Managing joint and muscle pain in patients with chronic lymphocytic leukemia treated with ibrutinib

The study evaluated the occurrence and risks of joint/muscle pain as side effects of ibrutinib (Imbruvica) in patients with chronic lymphocytic leukemia (CLL). The authors found that 36% of patients developed joint/muscle pain and most were younger and females receiving ibrutinib as the first treatment.

Ibrutinib kills leukemic cells by inhibiting cancerous enzymes. It dramatically improved survival in patients with CLL in recent years. However, it has toxic side effects including irregular heartbeat, increased bleeding and joint/muscle pain. Joint/muscle pain is one of the reasons for patients stopping ibrutinib treatment. It is unclear how commonly does ibrutinib cause joint/muscle pain and how to manage it.

The study collected data from 214 patients with CLL who were treated with ibrutinib. 134 of them received ibrutinib as front-line or initial therapy. The rest were treated for relapsed/refractory (r/r) CLL. Relapsed signifies leukemia’s return after initial therapy. Refractory means when CLL fails responding to any treatment. Patients were followed up for an average of 26.4 months on average.

76 patients (36%) developed joint/muscle pain. Among these, 79% had mild/moderate pain while 21% had severe pain. 47% of patients in the front-line group developed joint/muscle pain. Whereas, 30% of r/r group experienced it. The average time to develop joint/muscle pain was 34.5 months.

Joint/muscle pain’s risk was 1.59 times higher in patients below 65 years of age and 1.89 times higher in the front-line group. Females had a 2 times higher risk of developing this symptom than males.

28% of patients with mild/moderate toxicity continued ibrutinib and had their symptoms improved. Dosage was paused for managing this toxicity. Ibrutinib was stopped in 62% of patients with severe side effects. Joint/muscle pain was finally improved in 42 out of 76 patients who developed it.

The study concluded that more than one-third of patients with CLL developed joint/muscle pain under ibrutinib treatment. Patients younger than 65 years of age, females, and patients who had ibrutinib as initial therapy were at higher risks for this side effect.

The study could not confirm if supportive therapies are effective to manage ibrutinib related joint/muscle pain. Supportive therapies include using anti-inflammatory drugs, acetaminophen (Tylenol), or steroid hormones.