iwCLL 2023 | MAIC of pirtobrutinib vs venetoclax continuous monotherapy in patients with R/R CLL

So I’ve been involved with a matched-adjusted indirect comparison of pirtobrutinib and venetoclax for the relapsed refractory CLL population. This is increasingly a clinical issue that we’re facing, that patients are progressing after covalent BTK inhibitors and we don’t currently have any randomized data to understand what the benefits may be of the non-covalent inhibitor pirtobrutinib that’s in development for CLL versus more typical venetoclax-based therapy, which would be the standard of care.

So we use this MAIC analysis to compare across two different studies in the relapsed setting- one study of pirtobrutinib, the BRUIN study, and an older study of venetoclax, the 1432 trial- to try to understand the differences between these two agents; certainly they have different toxicity profiles, but we also wanted to see how the efficacy might match up. And the matched adjusted part allows us to match the baseline characteristics between these populations as well as we can, obviously with the limitations of non-randomized data. What we found is that overall these drugs look pretty similar in this context, the median progression free survival is in the range of a little under two years or so with both agents, so they certainly can both have a role here. Of course they have very different profiles in terms of how we initiate therapy, so it’s nice to understand a little bit more about how pirtobrutinib may be useful here.

[Pirtobrutinib] is now listed in the NCCN guidelines here in the US so it is an option to consider, but we also await randomized data to better understand how it will compare to the existing standard of care.