A large real-world analysis suggests that zanubrutinib (Brukinsa) may provide better outcomes than acalabrutinib (Calquence) and ibrutinib (Imbruvica) when used as first-line treatment for older patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). Researchers analyzed Medicare data from 10,523 patients aged 65 years and older who began treatment between January 2020 and September 2025.
Patients treated with zanubrutinib remained on therapy longer and were less likely to require a subsequent treatment. Median time to treatment discontinuation and median time to next treatment were not reached for zanubrutinib, compared with 24 and 40 months for acalabrutinib and 14 and 30 months for ibrutinib, respectively.
The study also found a survival advantage for zanubrutinib. Patients receiving zanubrutinib had a 36% lower risk of death than those receiving ibrutinib and a 24% lower risk than those receiving acalabrutinib. The benefit was observed across most age groups, supporting zanubrutinib as a potentially preferred first-line BTK inhibitor for older patients with CLL or SLL.