BTK Inhibitors 

Benefits

BTK inhibitors, including acalabrutinib, zanubrutinib, ibrutinib, and pirtobrutinib, offer a convenient treatment option for CLL with minimal requirements for doctor checkups. This is particularly advantageous for those living far from medical facilities. Although these inhibitors do not achieve undetectable minimal residual disease (uMRD) as quickly as venetoclax, they effectively control the progression of CLL over multiple years, provided the medication is taken continuously.

Drawbacks

However, these therapies require daily intake for an indefinite period, leading to ongoing exposure to potential side effects and continuous treatment costs. Furthermore, patients with poor heart health may find BTK inhibitors unsuitable due to an increased risk of heart-related side effects.

Choosing Between BTK Inhibitors

Medical experts generally favor second-generation BTK inhibitors, such as acalabrutinib or zanubrutinib, over first-generation ibrutinib due to their lower incidence of heart-related side effects. When selecting between the second-generation options, the choice may depend on individual health concerns: zanubrutinib might be recommended for those prone to headaches, whereas acalabrutinib could be preferable for those with high blood pressure issues. For further insight about choosing between acalabrutinib and zanubrutinib, click here. 

Pirtobrutinib as a Third-Line Therapy

Pirtobrutinib, approved for use after treatment with other BTK inhibitors and venetoclax, addresses resistance that develops with earlier treatments. It is associated with fewer side effects than both the first and second-generation inhibitors. However, its effectiveness tends to last about 1.5 years. Ongoing clinical trials, such as those led by Dr. Ahn, are exploring whether pirtobrutinib might be more effective when used as an initial treatment option. Click here to read more about Dr. Ahn’s study.