AUTHOR=Nunes Rafael Amorim Belo , Neves Precil Diego Miranda de Menezes , da Costa Leandro Menezes Alves , Bachour Philip , Cantarelli Marcelo José de Carvalho , Oliveira Gustavo Bernardes de Figueiredo , Avezum Jr. Álvaro 

TITLE=Five-year cardiovascular outcomes in patients with chronic myeloid leukemia treated with imatinib, dasatinib, or nilotinib: A cohort study using data from a large multinational collaborative network

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.888366

DOI=10.3389/fcvm.2023.888366

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Breakpoint cluster region-Abelson gene (BCR-ABL) tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of patients with chronic myeloid leukemia (CML). However, concern has arisen about the cardiac safety profile of these drugs.</p></sec><sec><title>Objectives</title><p>This study aims to compare long-term risks of adverse cardiovascular and cerebrovascular events (ACE), heart failure or left ventricular ejection fraction (LVEF) &lt; 50%, and venous thromboembolic events (VTE) in patients with CML treated with BCR-ABL TKIs, using data from a large multinational network.</p></sec><sec><title>Methods</title><p>Patients aged ≥ 18 years with CML treated with imatinib, dasatinib, or nilotinib without prior cardiovascular or cerebrovascular disease were included. We used propensity score matching to balance the cohorts. The 5-year cumulative incidences and hazard ratios were calculated.</p></sec><sec><title>Results</title><p>We identified 3,722 patients with CML under treatment with imatinib (<italic>n</italic> = 1,906), dasatinib (<italic>n</italic> = 1,269), and nilotinib (<italic>n</italic> = 547). Patients with imatinib compared to dasatinib showed a higher hazard ratio (HR) for ACE (HR 2,13, 95% CI 1.15–3.94, <italic>p</italic> = 0.016). Patients with imatinib presented a lower HR than nilotinib for ACE (HR 0.50, 95% CI 0.30–0.83, <italic>p</italic> = 0.0074). In relation to heart failure or LVEF &lt; 50%, patients with imatinib had a higher HR than dasatinib (HR 9.41, 95% CI 1.22–72.17, <italic>p</italic> = 0.03), but no significant difference was observed between imatinib and nilotinib (HR 0.48, 95% CI 0.215–1.01, <italic>p</italic> = 0.064).</p></sec><sec><title>Conclusion</title><p>In this retrospective study with a large number of patients with CML, those treated with nilotinib had a higher 5-year ratio of ACE, while patients with dasatinib showed a lower ratio than patients with imatinib. The ratio of heart failure was higher in patients with imatinib than in patients with dasatinib, but not when compared to nilotinib.</p></sec>