Study: 3% of patients on ibrutinib developed invasive fungal infection within 1 year
The 1-year incidence of invasive fungal infections among patients taking small molecule kinase inhibitors was as high as 10.6%, a study found. The incidence was 3% for patients on ibrutinib.
Jeremy A.W. Gold, MD, MS, an Epidemic Intelligence Service officer in the CDC’s Mycotic Diseases Branch, explained that small molecule kinase inhibitors (SMKIs) like ibrutinib have become increasingly used in recent years and often provide a lifesaving treatment option for patients with different cancers and inflammatory diseases.
“Researchers have linked SMKIs, ibrutinib in particular, to life-threatening invasive fungal infections, likely because of effects on the immune system,” Gold told Healio. “Data on the risk of fungal infections in patients starting SMKIs are limited, but this information is important to inform clinical practice and antifungal prophylaxis strategies.”
Gold and colleagues analyzed data from IBM MarketScan to assess the 1-year incidence of invasive fungal infections (IFIs) among patients starting ibrutinib or other SMKIs. As they explained in the study, the researchers followed patients for 1 year after their initial prescription to ascertain if and where they were diagnosed with an IFI.
Among the 29 cohorts of patients initiating outpatient SMKI treatment, IFI incidence ranged from 0% to 10.6%, Gold and colleagues determined. Overall, they found that the time to IFI development varied by SMKI, but most IFI diagnoses occurred more than 90 days after drug initiation, and 42.7% of initial IFI diagnoses occurred in the inpatient setting. Among seven SMKI cohorts in which 10 or more patients developed an IFI, four involved a predominant IFI type affecting more than a third of patients.
Additionally, the study showed that the predominant IFI type was candidiasis in patients receiving palbociclib (64%) and tofacitinib (63%), Pneumocystis pneumonia in patients receiving dasatinib (40%) and aspergillosis in patients receiving ibrutinib (37%).
Among the 1,286 patients initiating ibrutinib, 3% had an IFI diagnosis an average of 169 days from initiation. The researchers found that the incidence did not differ significantly by age, sex or ibrutinib indication. However, a nonsignificantly higher percentage of patients who developed an IFI had relapsed chronic lymphocytic leukemia compared with ibrutinib patients who did not develop an IFI (13.2% vs. 6.2%, P = .089).
“The number of SMKIs on the market is rapidly increasing, and clinicians and researchers should be mindful of the possibility of invasive fungal infections in patients receiving these drugs,” Gold said. “Our findings highlight the importance of clinical vigilance for invasive fungal infections in patients taking SMKIs and the need for in-depth clinical studies to further stratify invasive fungal infection risk and guide antifungal prophylaxis strategies.”
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