Chronic Ibrutinib Therapy Effect on Left Atrial Function

NCT03751410 | Completed

• 2 other identifiers: UHS-2U1111-1221-9732
• Study Type: observational
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

Ibrutinib is an irreversible Bruton tyrosine-kinase inhibitor. In prospective studies, the ibrutinib efficacy in the treatment of various B-cell malignancies was established. Different ibrutinib side-effects have been found: diarrhea, arthralgia, infections, neutropenia, hypertension and increased risk of bleeding. Most of the mentioned side-effects were \<3rd degree of severity and mostly didn't require dose adjustment or therapy discontinuation. Also, there was an increase in the incidence of atrial fibrillation (AFib) (6-16%). The AFib pathogenesis in this patient population is not clarified, but there are indications that ibrutinib inhibits phosphoinositide-3-kinase (PI3K)-Akt signal-pathway expressed in the myocytes. Regardless of the molecular pathogenesis, the clinical effect of ibrutinib on the myocardium, especially the left atrium, has not been studied. Hence, the aim of this study is to determine the ibrutinib effect on echocardiographic parameters of left atrial function. This study will be performed as a clinical, prospective, observational cohort study with a structured follow-up period of 12 months. All consecutive patients with hemato-oncologic diseases (including chronic lymphocytic leukemia, Mantle-cell lymphoma, Waldenstrom macroglobulinemia, etc.) prescribed with chronic ibrutinib therapy, who are able to understand and sign informed consent, will be enrolled. Primary objective is change of the left atrial function measured by the decrease of the left atrial strain deformation \> 10%. Recruiting should not exceed 12 months with the minimal follow-up period of 12 months (24 months in total). Standardized statistical methods and tests will be done using SPSS Version 22.0 or newer. This unique study offers the possibility to show the long-term effect of chronic ibrutinib therapy on left atrial function assessed by transthoracic echocardiography. This observational data is needed to further refine the treatment of these patients and to prevent possible side-effects of ibrutinib which could endanger this specific patient population.

Conditions

Atrium; Beat; Echocardiography; Physiology; Therapy Adverse Effect

Keywords

ibrutinib; echocardiography; left atrium; function; long-term

Outcome Measures

Primary Outcomes (1)

• left atrial function change

  change of the left atrial function measured by the decrease of the left atrial strain deformation \> 10% assessed by transthoracic echocardiography

  initial measurement, 3 months, 6 months and 12 months after initiation of ibrutinib therapy

Secondary Outcomes (6)

• left ventricular ejection fraction change

  initial measurement, 3 months, 6 months and 12 months after initiation of ibrutinib therapy

• left ventricular diastolic function change

  initial measurement, 3 months, 6 months and 12 months after initiation of ibrutinib therapy

• left atrial volume change

  initial measurement, 3 months, 6 months and 12 months after initiation of ibrutinib therapy

• P wave duration change

  initial measurement, 3 months, 6 months and 12 months after initiation of ibrutinib therapy

• left atrial pump function change

  initial measurement, 3 months, 6 months and 12 months after initiation of ibrutinib therapy

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

All consecutive patients with haemato-oncologic diseases (including chronic lymphocytic leukemia, Mantle-cell lymphoma, Waldenstrom macroglobulinaemia) prescribed with chronic ibrutinib therapy, who are able to understand and sign informed consent, will be enrolled.

You may qualify if:

• patients with haemato-oncologic diseases (including chronic lymphocytic leukemia, Mantle-cell lymphoma, Waldenstrom macroglobulinaemia, etc.)
• patients prescribed with chronic ibrutinib therapy
• patients who are able to understand and sign informed consent

You may not qualify if:

• patients with haemato-oncologic diseases who were prescribed with concomitant chemotherapy which can impact left atrial function
• patients \< 18 years old
• patients with known or at initial echocardiography established dilated cardiomyopathy with left ventricular ejection fraction \< 35%
• patients with permanent atrial fibrillation and dilated left atrium or dilated both atriums
• patients implanted with cardiac implantable electronic devices
• patients who underwent cardiac surgery
• patients with congenital heart diseases (surgically corrected or not)
• patients with severe valvular pathology
• patients with terminal renal disease
• patients with chronic obstructive pulmonary disease - GOLD grade 4
• patients with life expectancy \< 12 months
• patients not willing to undergo clinical follow-up or sign informed consent
• patients recruited in another clinical study

Sponsors & Collaborators

• University Hospital Sestre Milosrdnice: lead

Study Sites (1)

Sestre milosrdnice University Hospital

Zagreb, 10000, Croatia

Location

Related Publications (11)

• Deeks ED. Ibrutinib: A Review in Chronic Lymphocytic Leukaemia. Drugs. 2017 Feb;77(2):225-236. doi: 10.1007/s40265-017-0695-3.

  PMID: 28105602 RESULT

• Byrd JC, Brown JR, O'Brien S, Barrientos JC, Kay NE, Reddy NM, Coutre S, Tam CS, Mulligan SP, Jaeger U, Devereux S, Barr PM, Furman RR, Kipps TJ, Cymbalista F, Pocock C, Thornton P, Caligaris-Cappio F, Robak T, Delgado J, Schuster SJ, Montillo M, Schuh A, de Vos S, Gill D, Bloor A, Dearden C, Moreno C, Jones JJ, Chu AD, Fardis M, McGreivy J, Clow F, James DF, Hillmen P; RESONATE Investigators. Ibrutinib versus ofatumumab in previously treated chronic lymphoid leukemia. N Engl J Med. 2014 Jul 17;371(3):213-23. doi: 10.1056/NEJMoa1400376. Epub 2014 May 31.

  PMID: 24881631 RESULT

• Thompson PA, Burger JA. Bruton's tyrosine kinase inhibitors: first and second generation agents for patients with Chronic Lymphocytic Leukemia (CLL). Expert Opin Investig Drugs. 2018 Jan;27(1):31-42. doi: 10.1080/13543784.2018.1404027. Epub 2017 Nov 15.

  PMID: 29125406 RESULT

• Wierda WG, Zelenetz AD, Gordon LI, Abramson JS, Advani RH, Andreadis CB, Bartlett N, Byrd JC, Caimi P, Fayad LE, Fisher RI, Glenn MJ, Habermann TM, Harris NL, Hernandez-Ilizaliturri F, Hoppe RT, Horwitz SM, Kaminski MS, Kelsey CR, Kim YH, Krivacic S, LaCasce AS, Martin MG, Nademanee A, Porcu P, Press O, Rabinovitch R, Reddy N, Reid E, Roberts K, Saad AA, Snyder ED, Sokol L, Swinnen LJ, Vose JM, Yahalom J, Dwyer MA, Sundar H. NCCN Guidelines Insights: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 1.2017. J Natl Compr Canc Netw. 2017 Mar;15(3):293-311. doi: 10.6004/jnccn.2017.0030.

  PMID: 28275031 RESULT

• Burger JA, Tedeschi A, Barr PM, Robak T, Owen C, Ghia P, Bairey O, Hillmen P, Bartlett NL, Li J, Simpson D, Grosicki S, Devereux S, McCarthy H, Coutre S, Quach H, Gaidano G, Maslyak Z, Stevens DA, Janssens A, Offner F, Mayer J, O'Dwyer M, Hellmann A, Schuh A, Siddiqi T, Polliack A, Tam CS, Suri D, Cheng M, Clow F, Styles L, James DF, Kipps TJ; RESONATE-2 Investigators. Ibrutinib as Initial Therapy for Patients with Chronic Lymphocytic Leukemia. N Engl J Med. 2015 Dec 17;373(25):2425-37. doi: 10.1056/NEJMoa1509388. Epub 2015 Dec 6.

  PMID: 26639149 RESULT

• Kaur V, Swami A. Ibrutinib in CLL: a focus on adverse events, resistance, and novel approaches beyond ibrutinib. Ann Hematol. 2017 Jul;96(7):1175-1184. doi: 10.1007/s00277-017-2973-2. Epub 2017 Mar 24.

  PMID: 28342031 RESULT

• O'Brien S, Hillmen P, Coutre S, Barr PM, Fraser G, Tedeschi A, Burger JA, Dilhuydy MS, Hess G, Moreno C, Cramer P, Liu E, Chang S, Vermeulen J, Styles L, Howes A, James DF, Patel K, Graef T, Valentino R. Safety Analysis of Four Randomized Controlled Studies of Ibrutinib in Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma or Mantle Cell Lymphoma. Clin Lymphoma Myeloma Leuk. 2018 Oct;18(10):648-657.e15. doi: 10.1016/j.clml.2018.06.016. Epub 2018 Jun 28.

  PMID: 30061088 RESULT

• Reda G, Fattizzo B, Cassin R, Mattiello V, Tonella T, Giannarelli D, Massari F, Cortelezzi A. Predictors of atrial fibrillation in ibrutinib-treated CLL patients: a prospective study. J Hematol Oncol. 2018 Jun 11;11(1):79. doi: 10.1186/s13045-018-0626-0.

  PMID: 29891001 RESULT

• Boriani G, Corradini P, Cuneo A, Falanga A, Foa R, Gaidano G, Ghia PP, Martelli M, Marasca R, Massaia M, Mauro FR, Minotti G, Molica S, Montillo M, Pinto A, Tedeschi A, Vitolo U, Zinzani PL. Practical management of ibrutinib in the real life: Focus on atrial fibrillation and bleeding. Hematol Oncol. 2018 Oct;36(4):624-632. doi: 10.1002/hon.2503. Epub 2018 Mar 7.

  PMID: 29512173 RESULT

• Mato AR, Clasen S, Pickens P, Gashonia L, Rhodes J, Svoboda J, Hughes M, Nabhan C, Ali N, Schuster S, Carver J. Left atrial abnormality (LAA) as a predictor of ibrutinib-associated atrial fibrillation in patients with chronic lymphocytic leukemia. Cancer Biol Ther. 2018 Jan 2;19(1):1-2. doi: 10.1080/15384047.2017.1394554. Epub 2017 Dec 27.

  PMID: 29281559 RESULT

• Leong DP, Caron F, Hillis C, Duan A, Healey JS, Fraser G, Siegal D. The risk of atrial fibrillation with ibrutinib use: a systematic review and meta-analysis. Blood. 2016 Jul 7;128(1):138-40. doi: 10.1182/blood-2016-05-712828. Epub 2016 May 31. No abstract available.

  PMID: 27247135 RESULT

Study Officials

• Matea Kolacevic, MD

  University Hospital Sestre Milosrdnice

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Target Duration: 12 Months
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal co-investigator

Study Record Dates

• First Submitted: November 19, 2018
• First Posted: November 23, 2018
• Study Start: December 1, 2018
• Primary Completion: March 4, 2023
• Study Completion: March 4, 2023
• Last Updated: October 17, 2023

Record last verified: 2023-10

Data Sharing

• IPD Sharing: Will not share

Locations

CR (1)