BCR-ABL tyrosine kinase inhibitors (TKIs) have been associated with pulmonary arterial hypertension (PAH) since 2009, although supporting data have remained limited. Clarifying comparative PAH risk across different BCR-ABL TKIs is important for treatment selection in chronic myeloid leukemia.

Using the French national healthcare database (2008–2024), investigators applied a prevalent new-user design to emulate a randomized trial comparing second- and third-generation TKIs with the first-generation agent imatinib. The study was published in Circulation. Adults initiating dasatinib (n=6,625; mean age 59.7±15.2 years; 44.0% women), nilotinib (n=5,205; 55.4±15.0 years; 44.2% women), bosutinib (n = 2,421; 63.8±14.2 years; 42.1% women), ponatinib (n=1,358; 57.3±14.9 years; 46.1% women), or asciminib (n=922; 64.3±13.8 years; 43.7% women) were matched to imatinib users on time-conditional propensity score and duration of prior imatinib exposure. Follow-up continued until new-onset PAH, treatment switch, death, database exit, or study end.

Dasatinib use was associated with a higher risk of PAH compared with imatinib (1,829 vs 43 events per million persons per year; HR 8.89; 95% CI 5.30–14.92). Bosutinib (HR 10.76; 95% CI 4.68–24.73) and ponatinib (HR 7.74; 95% CI 2.33–25.70) were also associated with increased risk, with most cases occurring in patients previously exposed to dasatinib. Nilotinib and asciminib were not associated with increased PAH risk.

These findings suggest differential PAH risk profiles among BCR-ABL TKIs. Whether bosutinib or ponatinib can induce PAH without prior dasatinib exposure requires further evaluation.