CML: which tyrosine kinase inhibitor is safest?

  • Fachi MM & al.
  • Br J Clin Pharmacol
  • 25 Mar 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • In patients receiving tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML), dasatinib 140 mg had the lowest level of safety in grade 3-4 hematological adverse events (AEs) while nilotinib 600 and 800 mg had the highest safety levels.  

Why this matters

  • No prior studies have been published to compare incidence of such AEs with different TKIs.

Study design

  • Systematic review to investigate the hematological safety profile of TKIs in the treatment of patients with CML.
  • A database search yielded 17 studies for inclusion.
  • Funding: None.

Key results

  • Dasatinib 140 mg had the highest probability of being least safe per surface under the cumulative ranking curve analysis (SUCRA) for:
    • Anemia: 90%.
    • Leukopenia: 87%.
    • Neutropenia: 91%.
    • Thrombocytopenia: 97%.
  • Top 3 TKIs with the lowest probability of being least safe were:
    • Anemia: imatinib 600 mg (5%), nilotinib 600 mg (22%), nilotinib 800 mg (36%).
    • Leukopenia: nilotinib 800 mg (15%), nilotinib 600 mg (24%), imatinib 600 mg (24%).
    • Neutropenia: nilotinib 800 mg (18%), ponatinib (21%), bosutinib (21%).
    • Thrombocytopenia: imatinib 600 mg (20%), radotinib 600 mg (28%), nilotinib 800 mg (33%).

Limitations

  • Retrospective data.

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