Discover and read the best of Twitter Threads about #ibrutinib

Most recents (4)

Aberrant #glycosylation of anti-Spike antibodies promotes #thrombosis as observed in severely ill #COVID19 patients. Very interesting work from our collaborators in the UK: biorxiv.org/content/10.110…. A few thoughts on why this could be important. 1/4
Severely ill patients make IgG with aberrant glycosylation. We previously showed that this (over)activates lung macrophages, which in turn activates endothelium, which in turn activates platelets. But this paper shows that the antibodies (over)activate platelets directly! 2/4
Interestingly, anti-Spike IgG with “normal” glycosylation (mild COVID-19 patients) has no effect. Only IgG with the combination of low fucose AND high galactose (severely ill patients) promotes thrombosis. In contrast, (over)activation of macrophages only requires low fucose. 3/4
Read 5 tweets
THREAD - Chronic Lymphocytic Leukemia: There is an under-studied, emerging phenomenon affecting some #CLL patients on #ibrutinib who develop "psuedo-Richter transformation when ibrutinib is withdrawn onlinelibrary.wiley.com/doi/10.1111/bj…
This mistaken diagnosis of the very serious condition of Richter transformation in #CLL patients after #ibrutinib withdrawal has been unnecessarily treated w R-CHOP in some cases, when all that was needed to resolve it was for ibrutinib to be resumed, since it was not true RT.
A group of researchers is starting to investigate individual cases of misdiagnosis & R-CHOP treatment of #CLL patients who developed psuedo-Richter's transformation following #ibrutinib withdrawal.
Read 4 tweets
So how safe is #Ibrutinib ?
A very relevant question given that it needs to be administered indefinitely.
41% discontinuation rate in the "real world", most d/t toxicity.

Thread [1/12]
So what are the major adverse events anyway ?
1. A fib
2. ⬆️ Risk of bleeding
3. ⬆️ Infections
4. Arthralgias
5. Htn
6. Diarrhoea
7. Pneumonitis

[2/12]
A very common concern is tox no.1 and 2 .
⬆️A .fib = anticoag for stroke prophylax. but that's when tox no.2 comes into play.
Very difficult to ⚖️ it out .
In RESONATE trial >grade 3 afib in 3% of pts.
Most events occur within 3 mts of starting #ibrutinib

[3/12]
Read 13 tweets
Re: #COVID19 / #Hydroxychloroquine - single arm phase 2 data is the scientific equivalent of a hypothesis - don’t confuse larger number of uncontrolled patients as evidence - it is only the volume with which you are yelling. Proof requires randomized studies @VPrasadMDMPH
Sometimes uncontrolled ph2 studies show “preliminary findings” that in the judgement of experts render the “hypothesis” compelling or encouraging, but you still cannot argue that it is proof something works. And yes - the therapy “can still hurt” @realDonaldTrump
Sometimes uncontrolled ph2 studies are even good enough to get a new cancer therapy approved #ibrutinib in cll/mcl but the burden of evidence remains on the Pharma company to perform the correct study and create proof.
Read 7 tweets

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