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# First-line covalent BTK inhibitors for CLL are often stopped early in US community care
- URL: https://www.coios.me/first-line-covalent-btk-inhibitors-for-cll-are-often/
- Published: 2026-11-08T13:05:48.000Z
- Updated: 2026-11-08T14:09:48.000Z
- Description: Among 584 US community oncology patients with CLL/SLL, half had stopped first-line ibrutinib, acalabrutinib or zanubrutinib by 24 months, most often because of adverse events.
- Author: Daniel Ryan
- Tags: Health today, Cancer, Adherence and persistence, United States, #peer-reviewed, #refines, #item, #source-2026-11, #score-65

This retrospective cohort followed 584 US community oncology patients starting first-line covalent BTK inhibitors for CLL/SLL, 2019 to 2023\. Electronic health records and chart abstraction showed 384 took ibrutinib, 150 acalabrutinib and 50 zanubrutinib; median age was 73\. By 24 months 51.2% had discontinued, and 65.9% by end of follow-up, most often for adverse events (38.4%). Of those who stopped, 61.8% did not start second-line therapy. Acalabrutinib was linked to longer time on treatment than ibrutinib (HR 0.61), and 24-month overall survival was 81.9%. Records may be incomplete, and the zanubrutinib group was small, with median follow-up of 16.1 months.

*Why it is interesting: Median time on first-line therapy was 23 months, far shorter than in the trials. Many who stopped then went without further treatment for some time, as median time to next treatment or death was 48 months.*

Source

[eJHaem, 6 November 2026](https://doi.org/10.1002/jha2.70432?ref=coios.me)

Paper

Real‐World Treatment Patterns, Tolerability, and Outcomes Among Patients With CLL/SLL Treated With First‐Line Ibrutinib, Acalabrutinib, or Zanubrutinib in the US Community Oncology Setting: A Retrospective Cohort Study

Authors

Burke JM, Zackon I, Wang Y, Aguilar KM, Murphy J, Wayne B et al.

DOI

10.1002/jha2.70432

Full text

[Open copy](https://pmc.ncbi.nlm.nih.gov/articles/PMC13739135/?ref=coios.me) (open-access copy, PubMed Central)

Type

Peer-reviewed article

Design

Retrospective EHR cohort, 584 first-line CLL/SLL patients in US community oncology, initiations Nov 2019–Jul 2023, median follow-up 16–42 months by drug

Verdict

Refines prior evidence

Driver

[Cancer](https://www.coios.me/d-cancer/)

Driver

[Adherence and persistence](https://www.coios.me/d-adherence/)