data Warehouse (de-identified claims and electronic health records) between 2000 and 2016 and compared with a non-cancer cohort (n = 7635). The 5-year cumulative incidence of all organ system outcomes was significantly greater for the TKI versus non-cancer group. In the first year, compared with imatinib, later generation TKIs were associated with primary infections (hazard ratios [HR] 1.43, 95% CI 1.02–2.00), circulatory events (HR 1.15, 95% CI 1.01–1.31), and skin issues (HR 1.43, 95% CI 1.13–1.80); musculoskeletal and nervous system/sensory issues were less common (HRs 0.83–0.84, p < 0.05). Increased risk of infections, cardiopulmonary and skin issues associated with later generation TKIs persisted in subsequent years. In this real-world population, TKI therapy was associated with a high burden of adverse events. Later generation TKIs may have greater toxicity than imatinib.

Keywords:

• Chronic myelogenous leukemia
• tyrosine kinase inhibitor
• complications
• epidemiology
• insurance

Author contributions

Research design: EJC, GHL; data acquisition: HJH, LKB, PEM; analysis: DRD, SC, EJC; interpretation of data: all; writing and approval: all.

Disclosure statement

The authors report no potential disclosures related to this research.

Additional information

Funding

The funding was provided by Stand Up To Cancer, the American Association for Cancer Research, and the US National Institutes of Health [P30 CA015704].