Number needed to treat to avoid progression or death: Zanubrutinib vs other covalent Bruton tyrosine kinase inhibitors in relapsed/refractory chronic lymphocytic leukemia

ASH 2025 CLL Zanubrutinib

Mazyar Shadman

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This study compared zanubrutinib to ibrutinib and acalabrutinib in patients with high-risk, relapsed/refractory chronic lymphocytic leukemia (R/R CLL). Based on modeling across studies, for every five patients treated with zanubrutinib instead of ibrutinib, one extra patient avoids disease progression or death over two years; for acalabrutinib, the number is six patients treated with zanubrutinib. In a hypothetical cohort of 100 patients, about 20 and 17 cases of disease progression or death would be avoided with treatment of zanubrutinib compared to that with ibrutinib and alacalbrutinib, respectively. These results suggest that zanubrutinib may offer better outcomes, though differences in patient population and study designs should be considered. Zanubrutinib and acalalburtinib have not been directly compared in randomized head-to-head clinical trials. Study findings should be interpreted based on modeling assumptions and potential patient population differences across trials.

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