1
|
Vijaykumar K, Leung HM, Barrios A, Wade J, Hathorne HY, Nichols DP, Tearney GJ, Rowe SM, Solomon GM. Longitudinal improvements in clinical and functional outcomes following initiation of elexacaftor/tezacaftor/ivacaftor in patients with cystic fibrosis. Heliyon 2024; 10:e29188. [PMID: 38681615 PMCID: PMC11052906 DOI: 10.1016/j.heliyon.2024.e29188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024] Open
Abstract
Background Use of elexacaftor/tezacaftor/ivacaftor (ETI) for treatment of cystic fibrosis (CF) has resulted in unprecedented clinical improvements necessitating development of outcome measures for monitoring disease course. Intranasal micro-optical coherence tomography (μOCT) has previously helped detect and characterize mucociliary abnormalities in patients with CF. This study was done to determine if μOCT can define the effects of ETI on nasal mucociliary clearance and monitor changes conferred to understand mechanistic effects of CFTR modulators beyond CFTR activation. Methods 26 subjects, with at least 1 F508del mutation were recruited and followed at baseline (visit 1), +1 month (visit 2) and +6 months (visit 4) following initiation of ETI therapy. Clinical outcomes were computed at visits 1, 2 and 4. Intranasal μOCT imaging and functional metrics analysis including mucociliary transport rate (MCT) estimation were done at visits 1 and 2. Results Percent predicted forced expiratory volume in 1 s (ppFEV1) showed a significant increase of +10.9 % at visit 2, which sustained at visit 4 (+10.6 %). Sweat chloride levels significantly decreased by -36.6 mmol/L and -41.3 mmol/L at visits 2 and 4, respectively. μOCT analysis revealed significant improvement in MCT rate (2.8 ± 1.5, visit 1 vs 4.0 ± 1.5 mm/min, visit 2; P = 0.048). Conclusions Treatment with ETI resulted in significant and sustained clinical improvements over 6 months. Functional improvements in MCT rate were evident within a month after initiation of ETI therapy indicating that μOCT imaging is sensitive to the treatment effect of HEMT and suggests improved mucociliary transport as a probable mechanism of action underlying the clinical benefits.
Collapse
Affiliation(s)
- Kadambari Vijaykumar
- Department of Medicine, University of Alabama at Birmingham, AL, United States
- Gregory Fleming James CF Research Center, Birmingham, AL, United States
| | - Hui Min Leung
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, United States
| | - Amilcar Barrios
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, United States
| | - Justin Wade
- Gregory Fleming James CF Research Center, Birmingham, AL, United States
| | | | | | - Guillermo J. Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, United States
| | - Steven M. Rowe
- Department of Medicine, University of Alabama at Birmingham, AL, United States
- Gregory Fleming James CF Research Center, Birmingham, AL, United States
| | - George M. Solomon
- Department of Medicine, University of Alabama at Birmingham, AL, United States
- Gregory Fleming James CF Research Center, Birmingham, AL, United States
| |
Collapse
|
2
|
Flume PA, Saiman L, Marshall B. The Impact of COVID-19 in Cystic Fibrosis. Arch Bronconeumol 2022; 58:466-468. [PMID: 34934258 PMCID: PMC8679495 DOI: 10.1016/j.arbres.2021.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 02/06/2023]
Affiliation(s)
| | - Lisa Saiman
- Columbia University Irving Medical Center, New York, NY, USA
| | | |
Collapse
|
3
|
Chiner-Vives E, Cordovilla-Pérez R, de la Rosa-Carrillo D, García-Clemente M, Izquierdo-Alonso JL, Otero-Candelera R, Pérez-de Llano L, Sellares-Torres J, de Granda-Orive JI. Short and Long-Term Impact of COVID-19 Infection on Previous Respiratory Diseases. Arch Bronconeumol 2022; 58 Suppl 1:39-50. [PMID: 35501222 PMCID: PMC9012323 DOI: 10.1016/j.arbres.2022.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Till now, it affected 452.4 million (Spain, 11.18 million) persons all over the world with a total of 6.04 million of deaths (Spain, 100,992). It is observed that 75% of hospitalized COVID-19 patients have at least one COVID-19 associated comorbidity. It was shown that people with underlying chronic illnesses are more likely to get it and grow seriously ill. Individuals with COVID-19 who have a past medical history of cardiovascular disorder, cancer, obesity, chronic lung disease, diabetes, or neurological disease had the worst prognosis and are more likely to develop acute respiratory distress syndrome or pneumonia. COVID-19 can affect the respiratory system in a variety of ways and across a spectrum of levels of disease severity, depending on a person's immune system, age and comorbidities. Symptoms can range from mild, such as cough, shortness of breath and fever, to critical disease, including respiratory failure, shock and multi-organ system failure. So, COVID-19 infection can cause overall worsening of these previous respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease, etc. This review aims to provide information on the impact of the COVID-19 disease on pre-existing lung comorbidities.
Collapse
Affiliation(s)
- Eusebi Chiner-Vives
- Multidisciplinary Sleep Unit, Respiratory Department, Sant Joan University Hospital, Sant Joan d'Alacant, Alicante, Spain
| | - Rosa Cordovilla-Pérez
- Respiratory Department, Salamanca University Hospital, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | | | - Marta García-Clemente
- Lung Management Area, HUCA, Institute for Health Research of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
| | - José Luis Izquierdo-Alonso
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain; Respiratory Medicine, University Hospital of Guadalajara, Guadalajara, Spain
| | | | - Luis Pérez-de Llano
- Respiratory Department, Lucus Augusti University Hospital, EOXI Lugo, Monforte, CERVO, Lugo, Spain
| | - Jacobo Sellares-Torres
- Interstitial Lung Diseases Working Group, Respiratory Department, Clinic-University Hospital-IDIBAPS, Barcelona, Spain
| | | |
Collapse
|
4
|
Flume PA. From the Editor's Desk. J Cyst Fibros 2022; 21:197-198. [PMID: 35337599 PMCID: PMC8938743 DOI: 10.1016/j.jcf.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Patrick A Flume
- Editor in Chief, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
5
|
Barr HL, Bihouee T, Zwitserloot AM. A year in review: Real world evidence, functional monitoring and emerging therapeutics in 2021. J Cyst Fibros 2022; 21:191-196. [PMID: 35272931 PMCID: PMC8900606 DOI: 10.1016/j.jcf.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 12/20/2022]
Affiliation(s)
- H L Barr
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Nottingham Respiratory Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom.
| | - T Bihouee
- Chronic Childhood Diseases unit, Pediatric Department, Nantes University Hospital, Nantes, France
| | - A M Zwitserloot
- University of Groningen, Department of Pediatric Pulmonology and Pediatric Allergy, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| |
Collapse
|
6
|
Fettes E, Riley M, Brotherston S, Doughty C, Griffiths B, Laverty A, Aurora P. "You're on mute!" Does pediatric CF home spirometry require physiologist supervision? Pediatr Pulmonol 2022; 57:278-284. [PMID: 34581507 DOI: 10.1002/ppul.25708] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/03/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has accelerated the move towards home spirometry monitoring, including in children. The aim of this study is to determine whether the remote supervision of spirometry by a physiologist improves the technical quality and failure rate of the maneuvers. METHOD Children with cystic fibrosis who had been provided with NuvoAir home spirometers were randomly allocated to either supervised or unsupervised home spirometry following a detailed training session. Home spirometry was performed every 2 weeks for 12 weeks. Tests were assigned a quality factor (QF) using our laboratory grading system as per American Thoracic Society/European Respiratory Society standards, with tests marked from A to D, or Fail. In our laboratory, we aim for QF A in all spirometry tests, but report results of QF B or C with a cautionary note. QF A was, therefore, the primary outcome, and QF A-C, the secondary outcome. RESULTS Sixty-one patients were enrolled; 166 measurements were obtained in the supervised group, and 153 in the unsupervised group. Significantly more measurements achieved QF A in the supervised compared to unsupervised group (89% vs. 74%; p = <0.001), while proportions reaching Grade A-C were similar (99% vs. 95%; p = 0.1). All significant declines in spirometry results had a clinical rather than technical reason. Family/patient feedback for both arms was very positive. CONCLUSION These results suggest that home spirometry in children should ideally be remotely supervised by a physiologist, but acceptable results can be obtained if resources do not allow this, provided that training is delivered and results monitored according to our protocol.
Collapse
Affiliation(s)
- Emma Fettes
- Lung Function Laboratory, Great Ormond Street Hospital for Children, HNS Foundation Trust, London, UK
| | - Mollie Riley
- Lung Function Laboratory, Great Ormond Street Hospital for Children, HNS Foundation Trust, London, UK
| | - Stephanie Brotherston
- Lung Function Laboratory, Great Ormond Street Hospital for Children, HNS Foundation Trust, London, UK
| | - Claire Doughty
- Lung Function Laboratory, Great Ormond Street Hospital for Children, HNS Foundation Trust, London, UK
| | - Benjamin Griffiths
- Lung Function Laboratory, Great Ormond Street Hospital for Children, HNS Foundation Trust, London, UK
| | - Aidan Laverty
- Lung Function Laboratory, Great Ormond Street Hospital for Children, HNS Foundation Trust, London, UK
| | - Paul Aurora
- Lung Function Laboratory, Great Ormond Street Hospital for Children, HNS Foundation Trust, London, UK.,Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Department of Infection, Immunity and Inflammation Research and Teaching, University College London Great Ormond Street Institute of Child Health, London, UK
| |
Collapse
|
7
|
Ong T, Van Citters AD, Dowd C, Fullmer J, List R, Pai SA, Ren CL, Scalia P, Solomon GM, Sawicki GS. Remote monitoring in telehealth care delivery across the U.S. cystic fibrosis care network. J Cyst Fibros 2021; 20 Suppl 3:57-63. [PMID: 34930544 DOI: 10.1016/j.jcf.2021.08.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) programs and people with CF (PwCF) employed various monitoring methods for virtual care during the COVID-19 pandemic. This paper characterizes experiences with remote monitoring across the U.S. CF community. METHODS The CF Foundation (CFF) sponsored distribution of home spirometers (April 2020 to May 2021), surveys to PwCF and CF programs (July to September 2020), and a second program survey (April to May 2021). We used mixed methods to explore access, use, and perspectives regarding the use of remote monitoring in future care. RESULTS By October 2020, 13,345 spirometers had been distributed, and 19,271 spirometers by May 2021. Programs (n=286) estimated proportions of PwCF with home devices increased over seven months: spirometers (30% to 70%), scales (50% to 70%), oximeters (5% to 10%) with higher estimates in adult programs for spirometers and oximeters. PwCF (n=378) had access to scales (89%), followed by oximeters (48%) and spirometers (47%), often using scales and oximeters weekly, and spirometers monthly. Over both surveys, some programs had no method to collect respiratory specimens for cultures associated with telehealth visits (47%, n=132; 41%, n=118). Most programs (81%) had a process for phlebotomy associated with a telehealth visit, primarily through off-site labs. Both PwCF and programs felt future care should advance remote monitoring and recommended improvements for access, training, and data collection systems. CONCLUSIONS PwCF and programs experienced unprecedented access to remote monitoring and raised its importance for future care. Improvements to current systems may leverage these shared experiences to augment future care models.
Collapse
Affiliation(s)
- Thida Ong
- Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, WA, United States.
| | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | | | - Jason Fullmer
- DCMG Pediatric Pulmonology & Sleep Medicine, Dell Children's Medical Group, Austin, TX, United States
| | - Rhonda List
- Division of Pulmonary and Critical Care, University of Virginia, Charlottesville, VA, United States
| | - Shine-Ann Pai
- Marnie Paul Specialty Care Center, Dell Children's Medical Center of Central Texas, Austin, TX, United States
| | - Clement L Ren
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - George M Solomon
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gregory S Sawicki
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, United States
| |
Collapse
|
8
|
Moor CC. Home monitoring for cystic fibrosis: The future is now. J Cyst Fibros 2021; 21:15-17. [PMID: 34906432 DOI: 10.1016/j.jcf.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Catharina C Moor
- Department of Respiratory Medicine, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| |
Collapse
|
9
|
Nichols DP, Paynter AC, Heltshe SL, Donaldson SH, Frederick CA, Freedman SD, Gelfond D, Hoffman LR, Kelly A, Narkewicz MR, Pittman JE, Ratjen F, Rosenfeld M, Sagel SD, Schwarzenberg SJ, Singh PK, Solomon GM, Stalvey MS, Clancy JP, Kirby S, Van Dalfsen JM, Kloster MH, Rowe SM. Clinical Effectiveness of Elexacaftor/Tezacftor/Ivacaftor in People with Cystic Fibrosis. Am J Respir Crit Care Med 2021; 205:529-539. [PMID: 34784492 PMCID: PMC8906485 DOI: 10.1164/rccm.202108-1986oc] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale The cystic fibrosis (CF) modulator drug, elexacaftor/tezacaftor/ivacaftor (ETI), proved highly effective in controlled clinical trials for individuals with at least one F508del allele, which occurs in at least 85% of people with CF. Objectives PROMISE is a postapproval study to understand the broad effects of ETI through 30 months’ clinical use in a more diverse U.S. patient population with planned analyses after 6 months. Methods Prospective, observational study in 487 people with CF age 12 years or older with at least one F508del allele starting ETI for the first time. Assessments occurred before and 1, 3, and 6 months into ETI therapy. Outcomes included change in percent predicted FEV1 (ppFEV1), sweat chloride concentration, body mass index (BMI), and self-reported respiratory symptoms. Measurements and Main Results Average age was 25.1 years, and 44.1% entered the study using tezacaftor/ivacaftor or lumacaftor/ivacaftor, whereas 6.7% were using ivacaftor, consistent with F508del homozygosity and G551D allele, respectively. At 6 months into ETI therapy, ppFEV1 improved 9.76 percentage points (95% confidence interval [CI], 8.76 to 10.76) from baseline, cystic fibrosis questionnaire–revised respiratory domain score improved 20.4 points (95% CI, 18.3 to 22.5), and sweat chloride decreased −41.7 mmol/L (95% CI, −43.8 to −39.6). BMI also significantly increased. Changes were larger in those naive to modulators but substantial in all groups, including those treated with ivacaftor at baseline. Conclusions ETI by clinical prescription provided large improvements in lung function, respiratory symptoms, and BMI in a diverse population naive to modulator drug therapy, using existing two-drug combinations, or using ivacaftor alone. Each group also experienced significant reductions in sweat chloride concentration, which correlated with improved ppFEV1 in the overall study population. Clinical trial registered with www.clinicaltrials.gov (NCT NCT04038047).
Collapse
Affiliation(s)
- David P Nichols
- University of Washington School of Medicine, 12353, Pediatrics, Seattle, Washington, United States.,Seattle Children's Hospital, 7274, Pediatric Pulmonology, Seattle, Washington, United States;
| | - Alex C Paynter
- Seattle Children's Research Institute, 145793, Seattle, Washington, United States
| | - Sonya L Heltshe
- Seattle Children's Research Institute, Cystic Fibrosis Therapeutics Development Network Coordinating Center, Seattle, Washington, United States.,University of Washington School of Medicine, Pediatrics, Seattle, Washington, United States
| | | | - Carla A Frederick
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 12291, Buffalo, New York, United States
| | - Steven D Freedman
- Beth Israel Deaconess Medical Center, Gastroenterology, Boston, Massachusetts, United States
| | - Daniel Gelfond
- Western New York Pediatric Gastroenterology, Batavia, New York, United States
| | - Lucas R Hoffman
- University of Washington School of Medicine, 12353, Seattle, Washington, United States.,Seattle Children's Hospital, 7274, Seattle, Washington, United States
| | - Andrea Kelly
- The Children's Hospital of Philadelphia, 6567, Pediatrics, Division of Endocrinology & Diabetes, Philadelphia, Pennsylvania, United States
| | - Michael R Narkewicz
- Children's Hospital Colorado and University of Colorado School of Medicine, Digestive Health Institute and Pediatrics, Aurora, Colorado, United States
| | - Jessica E Pittman
- Washington University in Saint Louis School of Medicine, 12275, Department of Pediatrics, Saint Louis, Missouri, United States
| | - Felix Ratjen
- University of Toronto HSC, Division of Respiratory Medicine, Toronto, Ontario, Canada
| | - Margaret Rosenfeld
- Seattle Children's, Pediatrics / Pulmonary, Seattle, Washington, United States
| | - Scott D Sagel
- University of Colorado School of Medicine, Pediatrics, Aurora, Colorado, United States
| | - Sarah Jane Schwarzenberg
- University of Minnesota Masonic Children's Hospital, 501779, Pediatrics, Minneapolis, Minnesota, United States
| | - Pradeep K Singh
- University of Washington, 7284, Department of Microbiology and Medicine, Seattle, Washington, United States
| | - George M Solomon
- University of Alabama at Birmingham, 9968, Medicine, Gregory Fleming James Cystic Fibrosis Research Center, Birmingham, Alabama, United States
| | - Michael S Stalvey
- The University of Alabama at Birmingham School of Medicine, 9967, Birmingham, Alabama, United States
| | - John P Clancy
- Cincinnati Children's Hospital Medical Center, 2518, Department of Pediatrics, Cincinnati, Ohio, United States.,Cincinnati Children's Hospital Medical Center, 2518, Division of Pulmonary Medicine, Cincinnati, Ohio, United States
| | - Shannon Kirby
- Seattle Children's Research Institute, 145793, Seattle, Washington, United States
| | - Jill M Van Dalfsen
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Margaret H Kloster
- Seattle Children's Research Institute, Cystic Fibrosis Therapeutics Development Network Coordinating Center, Seattle, Washington, United States
| | - Steven M Rowe
- University of Alabama at Birmingham, Medicine, Cystic Fibrosis Center, Birmingham, Alabama, United States
| | | |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW The COVID-19 global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a dramatic impact that is still ongoing around the world. Cystic fibrosis (CF) has been identified as a possible risk factor of poor outcome. RECENT FINDINGS Data collected by multiple National CF registries around the world have indicated that persons with CF (PwCF) are not more likely to be affected by SARS-CoV-2 than the general population. The course of SARS-CoV-2 is usually mild in PwCF who are relatively young. Severe outcomes have been described in patients with low lung function and in those with immune suppression (i.e. solid organ transplantation). Indirect impact of the pandemic on the CF community has also been observed, including difficulties in the organization of CF care, leading to a dramatic increase in telehealth for PwCF. The pandemic has further affected clinical research by complicating ongoing clinical trials. Vaccination appears important to all PwCF, with special priority on developing adequate vaccination scheme for transplant recipients. Long-term effects of COVID-19 on the CF population remains unknown. SUMMARY The COVID-19 pandemic has caused significant impacts on PwCF and on healthcare professionals who provide specialized CF care and clinical research.
Collapse
Affiliation(s)
- Pierre-Régis Burgel
- Université de Paris, Institut Cochin, Inserm U1016
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Cochin Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Christopher Goss
- CF Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute
- Department of Pediatrics
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|