4CPS-075 Ibrutinib associated atrial fibrillation: incidence and management in the real life clinical setting

Background and importanceAtrial fibrillation (AF) is one of the most common side effects of ibrutinib, a drug that has improved the prognosis of chronic B cell malignancies. The incidence of ibrutinib related AF (IRAF) is not well known in the ‘real life’ setting, and management is challenging, especially due to the risk of bleeding with ibrutinib and its pharmacological interactions with antiarrhythmics and anticoagulants.Aim and objectivesTo determine the incidence of IRAF, and to analyse the characteristics and treatment of this arrhythmia in a real life clinical setting.Material and methodsA retrospective observational study was conducted including patients treated with ibrutinib. Patient characteristics and the management of IRAF were recorded using the electronic medical history. Numerical variables were expressed as mean (SD) and categorical as frequencies (percentages).ResultsTwenty-eight patients were treated with ibrutinib and 5/28 (17.8%) patients developed IRAF. Patient characteristics are shown in table 1.Abstract 4CPS-075 Table 1 Patients without IRAF =23 (85.2%) Patients with IRAFN =5 (17.8%) Age (years) 73±11 75±6 Sex (M/F) 12/11 4/1 Previously AF (n (%)) 1 (4.4) 1 (20) Indication LLC (n (%)) 20 (86.9) 4 (80.0) Ibrutinib duration (months) 13.7±11.2 18.6±9.7 Of the 5 patients who developed IRAF, 2 were grade 3 requiring electric cardioversion and discontinuation of treatment until recovery to grade 1. The other three cases were grade 1 or 2 and treatment was not suspended. In all 5 patients, anticoagulant was initiated (apixaban in 3, rivaroxaban and low molecular weight heparin in 1 patient, respectively). Treatment with beta-blockers was started in 3 patients and in 1 patient the arrhythmia was recurrent, requiring new cardioversion, initiation of amiodarone treatment and ibrutinb dose adjustment. Median time for the appearance of IRAF was 13 months. No major bleeding events occurred.Conclusion and relevanceThis study showed a higher prevalence of IRAF similar to other studies in real life, but with a longer median onset, justifying close monitoring during the first months but also throughout treatment with ibrutinib.References and/or acknowledgements1. Stephens DM, Byrd JC. How I manage ibrutinib intolerance and complications in patients with chronic lymphocytic leukemia. Blood 2019;133:1298–1307. doi: 10.1182/blood-2018-11-846808. Epub 2019 January 14.No conflict of interest.