Recent patterns of care with BTK inhibitors and distribution of social determinants of health among
patients with CLL/SLL in the US community setting
Authors: David J. Andorsky,¹ Thomas W. Wilson,² Kathleen M. Aguilar,² Chuck Wentworth,² YunfeiWang,² Scott D. Goldfarb,³ Keri Yang,³ Erlene K. Seymour,³ Mark Balk,³ Gregory A. Maglinte,³ Ira Zackon²
Affiliations: ¹The US Oncology Network/Rocky Mountain Cancer Centers, Boulder, CO, USA; ²Ontada,Boston, MA, USA; ³BeiGene USA, Inc, San Mateo, CA, USAABSTRACT
Objective: Few real-world studies have examined Bruton tyrosine kinase (BTK) inhibitor sequencing
patterns for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). This study examinedcharacteristics, treatment patterns, and social determinants of health (SDOH) of BTK inhibitor-treatedpatients with CLL/SLL in a community practice network.
Methods: This was a retrospective study in adults with CLL/SLL who were prescribed a BTK inhibitor
between 1/1/2020–4/30/2023 in The US Oncology Network. Structured study data from the iKnowMedelectronic health record system were analyzed. Area Deprivation Index (ADI) scores for socioeconomicstatus (SES) levels were determined using community-specific income, education, employment, andhousing data; low SES was defined as the top 20% of state- and national-level ADI scores. Rural/urban
status was classified using US Department of Agriculture Rural-Urban Community Area codes. Insurance
coverage was reported “as is”; Medicaid was considered a low SES indicator. Results were assessed bytreatment sequences and the data were evaluated for treatment subgroups with at least 30 eligible
patients. SDOH results were reported as counts or frequencies. Chi-square P-values were reported forselected SDOH measures.
Results: Patients with CLL/SLL were included (N=2082; median age, 73 years; 61.9% male; medianfollow-up, 14.1 months). Most patients received acalabrutinib (n=1159) or ibrutinib (n=628) only;
subsequent BTK inhibitors were reported for 8.7% (n=182). Patient characteristics across treatment
sequences were similar. Among 597 BTK inhibitor-treated patients in 2020, 62.3% (n=372) received
ibrutinib; 1 received zanubrutinib. Among 206 BTK inhibitor–treated patients in 2023, 6.8% (n=14) and
28.6% (n=59) received ibrutinib and zanubrutinib, respectively. Low SES per state and national indicators
was observed for 361 (17.3%) and 125 patients (6.0%), respectively, and was similar across subgroups.
Most had Medicare (n=877 [42.1%]), followed by managed Medicare (n=508 [24.4%]). A statisticaldifference between treatments was seen for rural/urban status (P<.01) but not for state ADI (P=.52),
national ADI (P=.36), or Medicaid vs other insurance (P=.18).
Conclusions: Between 1/1/2020–4/30/2023, ibrutinib use decreased while acalabrutinib andzanubrutinib use increased. SDOH were similar across BTK inhibitor sequence subgroups, althoughrural/urban status, and not SES or Medicaid, was associated with differences in prescribing patterns.
Further real-world research and longitudinal follow-up are needed to examine the impact of SDOH on
BTK inhibitor choice, switching, reasons for switching, and outcomes.
Presented previously at the ASH Annual Meeting; Dec 2023.

PPLC 2024