EHA 2022 | Acalabrutinib vs ibrutinib in previously untreated high-risk CLL

The key trial for the comparison of ibrutinib and acalabrutinib was the ELEVATE R/R or relapsed/refractory trial, where we randomized patients with poor-risk features. So they had to have 17p or 11q deletions. So they were selected to be worse in terms of chemotherapy outcomes, on the head-to-head basis between the two, the highly specific acalabrutinib reversible inhibitor compared to ibrutinib. What that showed was that there was it was a non-inferiority trial. So we said there was no difference in terms of progression-free survival between the two BTK inhibitors, but there was a significant improvement in terms of atrial fibrillation with less atrial fibrillation, with acalabrutinib, significantly less hypertension. And we’ve shown from other trials, that’s a concern in terms of the long-term toxicity of BTK inhibitors, potentially. And also a significant reduction in the nuisance side effects that we see with ibrutinib of diarrhea, arthralgia, and similar symptoms such as that. I think the value of the head-to-head comparison is that we can show a statistical difference between the next generation selective inhibitors and ibrutinib.