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Burgel PR, Paillasseur JL, Durieu I, Reynaud-Gaubert M, Hamidfar R, Murris-Espin M, Danner-Boucher I, Chiron R, Leroy S, Douvry B, Grenet D, Mely L, Ramel S, Moncouquiol S, Burnet E, Ouaalaya EH, Sogni P, Da Silva J, Martin C. Multisystemic Effects of Elexacaftor-Tezacaftor-Ivacaftor in Adults with Cystic Fibrosis and Advanced Lung Disease. Ann Am Thorac Soc 2024. [PMID: 38579175 DOI: 10.1513/annalsats.202312-1065oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/04/2024] [Indexed: 04/07/2024] Open
Abstract
RATIONALE Limited data exist on safety and effectiveness of elexacaftor-tezacaftor-ivacaftor (ETI) in people with cystic fibrosis (pwCF) and advanced lung disease. OBJECTIVE To evaluate the effects of ETI in an unselected population of pwCF and advanced lung disease. METHODS A prospective observational study, including all adults, aged 18 years and older, with a percent predicted FEV1 (ppFEV1)≤ 40 who initiated ETI from December 2019 to June 2021 in France was conducted. PwCF were followed until August 8th, 2022. RESULTS ETI was initiated in 434 pwCF with a median [interquartile range, IQR] ppFEV1=30 [25; 35], including 27 with severe CF liver disease and 183 with diabetes. PwCF were followed for a median [IQR] 587 [396; 728] days after ETI initiation. Discontinuation of ETI occurred in 12 (2.8%) pwCF and was mostly due to lung transplantation (n=5) or death (n=4). Absolute increase in ppFEV1 by a mean +14.2% (95% CI, 13.1-15.4) occurred at 1 month and persisted throughout the study. Increase in ppFEV1 in the younger age quartile was almost twice that of the oldest quartile (P<0.001); body mass index <18.5 kg/m2 was found in 38.6% at initiation vs. 11.3% at 12 months (P=0.0001). Increase in serum concentrations of vitamin A and E, but not 25OHD3, was observed. Significant reduction in the % of pwCF using oxygen therapy, noninvasive ventilation, nutritional support, inhaled and systemic therapies (including antibiotics) were observed; insulin was discontinued in 12% of diabetics. CONCLUSION ETI is safe in pwCF and advanced lung disease with multisystem pulmonary and extrapulmonary benefits.
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Affiliation(s)
| | | | - Isabelle Durieu
- Hospices Civils de Lyon, 26900, Service de médecine interne, Pierre Bénite, Auvergne-Rhône-Alpes , France
| | | | - Rebecca Hamidfar
- Centre Hospitalier Universitaire de Grenoble-Alpes, Service Hospitalo-Universitaire de Pneumologie et Physiologie, Pôle Thorax et Vaisseaux, , La Tronche, France
| | - Marlène Murris-Espin
- Centre Hospitalier Universitaire de Toulouse, 36760, Pulmonology, Toulouse, Midi-Pyrénées, France
| | | | | | - Sylvie Leroy
- University Hospital of Nice, Service de Pneumologie, Nice, France
| | - Benoit Douvry
- Centre Hospitalier Intercommunal de Creteil, 26949, Creteil, Île-de-France, France
| | | | | | | | | | - Espérie Burnet
- Cochin hospital, APHP, Respiratory Medicine, Paris, France
| | | | | | | | - Clémence Martin
- Groupe Hospitalier Cochin-Hotel Dieu, AP-HP, Pulmonary Department and Adult CF Centre, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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