Tara Graff, DO, MS: We were waiting for the head-to-head data on acalabrutinib vs ibrutinib for a really long time, especially since ibrutinib has been the drug of choice in a lot of practices for a really long time, partially because that’s what was around for a long time and old habits die hard. Having these data was really important. First, in terms of efficacy, they’re the same. Acalabrutinib is noninferior to ibrutinib in terms of PFS [progression-free survival]. Overall survival was not reached. In terms of efficacy, they’re both very good choices.

Where they really show their differences is with the cardiac ARs, or adverse reactions, specifically the hypertension and atrial fibrillation. We know they can happen in both drugs, but we continue to see that ibrutinib has higher percentages of atrial fibrillation and hypertension vs acalabrutinib. For instance, atrial fibrillation was 9.4% with acalabrutinib, and 16% in the patients with ibrutinib. For the hypertension, it was 9.4% for acalabrutinib, and 23.2% for patients with ibrutinib.

The discontinuation rate was a little higher with ibrutinib vs acalabrutinib. That holds true in practice, or at least in my practice. I’ve had patients who we’ve had to dose reduce when they’ve been on ibrutinib because of high blood pressure and uncontrolled atrial fibrillation. I’ve switched a few patients from ibrutinib to acalabrutinib who’ve had issues with hypertension and atrial fibrillation. Those are real adverse effects and concerns in mainstream practice. This trial showed they’re both great drugs in terms of PFS and overall survival. That was the first question. It was important to show that acalabrutinib is noninferior to ibrutinib. But then looking at the adverse events or reactions, we’re seeing atrial fibrillation and high blood pressure higher in the ibrutinib group vs acalabrutinib.

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