Published: 18 February 2021
Authors: Pierre-Régis Burgel, Isabelle Durieu, Raphaël Chiron, Sophie Ramel, Isabelle Danner-Boucher, Anne Prevotat, Dominique Grenet, Christophe Marguet, Martine Reynaud-Gaubert, Julie Macey, Laurent Mely, Annlyse Fanton, Sébastien Quetant, Lydie Lemonnier, Jean-Louis Paillasseur, Jennifer Da Silva, and Clémence Martin; for the French Cystic Fibrosis Reference Network Study Group
Source: This abstract has been sourced from NZ Respiratory Research Review Issue 191
Rationale: Elexacaftor–tezacaftor–ivacaftor is a CFTR (cystic fibrosis [CF] transmembrane conductance regulator) modulator combination, developed for patients with CF with at least one Phe508del mutation.
Objectives: To evaluate the effects of elexacaftor–tezacaftor– ivacaftor in patients with CF and advanced respiratory disease.
Methods: A prospective observational study, including all patients aged ⩾12 years and with a percent-predicted FEV1 (ppFEV1) <40 who initiated elexacaftor–tezacaftor–ivacaftor from December 2019 to August 2020 in France was conducted. Clinical characteristics were collected at initiation and at 1 and 3 months. Safety and effectiveness were evaluated by September 2020. National-level transplantation and mortality figures for 2020 were obtained from the French CF and transplant centers and registries.
Measurements and Main Results: Elexacaftor–tezacaftor– ivacaftor was initiated in 245 patients with a median (interquartile range) ppFEV1 = 29 (24–34). The mean (95% confidence interval) absolute increase in the ppFEV1 was +15.1 (+13.8 to +16.4; P < 0.0001), and the mean (95% confidence interval) in weight was +4.2 kg (+3.9 to +4.6; P < 0.0001). The number of patients requiring long-term oxygen, noninvasive ventilation, and/or enteral tube feeding decreased by 50%, 30%, and 50%, respectively (P < 0.01). Although 16 patients were on the transplant waiting list and 37 were undergoing transplantation evaluation at treatment initiation, only 2 received a transplant, and 1 died. By September 2020, only five patients were still on the transplantation path. Compared with the previous 2 years, a twofold decrease in the number of lung transplantations in patients with CF was observed in 2020, whereas the number of deaths without transplantation remained stable.
Conclusions: In patients with advanced disease, elexacaftor–tezacaftor–ivacaftor is associated with rapid clinical improvement, often leading to the indication for lung transplantation being suspended.
Link to abstract
NZ Respiratory Research Review Issue 191