Hair and nail abnormalities were commonly seen with ibrutinib (Imbruvica; Pharmacyclics and Janssen Biotech) and appeared several months after treatment initiation, according to data from a prospective study published in JAMA Dermatology.

Ibrutinib is generally well tolerated but long-term treatment is required until disease progression of intolerable toxic effects occur. Researchers from National Institutes of Health conducted a study to describe the hair and nail manifestations associated with the long-term use of ibrutinib for the treatment of chronic lymphocytic leukemia (CLL).

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The study (n=66) included patients with CLL in a single-arm Phase 2 clinical trial of ibrutinib for CLL between March 2014 and October 2015 at the National Institutes of Health. The study’s primary outcome was nail and hair changes associated with ibrutinib treatment. Patients were given an 11-question survey and the severity of nail changes was assessed from a 0-3 rating scale for both onychoschizia and onychorrhexis. 

Among the study patients, 67% (n=44) reported brittle fingernails at a median of 6.5 months after treatment initiation. In addition, 23% of patients reported brittle toenails after a median of 9 months ibrutinib treatment. A total of 17 patients reported textural hair changes at a median of 9 months of ibrutinib treatment. 

Imbruvica, a Bruton tyrosine kinase (BTK) inhibitor, was approved by the Food and Drug Administration (FDA) for the treatment of mantle cell lymphoma (MCL) in patients who have received at least one prior therapy, CLL in patients who have received at least one prior therapy, CLL in patients with 17p deletion, and Waldenstrom’s macroglobulinemia (WM). 

“Whether ibrutinib affects the hair and nails by binding and altering cysteine-rich proteins of hair and nails or by means of another mechanism remains unknown,” concluded study authors.

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