Imbruvica May Cause High Blood Pressure, Expert Says Patients ‘Shouldn’t Be Afraid’

Hypertension, or high blood pressure, is a common side effect of Imbruvica (ibrutinib) in patients with chronic lymphocytic leukemia (CLL), although it is manageable in most patients, according to findings from a recent study.

In the study published in the journal, Cancer, researchers analyzed characteristics of 300 patients with CLL who were treated with Imbruvica. Of these patients, 68.5% developed new-onset hypertension (meaning they did not have high blood pressure at the start of their treatment) and 38% developed worsening hypertension (patients who had high blood pressure before treatment).

CURE® spoke with one of the researchers on the study, Dr. Alessandra Ferrajoli, professor of medicine in the department of leukemia at The University of Texas MD Anderson Cancer Center in Houston, to learn more about the occurrence of high blood pressure in patients with CLL treated with Imbruvica, how it can be managed and advice she offers patients.

Why was it so important for you and your colleagues to conduct this study?

(Imbruvica) had truly revolutionized the treatment of (CLL). However, it is given in an open-ended manner, in the sense that patients stay on the treatment for an unlimited time, usually as long as the treatment works, even pretty much as long as the patients are alive. So we wanted to have a long follow-up on patients treated with (Imbruvica), and that's why we looked at our five-year data.

What did the findings add to the knowledge base?

We highlighted how common new or worsening hypertension is. We found new hypertension was in almost two-thirds of patients and worsening hypertension in more than one-third (of patients). In my view, we highlighted that this is a common occurrence.

It is important that patients with CLL who are taking Imbruvica monitor their blood pressure.

Patients and their doctors should be aware and monitor. They shouldn't be dismissing the hypertension. For example, at the follow-up visit for their CLL, as due to the stress of the visit, or — I practice in Houston, so many patients say traffic was so bad when I was on my way to get to your visit, and so that's why (a patient says their) blood pressure is high.

The physicians and the patients should monitor the blood pressure at home so we can have a real awareness of where their blood pressure is. Then with the help of their primary care, cardiologist or any other physician involved — or sometimes the hematologist-oncologist themselves — the blood pressure can be treated properly. And the medication regimen can be modified or started so that the blood pressure stays within the optimal control.

Do we know why hypertension may occur in patients treated with Imbruvica?

We really don't know. There is research going on in this field, and more research in this field will be welcome. But we don't know exactly why we're seeing this phenomenon of an increase in blood pressure in patients with CLL who are taking (Imbruvica).

Are there any drug-drug interactions associated with Imbruvica and blood pressure-lowering medications?

No, there are very few drug-drug interactions. What I will say that is important to stress is that hypertension is due to many factors. So the patient should try as much as possible, for example, to avoid smoking; they should work on their weight and avoid to be overweight, and they should do regular exercise. Those are all components that will help in assisting in the control of the hypertension, but no, there are no drugs that are prohibited to use with (Imbruvica).

About how long may it take for blood pressure to be controlled while undergoing treatment?

It’s usually fairly fast, within a few weeks. Once you modify or implement treatment for hypertension, the hypertension is controlled. Very, very rarely we have patients that develop hypertension while they are on (Imbruvica) that we are not able to control. This is a rare event. The majority of the patients can be successfully managed.

Do doses of Imbruvica need to be adjusted in any way while controlling a patient’s blood pressure?

We have not evaluated the relationship between dose and hypertension, so I cannot speak on whether dose reduction may be helpful or (that) they may be related with less hypertension. So that type of research has not been conducted that I’m aware of.

My impression is that more likely, some patients will develop hypertension even with lower doses of (Imbruvica). However, I do not have data and we don't want to compromise the effectiveness of the treatment for something that can be controlled medically, except in very rare patients that the blood pressure cannot be controlled even on multiple antihypertensive agents. (At that point), considering other (CLL) treatments is reasonable. And the landscape is very rich these days, so there are other treatments that can be proposed, but this has been a very rare event.

What advice would you give to patients with CLL, who may be receiving treatment with Imbruvica?

My advice is to be very, very focused on their overall health. So measure their blood pressure regularly, take all the medications that are prescribed for any condition regularly, have a healthy lifestyle, exercise.

We are doing these studies because (Imbruvica) and all the medications in its group are so effective, that we want to learn how to best use them and not only use them and obtain the good responses, but also use them in the safest way possible. But (patients) shouldn't be afraid of (Imbruvica) or medications like (Imbruvica) because they are fantastic medications.

This transcription has been edited for clarity and conciseness.

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