PDF(Pubmed)
Abstract：
Pharmacotherapy options for chronic lymphocytic leukaemia (CLL) have expanded significantly in recent years. These options include chemotherapy, chemoimmunotherapy and signalling pathway inhibitors. A notable shift in the treatment landscape began with the widespread adoption of ibrutinib in 2016. This analysis of claims data focuses on understanding how the use of novel therapies has evolved in clinical practice over the past decade in Germany. Anonymized claims data (2010-2022) from German statutory health insurance was used, covering patient demographics, treatments, and prescriptions. The study population included patients with two confirmed CLL diagnoses. Treatment patterns were analysed, and survival outcomes were compared using time-to-event analyses. In the analysed cohort of 2983 incident CLL patients, 1041 started first-line therapy between 2011 and 2022, with a median duration of 18 months from diagnosis to the first prescription. Chemoimmunotherapy, the predominant 1L therapy until 2019, decreased significantly, while targeted therapy usage increased from 3% in 2015 to 77% in 2022. Targeted therapies became dominant in patients receiving treatment for relapsed or refractory disease after 2016. Median treatment durations were: 122 days for chemo, 176 days for chemo-immuno, and 373 days for targeted therapy. The overall survival for patients diagnosed in or after 2016 was significantly better (hazard ratio 0.56, 95% confidence interval, 0.44-0.69)). The adoption of targeted therapies like ibrutinib and venetoclax has transformed CLL treatment in Germany, leading to improved patient outcomes. Additionally, we demonstrate successful adherence to evolving clinical guidelines.
摘要：
近年来，慢性淋巴细胞白血病（CLL）的药物治疗选择显着扩展。这些选择包括化疗,化学免疫疗法和信号通路抑制剂。治疗领域的显着转变始于2016年ibrutinib的广泛采用。对索赔数据的分析侧重于了解过去十年德国在临床实践中新疗法的使用如何演变。使用德国法定健康保险的匿名索赔数据(2010-2022年)，涵盖患者人口统计学，治疗,和处方。研究人群包括有两个确诊的CLL诊断的患者。分析了治疗模式，和生存结局使用时间至事件分析进行比较.在2983例CLL患者的分析队列中，1041在2011年至2022年期间开始一线治疗，从诊断到第一次处方的中位持续时间为18个月。化学免疫疗法,主要的1L治疗到2019年，显着下降，而靶向治疗的使用率从2015年的3%增加到2022年的77%。2016年后，靶向治疗在接受复发或难治性疾病治疗的患者中占主导地位。中位治疗持续时间为：化疗122天，化疗免疫176天，和373天的靶向治疗。2016年或之后诊断的患者的总生存期明显更好（风险比0.56，95％置信区间，0.44-0.69））。ibrutinib和venetoclax等靶向治疗的采用改变了德国的CLL治疗，改善患者预后。此外,我们证明成功地遵守了不断发展的临床指南.
