The tools to choose: applying indirect treatment comparisons to the selection of frontline targeted therapy for CLL

Is BTKi or BCL2i preferable as first novel therapy in patients with CLL? The case for BCL2i

“… 23 However, methodologic flaws and the imbalance of baseline factors across trials make these indirect comparisons of questionable value. 24 In the setting of relapsed disease, one “real-world” comparison suggested a longer PFS with venetoclax compared with ibrutinib as first targeted agent, 25 whereas a network meta-analysis reported no difference in PFS or OS for venetoclax compared with an ibrutinib-based approach. 26 Given this inconclusive evidence base regarding the superior efficacy of either approach, our considerations should include additional factors, such as tolerability, long-term toxicity, societal cost, and options for effective subsequent treatments.…”