Comorbidities relevant to CML TKI choice common

Nov 27 2015

By Shreeya Nanda, Senior medwireNews Reporter

Comorbid conditions that could affect the choice of tyrosine kinase inhibitor (TKI) are common in patients with chronic myeloid leukaemia (CML), finds an analysis of a US claims database.

Researcher Elias Jabbour (The University of Texas MD Anderson Cancer Center, Houston, USA) and team explain that “NCCN [National Comprehensive Cancer Network] guidelines state that based on toxicity profiles, one [second-generation] TKI indicated for first-line therapy (ie, dasatinib, nilotinib) may be preferred over the other for treatment of CML patients with certain comorbidities.”

They add: “The results of this analysis provide real-world evidence that the prevalence of relevant comorbid conditions is substantial among CML patients in the US managed care setting and therefore needs to be considered throughout various health care decision-making processes related to CML.”

The analysis included 2296 CML patients identified from the Truven Health Analytics MarketScan Commercial and Medicare databases who started treatment with a TKI – either imatinib (72%), dasatinib (16%) or nilotinib (12%) – between 2007 and 2012.

Among these, 41% were diagnosed with at least one comorbid condition relevant to TKI choice as per the NCCN guidelines in the 12 months prior to initiation of TKI therapy.

Heart disease was the most prevalent condition, observed in 23% of patients, followed by diabetes and lung disease, with a respective prevalence of 18% and 13%, the team reports in Clinical Lymphoma, Myeloma and Leukemia.

The overall prevalence of comorbidities increased significantly with age, with at least one condition present in 15%, 33%, 47% and 65% of patients aged 18 to 44 years, 45 to 54 years, 55 to 64 years and 65 years and older, respectively. This was also the case for each individual included condition, with the exception of pancreatitis, the prevalence of which did not change significantly with age.

Gender also had a significant effect, with significantly more men than women diagnosed with one or more comorbidity relevant to TKI choice, at 44% versus 37%. This association was driven mainly by the significantly higher proportion of men with heart disease (27 vs 17%) and arrhythmia (8 vs 5%).

And the prevalence of certain conditions varied significantly by geographical location. For instance, patients from the Western region had a significantly lower prevalence of heart disease, arrhythmia and lung disease than those from the North Central, Northeast and South.

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