Ibrutinib was associated with a significantly increased risk of bleeding (overall bleeding and major bleeding) in individuals with B-cell malignancies [RR = 2.56, 95% CI 1.68C3.90, 0.0001 and RR = 2.08, 95% CI 1.36C3.16, = 0.0006, respectively]. bleeding) in individuals with B-cell malignancies [RR = 2.56, 95% CI 1.68C3.90, 0.0001 and RR = 2.08, 95% CI 1.36C3.16, = 0.0006, respectively]. The bleeding (overall bleeding and major bleeding) risk in individuals with CLL was more obvious [RR = 3.08, 95% CI 2.07C4.58, 0.00001 and RR = 2.46, 95% CI 1.37C4.41, = 0.003, respectively]. There were no statistically significant variations for risk of bleeding between the subgroups based on dose and treatment establishing. Summary: Ibrutinib was associated with a significantly higher risk of bleeding (both overall bleeding and major bleeding) in individuals with B-cell malignancies, especially in CLL. 0.0001, I2 = 78%; Number 2). GYKI53655 Hydrochloride The random-effect model was used because of the significant heterogeneity of studies. Of the 11 studies, nine studies showed a significantly improved risk of major bleeding in ibrutinib group, one study showed no significant difference between the ibrutinib group and the control group, while the additional study showed an increased risk of major bleeding in the control group. Overall, the pooled estimate showed that ibrutinib improved the risk of major bleeding (RR = 2.08, 95% CI 1.36C3.16, = 0.0006, I2 = 0%; Number 3) by using a fixed-effect model. Open in a separate window Number 2 Forest storyline of relative risk of overall bleeding in B-cell malignancies. Open in a separate window Number 3 Forest storyline of relative risk of major bleeding with in B-cell malignancies. Risk of Bleeding in Chronic Lymphocytic Leukemia In CLL, the pooled risk percentage in five studies showed a more than three-fold increase in the risk of overall bleeding with ibrutinib (RR = 3.08, 95% CI, 2.07C4.58, GYKI53655 Hydrochloride 0.00001, I2 = 53%; Number 4). The random-effect model was used because of heterogeneity. The risk of major bleeding was found to be significantly higher in individuals of CLL with ibrutinib than that in the control group (RR = 2.46, 95% CI, 1.37C4.41, = 0.003, I2 = 0; GYKI53655 Hydrochloride Number 5) through the fixed-effect model. Open in a GYKI53655 Hydrochloride separate window Number 4 Forest storyline of relative risk of overall bleeding in CLL. Open in a separate window Number 5 Forest storyline of relative risk of major bleeding in CLL. Subgroup Analysis The subgroup analysis was performed among individuals with different dose and treatment settings. For individuals on ibrutinib having a dose of 420?mg/day time, the risk of overall bleeding was significantly higher than that in the control group (RR = 2.86, 95% CI 2.10C3.89, 0.00001). For those on ibrutinib having a dose of 560?mg/day time, the difference was not significant (RR = 1.22, 95% CI 0.89C1.66, = 0.22; Number 6A). In terms of major bleeding, individuals who received ibrutinib treatment having a dose of 420?mg/day time encountered significantly elevated risk of major bleeding compared to the control group (RR = 2.27, 95% CI 1.31C3.94, = 0.004). No significant difference in major bleeding was found between the ibrutinib group when the dose was 560?mg/day time and control group (RR = 1.91, 95% CI 0.96C3.80, = 0.07; Number 6B). Open in a separate window Number 6 Forest storyline of relative risk of overall (A) and major (B) bleeding in different dose of ibrutinib. In terms of overall bleeding, treatment-na?ve individuals about ibrutinib tended to experience more overall bleeding events (RR = 4.94, 95% CI 0.81C30.19, = 0.08) than the control group, even though difference was not significant. Refractory/relapsed individuals who received ibrutinib treatment experienced a significantly increased risk of overall bleeding compared to control group (RR = 2.43, 95% CI 1.33C4.44, = 0.004; Number 7A). Regarding major bleeding, treatment-na?ve individuals who received ibrutinib treatment experienced significantly more major bleeding events than the control group (RR = 2.78, 95% CI 1.46C5.32, = 0.002). But no significant difference in major bleeding in refractory/relapsed individuals was identified between the ibrutinib group and control group (RR = 1.72, 95% CI 0.94C3.12, = 0.08; Number 7B). Open in a separate window Number 7 Forest storyline of relative risk of overall (A) and major bleeding (B) in different treatment setting. Study Heterogeneity and Publication Bias Two studies without full texts cannot be evaluated.In a real-world retrospective trial involving a total of 95 individuals receiving ibrutinib monotherapy, 46% of individuals had low-grade bleeding events without any major bleeding (Winqvist et al., 2016). and major bleeding) in individuals with B-cell malignancies [RR = 2.56, 95% CI 1.68C3.90, 0.0001 and RR = 2.08, 95% CI 1.36C3.16, = 0.0006, respectively]. The bleeding (overall bleeding and major bleeding) risk in individuals with CLL was more obvious [RR = 3.08, 95% CI 2.07C4.58, 0.00001 and RR = 2.46, 95% CI 1.37C4.41, = 0.003, respectively]. There were no statistically significant variations for risk of bleeding between the subgroups based on dose and treatment establishing. Summary: Ibrutinib was associated with a significantly higher risk of bleeding (both overall bleeding and major bleeding) in individuals with B-cell malignancies, especially in CLL. 0.0001, I2 = 78%; Number 2). The random-effect model was used because of the significant heterogeneity of studies. Of the 11 studies, nine studies showed a significantly increased risk of major bleeding in ibrutinib group, one study showed no significant difference between the ibrutinib group and the control group, while the additional study showed an increased risk of major bleeding in the control group. Overall, the pooled estimate showed that ibrutinib improved the risk of major bleeding (RR = 2.08, 95% CI 1.36C3.16, = 0.0006, I2 = 0%; Number 3) by using a fixed-effect model. Open in Itgb2 a separate window Number 2 Forest storyline of relative risk of overall bleeding in B-cell malignancies. Open in a separate window Number 3 Forest storyline of relative risk of major bleeding with in B-cell malignancies. Risk of Bleeding in Chronic Lymphocytic Leukemia In CLL, the pooled risk percentage in five studies showed a more than three-fold increase in the risk of overall bleeding with ibrutinib (RR = 3.08, 95% CI, 2.07C4.58, 0.00001, I2 = 53%; Number 4). The random-effect model was used because of heterogeneity. The risk of major bleeding was found to be significantly higher in individuals of CLL with ibrutinib than that in the control group (RR = 2.46, 95% CI, 1.37C4.41, = 0.003, I2 = 0; Number 5) through the fixed-effect model. Open in a separate window Number 4 Forest storyline of relative risk of overall bleeding in CLL. Open in a separate window Physique 5 Forest plot of relative risk of major bleeding in CLL. Subgroup Analysis The subgroup analysis was performed among patients with different dosage and treatment settings. For patients on ibrutinib with a dosage of 420?mg/day, the risk of overall bleeding was significantly higher than that in the control group (RR = 2.86, 95% CI 2.10C3.89, 0.00001). For those on ibrutinib with a dosage of 560?mg/day, the difference was not significant (RR = 1.22, 95% CI 0.89C1.66, = 0.22; Physique 6A). In terms of major bleeding, patients who received ibrutinib treatment with a dosage of 420?mg/day encountered significantly elevated risk of major bleeding compared to the control group (RR = 2.27, 95% CI 1.31C3.94, = 0.004). No significant difference in major bleeding was found between the ibrutinib group when the dosage was 560?mg/day and control group (RR = 1.91, 95% CI 0.96C3.80, = 0.07; Physique 6B). Open in a separate window Physique 6 Forest plot of relative risk of overall (A) and major (B) bleeding in different dosage of ibrutinib. In terms of overall bleeding, treatment-na?ve patients on ibrutinib tended to experience more overall.In terms of major bleeding, patients who received ibrutinib treatment with a dosage of 420?mg/day encountered significantly elevated risk of major bleeding compared to the control group (RR = 2.27, 95% CI 1.31C3.94, = 0.004). was associated with a significantly increased risk of bleeding (overall bleeding and major bleeding) in patients with B-cell malignancies [RR = 2.56, 95% CI 1.68C3.90, 0.0001 and RR = 2.08, 95% CI 1.36C3.16, = 0.0006, respectively]. The bleeding (overall bleeding and major bleeding) risk in patients with CLL was more obvious [RR = 3.08, 95% CI 2.07C4.58, 0.00001 and RR = 2.46, 95% CI 1.37C4.41, = 0.003, respectively]. There were no statistically significant differences for risk of bleeding between the subgroups based on dose and treatment setting. Conclusion: Ibrutinib was associated with a significantly higher risk of bleeding (both overall bleeding and major bleeding) in patients with B-cell malignancies, especially in CLL. 0.0001, I2 = 78%; Physique 2). The random-effect model was used because of the significant heterogeneity of studies. Of the 11 studies, nine studies showed a significantly increased risk of major bleeding in ibrutinib group, one study showed no significant difference between the ibrutinib group and the control group, while the other study showed an increased risk of major bleeding in the control group. Overall, the pooled estimate showed that ibrutinib increased the risk of major bleeding (RR = 2.08, 95% CI 1.36C3.16, = 0.0006, I2 = 0%; Physique 3) by using a fixed-effect model. Open in a separate window Physique 2 Forest plot of relative risk of overall bleeding in B-cell malignancies. Open in a separate window Physique 3 Forest plot of relative risk of major bleeding with in B-cell malignancies. Risk of Bleeding in Chronic Lymphocytic Leukemia In CLL, the pooled risk ratio in five studies showed a more than three-fold increase in the risk of overall bleeding with ibrutinib (RR = 3.08, 95% CI, 2.07C4.58, 0.00001, I2 = 53%; Physique 4). The random-effect model was used because of heterogeneity. The risk of major bleeding was found to be significantly higher in patients of CLL with ibrutinib than that in the control group (RR = 2.46, 95% CI, 1.37C4.41, = 0.003, I2 = 0; Physique 5) through the fixed-effect model. Open in a separate window Physique 4 Forest plot of relative risk of overall bleeding in CLL. Open in a separate window Physique 5 Forest plot of relative risk of major bleeding in CLL. Subgroup Analysis The subgroup analysis was performed among patients with different dosage and treatment settings. For patients on ibrutinib with a dosage of 420?mg/day, the risk of overall bleeding was significantly higher than that in the control group (RR = 2.86, 95% CI 2.10C3.89, 0.00001). For those on ibrutinib with a dosage of 560?mg/day, the difference was not significant (RR = 1.22, 95% CI 0.89C1.66, = 0.22; Physique 6A). In terms of major bleeding, patients who received ibrutinib treatment with a dosage of 420?mg/day encountered significantly elevated risk of major bleeding compared to the control group (RR = 2.27, 95% CI 1.31C3.94, = 0.004). No significant difference in major bleeding was found between the ibrutinib group when the dosage was 560?mg/day and control group (RR = 1.91, 95% CI 0.96C3.80, = 0.07; Physique 6B). Open in a separate window Physique 6 Forest plot of relative risk of overall (A) and major (B) bleeding in different dosage of ibrutinib. In terms of overall bleeding, treatment-na?ve patients on ibrutinib tended to experience more overall bleeding events (RR = 4.94, 95% CI 0.81C30.19, = GYKI53655 Hydrochloride 0.08) than the control group, even though difference was not significant. Refractory/relapsed patients who received ibrutinib treatment experienced a significantly increased risk of overall bleeding compared to control group (RR = 2.43, 95% CI 1.33C4.44, = 0.004; Physique 7A). Regarding major bleeding, treatment-na?ve patients who received ibrutinib treatment experienced significantly more major bleeding events than the control group (RR = 2.78, 95% CI 1.46C5.32, = 0.002). But no significant difference in major bleeding in refractory/relapsed patients was identified between the ibrutinib group and control group (RR = 1.72, 95% CI 0.94C3.12, = 0.08; Physique 7B). Open in a separate window Physique 7 Forest plot of relative risk of overall (A) and major bleeding (B) in different treatment setting. Study Heterogeneity and Publication Bias Two studies without full texts cannot be evaluated comprehensively. Five included studies were open-labeled, and six studies were double blind. The baseline demographic characteristics in each study were well balanced between experimental and control arms..
Ibrutinib was associated with a significantly increased risk of bleeding (overall bleeding and major bleeding) in individuals with B-cell malignancies [RR = 2
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