(075) Real-World Treatment of Patients with Chronic Lymphocytic Leukemia: Results from Analysis of US Health Insurance Claims Dataset

Background: The treatment (tx) landscape has evolved for patients (pts) with chronic lymphocytic leukemia (CLL) with novel targeted therapies. Evidence on holistic tx patterns in the real-world (RW) setting is limited, in part due to challenges of capturing therapies with different modes of administration.

Objectives: Leverage US health insurance claims data to develop a line of therapy algorithm (LoT-a) specific for patients with CLL including recently approved agents, and further examine tx patterns among RW pts.

Methods: Retrospective cohort study examined pts with CLL initiating tx in Optum® Clinformatics Data Mart between 1/1/15 and 9/30/22. Pts were indexed on their first record of a qualifying approved antineoplastic agent and required a continuous enrollment from 180 days (d) before diagnosis through 365 d following tx initiation. Antineoplastic agents initiated within 28 d post index were included in the index regimen. Pts treated with Venetoclax (Ven) had a 60-d window to account for the ramp-up period. Subsequent lines were defined by the initiation of a new agent after the regimen definition period or a gap of > 90 d before reinitiating the same regimen.

Results: This study identified 3,669 newly treated pts with a median follow-up of 30 months. Of these, 60% were male and median age at treatment initiation was 71 years. Most pts were White (78%) and median Charlson Comorbidity Index was 3. In pts starting tx pre-2019, most common regimens in the first line (1L) and second line (2L) setting, respectively, were ibrutinib (IB) (31%, 36%), bendamustine+rituximab (BR) (21%, 9%), and rituximab (RTX) (17%, 17%). RTX (22%), Ven-based therapy (20%), and IB (19%) were the most common regimens in third line (3L). In contrast, oral-based therapies were the most common regimens in 1L and 2L among pts who started tx in and after 2019: IB (37%, 22%), acalabrutinib (AC) (19%, 25%), and Ven-based therapy (13%, 18%). Ven-based therapy (25%), AC (24%), and RTX (22%) were the most common regimens in 3L. Novel oral combinations (ie, Ven+[Bruton tyrosine kinase inhibitor (BTKi)] were also observed in this cohort both pre-and post-2019.
676 pts (18%) died after initiating 1L tx, 1,318 (36%) went on to 2L tx with median time to next tx of 334 d [Interquartile Range, 135, 732]. Within the 12-month follow-up, 61%, 59% and 56% of pts treated with anti-CD20 monoclonal antibodies, Ven-based therapy, and BTKi-based therapies went from 1L to 2L, respectively.

Conclusions: This analysis developed a CLL-specific LoT-a using RW data, assessing the current CLL tx landscape, including novel therapies, to facilitate future research examining factors associated with treatment patterns that may impact clinical outcomes.