Economic Evaluations of Tyrosine Kinase Inhibitors for Patients with Chronic Myeloid Leukemia in Middle- and High-Income Countries: A Systematic Review

2018 ◽  
Vol 38 (12) ◽  
pp. 1167-1178 ◽  
Author(s):  
Jie Fu ◽  
Yuchen Liu ◽  
Houwen Lin ◽  
Bin Wu
Keyword(s):  
Systematic Review ◽  
Chronic Myeloid Leukemia ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
High Income ◽  
Economic Evaluations

scholarly journals Arterial Hypertension and Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Olga Mulas ◽  
Giovanni Caocci ◽  
Brunella Mola ◽  
Giorgio La Nasa
Keyword(s):  
Systematic Review ◽  
Chronic Myeloid Leukemia ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
Meta Analysis ◽  
Cardiovascular Complication ◽  
Third Generation ◽  
Pubmed Database

Background: Off-target effects in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs) are associated with cardiovascular toxicity. Hypertension represents an important cardiovascular complication and, if not appropriately managed, can contribute to developing thrombotic events. Third-generation TKI ponatinib is associated with hypertension development, and its use is more restricted than in the past. Few data are reported for second-generation TKI, nilotinib, dasatinib, and bosutinib. The aim of this article was to evaluate with a systematic review and meta-analysis the real incidence of hypertension in CML patients treated with second- or third-generation TKI.Methods: The PubMed database, Web of Science, Scopus, and ClinicalTrials.gov were systematically searched for studies published between January 1, 2000, and January 30, 2021; the following terms were entered in the database queries: Cardiovascular, Chronic Myeloid Leukemia, CML, Tyrosine kinases inhibitor, TKI, and Hypertension. The study was carried out according to the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) statement.Results: A pooled analysis of hypertension incidence was 10% for all new-generation TKI, with an even higher prevalence with ponatinib (17%). The comparison with the first-generation imatinib confirmed that nilotinib was associated with a significantly increased risk of hypertension (RR 2; 95% CI; 1.39-2.88, I2=0%, z=3.73, p=0.0002). The greatest risk was found with ponatinib (RR 9.21; 95% CI; 2.86-29.66, z=3.72, p=0.0002).Conclusion: Hypertension is a common cardiovascular complication in CML patients treated with second- or third-generation TKI.

Tyrosine-Kinase Inhibitors, Quality of Life and Symptom Burden in Chronic Myeloid Leukemia: What Have We Learned So Far?

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4236-4236
Author(s):  
Fabio Efficace ◽  
Annarita Cardoni ◽  
Francesco Cottone ◽  
Marco Vignetti ◽  
Franco Mandelli
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Chronic Myeloid Leukemia ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
Symptom Burden ◽  
Informed Treatment

Abstract Abstract 4236 BACKGROUND: Tyrosine kinase inhibitors (TKIs) have revolutionized treatment of chronic myeloid leukemia (CML) patients and quality of life (QoL) data can be of crucial importance in the current CML arena to make more informed treatment decisions. To date, a number of biomedical and laboratory data have been accumulated on clinical efficacy and toxicity of various TKIs; however, there is paucity of data on the impact of TKIs on patient outcomes. AIMS: The main objective of this systematic review is thus to quantify and to summarize all studies that have included QoL, or any other type of patient-reported outcomes (PROs) in patients with CML treated with TKIs. METHODS: A systematic review was performed, following the Cochrane methodology on all studies conducted in CML that have assessed QoL or any other type of PRO (e.g., symptom burden). The search was conducted on all full length manuscripts published up to November 2012. Candidate articles were identified mainly by PubMed, the Cochrane Library, PsycINFO and PsyArticles. Criteria for selection of studies were as follow. Types of participants: Patients diagnosed with CML, regardless of patients' age and the stage of the disease. Types of intervention: All treatments with TKIs, either used alone or in combination with other drugs. Types of outcome measures examined: Any studies including PROs were considered. Studies addressing adherence to therapy were not included. Types of studies: All type of studies were considered regardless of the design (e.g., prospective or cross-sectional study). No restriction in the number of enrolled patients or type of analysis (e.g. qualitative or quantitative) was applied. Two reviewers independently evaluated all candidate abstracts retrieved from electronic databases based on the above selection criteria. Extracted data from full length manuscripts were crosschecked and discrepancies resolved by consensus. The reviewers abstracted a number of basic features of the studies, including the type of treatment, the measures used to assess QoL and clinical characteristics of patients enrolled. Also, a summary of main PROs findings was provided. RESULTS: Six studies, enrolling overall 2171 CML patients, were identified up to November 2012. None of these studies were published before 2003. Out of six studies, two were conducted on a national level and four recruited patients in an international setting. Four studies reported QoL data of patients treated with imatinib, one on bosutinib and the other one included patients receiving various TKIs. QoL of patients younger than 60 years, who are in treatment with long-term imatinib therapy is greatly impaired when compared with that of their peers in the general population. This study suggests that although the less toxic profile of TKIs therapies is unquestionable, still much has to be done to further improve patient's QoL and reduce symptom burden. Also, another study suggested that fatigue is the main factor influencing QoL regardless of the type of TKIs. Some data also indicates that physicians might underestimate the importance of symptoms. Another study, conducted in patients treated with bosutinib, showed that QoL profile of patients who have failed first line Imatinib therapy, due to either resistance or intolerance, is not different. Second line therapy with bosutinb provide clinically meaningful QoL improvements in imatinib-intolerant patients (but not in imatinib-resistant patients). Remarkably, no study was identified measuring QoL, or any other type of PROs, in patients treated with dasatinib or nilotinib. Two studies reported a gender effect, showing that male tend to report better QoL outcomes than female patients. CONCLUSIONS: This systematic review revealed the paucity of evidence base data in this area. However, QoL assessments in these CML studies emphasize the unique information provided by the patient's perspective on the burden of the disease and treatment. Investigators are encouraged to include PROs in future CML studies to obtain additional meaningful data to make more informed treatment decisions. Disclosures: Efficace: Novartis: Research Funding; Bristol Myers Squibb: Honoraria.

scholarly journals Glycemic Control in Patients Treated with Tyrosine Kinase Inhibitors for Chronic Myeloid Leukemia: A Systematic Review

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4273-4273 ◽  
Author(s):  
Laura Spatafora ◽  
Breanne Golemiec ◽  
Lehana Thabane ◽  
Laura Banfield ◽  
Christopher M. Hillis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Study ◽  
Chronic Myeloid Leukemia ◽  
Glycemic Control ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Full Text ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
Glycemic Outcomes

Abstract Introduction Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML). Many endocrine receptors, such as insulin receptors, are tyrosine kinase receptors. Hence, TKIs may have effects that impact endocrine function. However, it is not clear to what extent glycemic outcomes are affected by TKI use in this patient population, including children (<18 years of age). A better understanding of these health outcomes and identification of populations at high risk for these effects is critical for choice of TKI and instituting appropriate long-term monitoring. Thus, the aim of this systematic review is to summarize the glycemic outcomes in patients with CML on TKI therapy. Methods A systematic review of the literature up until January 2018 was conducted, utilizing databases including Cochrane Central, EMBASE, and MEDLINE. We included randomized controlled trials (RCT), quasi-RCT, cohort studies, cross-sectional studies and case-series. Eligible studies included male and female CML patients of all ages receiving treatment with TKIs including imatinib, dasatinib, nilotinib, ponatinib, or bosutinib. We included studies that reported glycemic outcomes as a primary or secondary outcome. Markers of glycemia reported include fasting plasma glucose (FPG), random blood glucose, HbA1c, and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) if reported. Additionally, a meta-analysis was planned if two or more studies with similar designs comparing the similar population and measuring the same outcome were identified. Titles, abstracts, and full text papers were reviewed by two independent reviewers and a third reviewer was consulted to resolve disputes. Results Out of 607 full-text studies retrieved, six studies met the inclusion criteria. These studies included 10 to 267 patients. None of these studies included children. Elevations in FPG levels were demonstrated across all trials using nilotinib. The prevalence of hyperglycemia in these studies ranged from 2.7% to 35.3% within the study populations. One cohort study comparing nilotinib, imatinib, and dasatinib demonstrated that increase in FPG levels with nilotinib treatment was more significant that with imatinib (p = 0.015), and dasatinib (p = 0.009), but no significant differences between dasatinib and imatinib (p = 0.95). A second cohort study comparing nilotinib and imatinib also revealed an increased prevalence of hyperglycemia with Nilotinib use (35.3%) compared to Imatinib use (27.3%). No studies were identified that evaluated glycemic control in bosutinib or ponatinib treated patients. Two studies reported an increase in HOMA-IR with nilotinib use, however, this was not associated with an increase in HbA1c levels, a diagnostic marker of pre-diabetes and diabetes. Conclusions Nilotinib use appears to be associated with dysglycemia to a greater extent than other TKIs in adult CML patients. However, the clinical significance of hyperglycemia while on TKI treatment and future diabetes risk remains unclear. There were no data outlining the glycemic effects of TKI in the pediatric age group. Glycemic and metabolic outcomes in CML patients should be closely monitored, and further research is needed to elucidate the glycemic control in pediatric patients with CML since they are likely to use lifelong TKI therapy. Disclosures Hillis: Bristol-Myers Squibb: Honoraria; Novartis: Honoraria.

Tyrosine-kinase inhibitors and patient-reported outcomes in chronic myeloid leukemia: A systematic review

2013 ◽  
Vol 37 (2) ◽  
pp. 206-213 ◽  
Author(s):  
Fabio Efficace ◽  
Annarita Cardoni ◽  
Francesco Cottone ◽  
Marco Vignetti ◽  
Franco Mandelli
Keyword(s):  
Systematic Review ◽  
Chronic Myeloid Leukemia ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Myeloid Leukemia ◽  
Patient Reported Outcomes ◽  
Kinase Inhibitors ◽  
Patient Reported
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