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iwCLL 2025 | Managing the cardiac off-target side effects associated with ibrutinib treatment
In this interview, Inga Mandac-Smoljanovic, MD, PhD, Merkur Clinical Hospital, Zagreb, Croatia, provides insight into the management of the cardiac off-target side effects associated with ibrutinib treatment. Dr Mandac-Smoljanovic emphasizes the need for education and close collaboration between hematologists and cardiologists to minimize adverse events, highlighting the importance of referring to the recently updated guidelines. This interview took place at the biennial International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2025 in Krakow, Poland.
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Transcript
The good thing is that in the last 10 years we have managed to coordinate the guidelines, recommendations with our colleagues cardiologists who together with hematologists follow patients on ibrutinib treatment who are at high risk of worsening hypertension, atrial fibrillation. And the good thing is that we do have a lot of guidelines – the most recent recommendations are published this year with a group of colleagues chemohematologists and cardiologists...
The good thing is that in the last 10 years we have managed to coordinate the guidelines, recommendations with our colleagues cardiologists who together with hematologists follow patients on ibrutinib treatment who are at high risk of worsening hypertension, atrial fibrillation. And the good thing is that we do have a lot of guidelines – the most recent recommendations are published this year with a group of colleagues chemohematologists and cardiologists.
So definitely we have to take into account the pre-existing disorders that our patient can have to check his hypertensive status, in case he has atrial fibrillation. Yes, that’s not a contraindication to start a ibrutinib treatment, but many of these patients are educated to regularly follow their blood pressure in the beginning at least once a week every three in the first three months. They can control also ECG at the GP or in hematology outpatient clinics. And the good thing is that we really have a nice recommendation in case the patient has hypertension that is not controlled. Maybe in the beginning we reduce the dose, but at the end, many of them continue with antihypertensive treatment and usually do not stop ibrutinib in case the adverse event is lower than 3. It is similar with atrial fibrillation, although we do have also a recommendation about anticoagulant use. For most of the patients, if we use direct oral anticoagulants, comparing to these trials that have been published, apixaban seems to have a better safety profile compared to dabigatran or rivaroxaban. On the other hand, some of these patients, of course, have to have heparin. Some of them are on warfarin. But I think even today, we are keeping this patient under control. And due to the great, as I said, collaboration between us and cardiologists, these patients are doing also pretty well.
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