Pre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with Ibrutinib

Abstract Background Ibrutinib is a Bruton’s tyrosine kinase inhibitor used in the treatment of hematological malignancies. The most common cardiotoxicity associated with ibrutinib is atrial arrhythmia (atrial fibrillation and flutter). It is known that patients with cardiovascular disease (CVD) are...

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Autores principales:	Juan Carlo Avalon, Jacob Fuqua, Tyler Miller, Seth Deskins, Chelby Wakefield, Austin King, Sonya Inderbitzin-Brooks, Christopher Bianco, Lauren Veltri, Wei Fang, Michael Craig, Abraham Kanate, Kelly Ross, Midhun Malla, Brijesh Patel
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Ibrutinib Atrial fibrillation Cardio-oncology Cardiovascular disease Arrhythmia Hematologic malignancy Diseases of the circulatory (Cardiovascular) system RC666-701 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/dd55526f958e4bdbbb25c6d0cb0df70b
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spelling	oai:doaj.org-article:dd55526f958e4bdbbb25c6d0cb0df70b2021-11-21T12:40:31ZPre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with Ibrutinib10.1186/s40959-021-00125-82057-3804https://doaj.org/article/dd55526f958e4bdbbb25c6d0cb0df70b2021-11-01T00:00:00Zhttps://doi.org/10.1186/s40959-021-00125-8https://doaj.org/toc/2057-3804Abstract Background Ibrutinib is a Bruton’s tyrosine kinase inhibitor used in the treatment of hematological malignancies. The most common cardiotoxicity associated with ibrutinib is atrial arrhythmia (atrial fibrillation and flutter). It is known that patients with cardiovascular disease (CVD) are at an increased risk for developing atrial arrhythmia. However, the rate of atrial arrhythmia in patients with pre-existing CVD treated with ibrutinib is unknown. Objective This study examined whether patients with pre-existing CVD are at a higher risk for developing atrial arrhythmias compared to those without prior CVD. Methods A single-institution retrospective chart review of patients with no prior history of atrial arrhythmia treated with ibrutinib from 2012 to 2020 was performed. Patients were grouped into two cohorts: those with CVD (known history of coronary artery disease, heart failure, pulmonary hypertension, at least moderate valvular heart disease, or device implantation) and those without CVD. The primary outcome was incidence of atrial arrhythmia, and the secondary outcomes were all-cause mortality, risk of bleeding, and discontinuation of ibrutinib. The predictors of atrial arrhythmia (namely atrial fibrillation) were assessed using logistic regression. A Cox-Proportional Hazard model was created for mortality. Results Patients were followed for a median of 1.1 years. Among 217 patients treated with ibrutinib, the rate of new-onset atrial arrhythmia was nearly threefold higher in the cohort with CVD compared to the cohort without CVD (17% vs 7%, p = 0.02). Patients with CVD also demonstrated increased adjusted all-cause mortality (OR 1.9, 95% CI 1.06-3.41, p = 0.01) and decreased survival probability (43% vs 54%, p = 0.04) compared to those without CVD over the follow-up period. There were no differences in risk of bleeding or discontinuation between the two cohorts. Conclusions Pre-existing cardiovascular disease was associated with significantly higher rates of atrial arrhythmia and mortality in patients with hematological malignancies managed with ibrutinib.Juan Carlo AvalonJacob FuquaTyler MillerSeth DeskinsChelby WakefieldAustin KingSonya Inderbitzin-BrooksChristopher BiancoLauren VeltriWei FangMichael CraigAbraham KanateKelly RossMidhun MallaBrijesh PatelBMCarticleIbrutinibAtrial fibrillationCardio-oncologyCardiovascular diseaseArrhythmiaHematologic malignancyDiseases of the circulatory (Cardiovascular) systemRC666-701Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCardio-Oncology, Vol 7, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ibrutinib Atrial fibrillation Cardio-oncology Cardiovascular disease Arrhythmia Hematologic malignancy Diseases of the circulatory (Cardiovascular) system RC666-701 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Ibrutinib Atrial fibrillation Cardio-oncology Cardiovascular disease Arrhythmia Hematologic malignancy Diseases of the circulatory (Cardiovascular) system RC666-701 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Juan Carlo Avalon Jacob Fuqua Tyler Miller Seth Deskins Chelby Wakefield Austin King Sonya Inderbitzin-Brooks Christopher Bianco Lauren Veltri Wei Fang Michael Craig Abraham Kanate Kelly Ross Midhun Malla Brijesh Patel Pre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with Ibrutinib
description	Abstract Background Ibrutinib is a Bruton’s tyrosine kinase inhibitor used in the treatment of hematological malignancies. The most common cardiotoxicity associated with ibrutinib is atrial arrhythmia (atrial fibrillation and flutter). It is known that patients with cardiovascular disease (CVD) are at an increased risk for developing atrial arrhythmia. However, the rate of atrial arrhythmia in patients with pre-existing CVD treated with ibrutinib is unknown. Objective This study examined whether patients with pre-existing CVD are at a higher risk for developing atrial arrhythmias compared to those without prior CVD. Methods A single-institution retrospective chart review of patients with no prior history of atrial arrhythmia treated with ibrutinib from 2012 to 2020 was performed. Patients were grouped into two cohorts: those with CVD (known history of coronary artery disease, heart failure, pulmonary hypertension, at least moderate valvular heart disease, or device implantation) and those without CVD. The primary outcome was incidence of atrial arrhythmia, and the secondary outcomes were all-cause mortality, risk of bleeding, and discontinuation of ibrutinib. The predictors of atrial arrhythmia (namely atrial fibrillation) were assessed using logistic regression. A Cox-Proportional Hazard model was created for mortality. Results Patients were followed for a median of 1.1 years. Among 217 patients treated with ibrutinib, the rate of new-onset atrial arrhythmia was nearly threefold higher in the cohort with CVD compared to the cohort without CVD (17% vs 7%, p = 0.02). Patients with CVD also demonstrated increased adjusted all-cause mortality (OR 1.9, 95% CI 1.06-3.41, p = 0.01) and decreased survival probability (43% vs 54%, p = 0.04) compared to those without CVD over the follow-up period. There were no differences in risk of bleeding or discontinuation between the two cohorts. Conclusions Pre-existing cardiovascular disease was associated with significantly higher rates of atrial arrhythmia and mortality in patients with hematological malignancies managed with ibrutinib.
format	article
author	Juan Carlo Avalon Jacob Fuqua Tyler Miller Seth Deskins Chelby Wakefield Austin King Sonya Inderbitzin-Brooks Christopher Bianco Lauren Veltri Wei Fang Michael Craig Abraham Kanate Kelly Ross Midhun Malla Brijesh Patel
author_facet	Juan Carlo Avalon Jacob Fuqua Tyler Miller Seth Deskins Chelby Wakefield Austin King Sonya Inderbitzin-Brooks Christopher Bianco Lauren Veltri Wei Fang Michael Craig Abraham Kanate Kelly Ross Midhun Malla Brijesh Patel
author_sort	Juan Carlo Avalon
title	Pre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with Ibrutinib
title_short	Pre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with Ibrutinib
title_full	Pre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with Ibrutinib
title_fullStr	Pre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with Ibrutinib
title_full_unstemmed	Pre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with Ibrutinib
title_sort	pre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with ibrutinib
publisher	BMC
publishDate	2021
url	https://doaj.org/article/dd55526f958e4bdbbb25c6d0cb0df70b
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Pre-existing cardiovascular disease increases risk of atrial arrhythmia and mortality in cancer patients treated with Ibrutinib

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