Fibrillation atriale sous ibrutinib : une étude prospective de l’incidence, des caractéristiques et de la prise en charge

Abstract : Introduction: Ibrutinib is a Bruton tyrosine kinase inhibitor indicated in the treatment of B-cell malignancies. It is associated with atrial fibrillation (AF) and bleeding. Currently, no prospective study by cardio-oncolgists has been published. Objective: To describe the incidence, the characteristics and the management of ibrutinib-induced AF. Methods: Were prospectively included in two cardio-oncology centers patients receiving ibrutinib all indications combined. Were excluded patients lost to follow up. During each consultation, a physical examination, an electrocardiogram and an echocardiography were performed. The main objective was to determine the incidence of ibrutinib-related AF and to describe its characteristics and management. Results: 53 patients were included with a median follow-up of 12 months. 14 patients (26%) developed ibrutinib-related AF mainly after 6 months of treatment (57%). The cumulative incidence of AF was 21% (CI95%, 7 – 31), 23% (CI95%, 9 – 35), 38% (CI95%, 19 – 53) at 6, 12 and 24 months. In 64% of the cases, AF was asymptomatic, 71% were grade 1 or 2 CTCAE episodes. A «CLL AF Risk Score» ≥4 was an independent predictor of ibrutinib-related AF (HR = 3.8, p = 0.03). 86% of the patients were anticoagulated with no major bleeding described. Conclusion: Follow-up by cardio-oncologists of patients treated with ibrutinib improves AF screening with a cumulative incidence twice superior to previously published series. Ibrutinib-related AF episodes are observed early after initiation of treatment and are mainly asymptomatic. Anticoagulation seems safe. A « CLL AF Risk Score » ≥ 4 could justify a closer follow-up due to a more important risk of ibrutinib-related AF.
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Florian Baptiste. Fibrillation atriale sous ibrutinib : une étude prospective de l’incidence, des caractéristiques et de la prise en charge. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02049046⟩

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