Nav: Home

Study identifies cardiovascular toxicities associated with ibrutinib

September 23, 2019

After a recent study showed that chronic lymphocytic leukemia patients who received ibrutinib as a frontline treatment had a 7% death rate, a new study offers a clearer picture on the reasons for the deaths.

A team of researchers utilized the VigiBase, a global database of drug complications maintained by the World Health Organization, to analyze deaths associated with ibrutinib, a targeted therapy for several blood cancers that has boosted long-term survival rates and proven superior to other therapies.

However, ibrutinib also was shown to have a death rate of 7% compared to 1% for chemotherapy during treatment or within 30 days afterward, according to a study published Dec. 27, 2018, in The New England Journal of Medicine.

The death rate, which was noted on the eighth page of that study, stood out to Javid Moslehi, MD, director of Cardio-Oncology and associate professor of Medicine at Vanderbilt University Medical Center. He is part of a team at Vanderbilt-Ingram Cancer Center focusing on toxicities associated with targeted therapies, immunotherapies and other newer treatments.

"Seven percent of people dying from a frontline treatment is not a good thing," said Moslehi, the senior author of a follow-up study published Sept. 23 in Journal of The American College of Cardiology that analyzed deaths associated with ibrutinib utilizing VigiBase.

The study identified several cardiovascular toxicities associated with ibrutinib, including supraventricular arrhythmias, central nervous system hemorrhagic events, heart failure, ventricular arrhythmias, conduction disorders, ischemic strokes and organ damage related to hypertension.

"Our study is interesting in that it allowed for detection of new signals of potentially fatal cardiovascular toxicities associated with ibrutinib, such as heart failure, conduction disorders and central nervous system hemorrhagic events. Treating physicians should be aware of these risks," said the study's lead author, Joe-Elie Salem, MD, PhD, associate professor of Cardiology and Pharmacology at Sorbonne University and adjunct professor at Vanderbilt University.

Some of the cardiovascular adverse drug reactions associated with ibrutinib are difficult to treat.

"The challenge is that from a cardiology perspective we don't always know what to do," Moslehi said. "For example, we generally treat patients with atrial fibrillation with blood thinners. The problem is that ibrutinib also thins the blood, so you already have a bleeding risk. That is a problem."

The study noted "there is a clear and pressing need to improve management of these patients." The research team is currently investigating what protein kinase within the drug mechanism is causing the atrial fibrillations and how best to reverse the effect, Moslehi said.

Two of the cardiovascular adverse drug reactions identified in the VigiBase analysis - heart failure and conduction disorder - are new findings.

The median time from start of treatment with ibrutinib to onset of supraventricular arrythmia was two to three months. The median time was four to five months for hypertension. Heart failure, brain bleeds and ventricular arrythmias had onset times of two to three months. However, the onset of conduction disorder occurred more quickly, mainly within the first month of treatment.

Moslehi and the team of oncologists who are co-authors on the manuscript, including Nishitha Reddy, MBBS, MSCI, associate professor of Medicine at Vanderbilt University, urge monitoring patients closely when prescribing ibrutinib and to consult with cardiologists with difficult patient cases.

Vanderbilt University Medical Center

Related Heart Failure Articles:

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.
Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population
Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.
Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.
Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.
Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.
How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.
Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.
NSAID impairs immune response in heart failure, worsens heart and kidney damage
Non-steroidal anti-inflammatory drugs, or NSAIDs, are widely known as pain-killers and can relieve pain and inflammation.
Heart cell defect identified as possible cause of heart failure in pregnancy
A new Tel Aviv University study reveals that one of the possible primary causes of heart failure in pregnant women is a functional heart cell defect.
More Heart Failure News and Heart Failure Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Meditations on Loneliness
Original broadcast date: April 24, 2020. We're a social species now living in isolation. But loneliness was a problem well before this era of social distancing. This hour, TED speakers explore how we can live and make peace with loneliness. Guests on the show include author and illustrator Jonny Sun, psychologist Susan Pinker, architect Grace Kim, and writer Suleika Jaouad.
Now Playing: Science for the People

#565 The Great Wide Indoors
We're all spending a bit more time indoors this summer than we probably figured. But did you ever stop to think about why the places we live and work as designed the way they are? And how they could be designed better? We're talking with Emily Anthes about her new book "The Great Indoors: The Surprising Science of how Buildings Shape our Behavior, Health and Happiness".
Now Playing: Radiolab

The Third. A TED Talk.
Jad gives a TED talk about his life as a journalist and how Radiolab has evolved over the years. Here's how TED described it:How do you end a story? Host of Radiolab Jad Abumrad tells how his search for an answer led him home to the mountains of Tennessee, where he met an unexpected teacher: Dolly Parton.Jad Nicholas Abumrad is a Lebanese-American radio host, composer and producer. He is the founder of the syndicated public radio program Radiolab, which is broadcast on over 600 radio stations nationwide and is downloaded more than 120 million times a year as a podcast. He also created More Perfect, a podcast that tells the stories behind the Supreme Court's most famous decisions. And most recently, Dolly Parton's America, a nine-episode podcast exploring the life and times of the iconic country music star. Abumrad has received three Peabody Awards and was named a MacArthur Fellow in 2011.