Switching From Ibrutinib to Zanubrutinib Improves Cardiac Safety and Workflow: Mohit Narang, MD

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Switching patients with chronic lymphocytic leukemia (CLL) from ibrutinib to zanubrutinib has led to fewer cardiac adverse effects and a reduced workload for Mohit Narang, MD, managing partner at Maryland Oncology Hematology.

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For patients with chronic lymphocytic leukemia (CLL) who have been on ibrutinib for years, switching to zanubrutinib may offer significant advantages such as fewer cardiac events and a smoother clinical workflow, according to Mohit Narang, MD, managing partner at Maryland Oncology Hematology.

In an interview with The American Journal of Managed Care^® (AJMC^®), Narang described his approach to proactively transitioning patients to zanubrutinib, a next-generation Bruton tyrosine kinase inhibitor (BTK) approved to treat CLL. He said that among patients who had been on ibrutinib for 10 or more years, he began conversations early, emphasizing zanubrutinib’s improved safety profile, particularly its lower risk for atrial fibrillation (AFib) and other cardiac events.

“I must have converted close to 50 to 60 patients,” Narang said. “With our whole practice, we must have done 100 plus.”

Although ibrutinib has been an effective first-generation BTK inhibitor, Narang explained in the first part of this AJMC interview that his patients using it long term were experiencing adverse effects like AFib and stroke.¹ Since making the switch, his team has seen a noticeable drop in cardiology referrals, and with fewer adverse events being reported, patients are making fewer urgent calls, nurse triage encounters have declined, and unscheduled office visits are down.

“It has also helped my financial staff, because now it's easier to get them approved, because we are just doing 1 drug,” Narang added.

This improved safety in a real-world setting mirrors data from recent research. In one study, fewer patients taking zanubrutinib experienced severe (4% vs 9%) and serious adverse events (8% vs 17%) compared with the ibrutinib group.²Additionally, neutropenia was only reported in the ibrutinib arm (3%), with no cases in the zanubrutinib arm. While none these differences were statistically significant, researchers still find them clinically meaningful, noting that treatment decisions should still be individualized.

“My goal is to be preemptive so that we don't have any side effects,” Narang said in the interview.

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