gms | German Medical Science

Background: Chronic lymphocytic leukemia (CLL) is an indolent lymphoproliferative disease of malignant B-cells. According to the Robert Koch-Institute, CLL accounts for 34% and 38% of all leukemias diagnosed in Germany for males and females, respectively. Systemic treatment options for CLL patients include chemotherapy, chemoimmunotherapy, signaling pathway inhibitors, and cellular therapies. Here, we focus on the incidence and prevalence of CLL, as well as the detection and categorization of patient individual treatment lines. Using this approach, we quantified changes in treatment patterns over the past decade, helping to understand the impact and the speed of implementing novel therapeutic developments within the German care context.

Materials and Methods: A retrospective longitudinal analysis was performed covering the years 2010 to the third quarter (Q3) of 2021 using claims data of ~6.1 million patients. We estimated the incidence and prevalence of CLL in this dataset and identified frequently used treatment regimens. To determine therapy lines, patient individual CLL-specific drug prescriptions were chronologically ordered and grouped into regimes according to the German guideline.

Results: 7.7%, 2.6% and 0.7% of prevalent patients received first-line, second-line, and third-line or later therapy in 2015, respectively. By 2021, these numbers had increased to 7.9%, 4.8% and 2%. The longitudinal analysis of treatment lines reveals three major developments: (1) cyclophosphamide- and chlorambucil-based therapies accounted for more than 90% of all therapies in 2010. Their share decreased to 6% by 2021. (2) Bendamustine-based therapies accounted for 8% of all therapies in 2011, increased to 54% in 2013, and declined to 9% by 2021. (3) The introduction of ibrutinib in 2014 and venetoclax in 2016 was followed by a continuous increase in usage of targeted therapies from an initial 5% of all therapies in 2014 to 84.1% by 2021.

Conclusion: During the last decade, treatment of CLL has dramatically changed from cytotoxic drugs to targeted therapies with or without anti-CD20 antibodies. Our data demonstrates that licensing of new drugs was rapidly followed by a broad application to the CLL patient population at large in Germany, resulting in an increase of the treatment prevalence by ~65% from 2014 to 2020. Ultimately, these developments will increase the financial burden of health-care providers and our society, calling for knowledgeable decisions on how to effectively use the available financial resources dedicated to the health care system.