Adverse events among chronic myelogenous leukemia patients treated with tyrosine kinase inhibitors: a real-world analysis of health plan enrollees
Eric J. Chow, David R. Doody, Jennifer J. Wilkes, Laura Becker, Shasank Chennupati, Pamela Morin, Lena E. Winestone, Henry J. Henk, Gary H. Lyman
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.