The objective of the study was to evaluate real‑world effectiveness of zanubrutinib compared with acalabrutinib in adults with relapsed or refractory mantle cell lymphoma treated in the second‑line or later setting in the United States.

This was a retrospective cohort study using administrative claims data from the Komodo database. Adults with at least two diagnoses of mantle cell lymphoma who initiated zanubrutinib or acalabrutinib monotherapy as second‑line or later therapy were included. Patients with prior stem cell transplant, end‑stage renal disease, or clinical trial participation were excluded. The assessed endpoints were overall survival, measured from index date to all‑cause mortality, and time to next treatment, measured from index date to subsequent therapy with an allowable gap of 120 days.

A total of 2,219 patients were included (zanubrutinib, n=931; acalabrutinib, n=1,288). Median follow‑up was 14.8 months for zanubrutinib and 18.2 months for acalabrutinib. Median time to next treatment was 26.7 months with zanubrutinib and 20.8 months with acalabrutinib, while median overall survival was not reached for zanubrutinib and was 60.6 months for acalabrutinib. In unadjusted analyses, zanubrutinib was associated with longer overall survival (hazard ratio [HR], 0.74; 95% CI, 0.62-0.88; P<0.001) and time to next treatment (HR, 0.86; 95% CI, 0.76-0.97; P=0.012). After inverse probability of treatment weighting adjustment, both overall survival (HR, 0.81; 95% CI, 0.68-0.98; P=0.03) and time to next treatment (HR, 0.86; 95% CI, 0.76-0.98; P=0.025) favored zanubrutinib compared with acalabrutinib.