Cited by 140Cystic Fibrosis Research AdvancesPharmacogenetics and Drug MetabolismInhalation and Respiratory Drug Delivery

The DOI matches its Crossref record; 22 of the 22 references it cites were found in a registry or an index; 11 of the 24 sources its claims cite were checked for support.

Real-world safety and effectiveness of elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis: Interim results of a long-term registry-based study

Open access

Abstract

Background Phase 3 clinical trials showed elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) was safe and efficacious in people with cystic fibrosis (CF) with ≥1 F508del-CFTR allele. To assess long-term effects of ELX/TEZ/IVA under real-world conditions of use, a 5-year observational registry-based study is being conducted. We report interim results from the first 2 years of follow-up. Methods The study included people with CF in the US Cystic Fibrosis Foundation Patient Registry (CFFPR) who initiated ELX/TEZ/IVA between October 2019 and December 2020. Pulmonary exacerbations (PEx), percent predicted forced expiratory volume in 1 second (ppFEV 1 ), hospitalizations, bacterial pathogens, body mass index (BMI), CF complications and comorbidities, and liver function tests (LFTs) after treatment initiation were compared with the 5-year pre-treatment period. Death and lung transplantation were assessed relative to 2019 CFFPR data. Results 16,116 people with CF were included (mean treatment duration 20.4 months). Among those with 5 years of pre-treatment data, mean PEx/patient/year declined to 0.18 (95% CI: 0.17, 0.19) in Years 1 and 2 post-treatment from 0.86 (95% CI: 0.83, 0.88) in the baseline year (79% reduction), after a continued increase observed pre-treatment. Similarly, a decline in mean hospitalizations/patient/year was observed in Year 1 that was sustained in Year 2 (74% reduction from baseline year). The mean absolute change in ppFEV 1 from baseline was +8.2 percentage points (95% CI: 8.0, 8.4) in Year 1 and +8.9 percentage points (95% CI: 8.7, 9.1) in Year 2, after a continued decline observed pre-treatment. Positive bacterial cultures decreased for all evaluated pathogens, and mean BMI increased by 1.6 kg/m 2 (95% CI: 1.5, 1.6) by Year 2. No new safety concerns were identified based on evaluation of CF complications, comorbidities, and LFTs. The annualized rates of death (0.47% [95% CI: 0.39, 0.55]) and lung transplantation (0.16% [95% CI: 0.12, 0.22]) were considerably lower than reported in 2019 (1.65% and 1.08%, respectively). Conclusions ELX/TEZ/IVA treatment was associated with sustained improvements in lung function, reduced frequency of PEx and all-cause hospitalization, increased BMI, and lower prevalence of positive bacterial cultures. Additionally, there was a 72% lower rate of death and 85% lower rate of lung transplantation relative to the year before ELX/TEZ/IVA availability. These results, from the largest cohort of ELX/TEZ/IVA-treated people to date, extend our understanding of the broad clinical benefits of ELX/TEZ/IVA.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

Interim results from a 5-year registry-based study of 16,116 people with cystic fibrosis initiating elexacaftor/tezacaftor/ivacaftor in the US CFFPR show sustained improvements in pulmonary exacerbations, lung function, hospitalizations, BMI, and bacterial pathogens, with lower death and lung transplantation rates than 2019 historical data. No new safety concerns were identified.

Key findings

  • Among 11,951 people with 5 years of pre-treatment data, mean pulmonary exacerbations/patient/year declined to 0.18 (95% CI: 0.17, 0.19) in post-treatment Years 1 and 2 from 0.86 (95% CI: 0.83, 0.88) in the baseline year, a 79% reduction; mean hospitalizations/patient/year declined by 74% (0.23 in Year 2 vs. 0.87 at baseline).
  • Mean ppFEV1 increased from 72.7 at baseline to 80.9 in Year 1 (+8.2 percentage points; 95% CI: 8.0, 8.4) and 81.6 in Year 2 (+8.9 percentage points; 95% CI: 8.7, 9.1); mean BMI increased by 1.6 kg/m² (95% CI: 1.5, 1.6) by Year 2, and positive bacterial cultures decreased for all evaluated pathogens.
  • Annualized death rate was 0.47% (95% CI: 0.39, 0.55) and lung transplantation rate was 0.16% (95% CI: 0.12, 0.22), 72% and 85% lower than 2019 rates of 1.65% and 1.08%, respectively. No new safety concerns were identified based on CF complications, comorbidities, and liver function tests.

Methods

  • Observational, registry-based cohort study using the US Cystic Fibrosis Foundation Patient Registry; included all people with CF initiating ELX/TEZ/IVA between October 21, 2019 and December 31, 2020, followed until death, loss to follow-up, treatment discontinuation, or December 31, 2021 (n = 16,116; mean treatment duration 20.4 months).
  • Outcomes included pulmonary exacerbations, all-cause hospitalizations, ppFEV1, bacterial pathogens, BMI, CF complications/comorbidities, liver function tests, death, and lung transplantation; post-treatment outcomes were compared descriptively with the 5-year pre-treatment period, and death/lung transplantation annualized rates were compared with 2019 CFFPR data for people aged ≥12 years with ≥1 F508del allele.
  • Analyses were descriptive with no statistical hypothesis testing and no imputation of missing data.

Limitations

  • The paper states that data came from routine clinical practice without standardized assessments, no imputation was performed, and residual confounding is possible in the historical comparison despite similar baseline demographics; analyses of disease progression required 5 years of pre-treatment data, though 1-year analyses were consistent, and reasons for treatment discontinuation were unavailable.
  • The paper notes that the interim analysis overlapped with the SARS-CoV-2 pandemic, which may have partially affected some outcomes such as pulmonary exacerbations, although other outcomes and pre-pandemic studies supported the clinical benefits.
  • Evident from the text: the observational registry design cannot establish causality, and registry-based outcome ascertainment may be incomplete or subject to misclassification.

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Integrity signals

Registry

Crossref · 10.1016/j.jcf.2023.03.002

Cites

22 of 22 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Image 1
CC-BY-NC-ND · From the PDF
Fig. 1 PEx and hospitalization by year in people with CF treated with ELX/TEZ/IVA ( n = 11,951). (A) Risk of PEx in subgroup with 5 years of non-missing pre-treatment data; (B) risk of hospitalization for any reason in subgroup with 5 years of non-missing pre-treatment data. For both outcomes, annualized mean is presented to account for variable exposure duration during the post-treatment period. CF: cystic fibrosis; CI: confidence interval; ELX/TEZ/IVA: elexacaftor/tezacaftor/ivacaftor; PEx: pulmonary exacerbations.
Fig. 1 PEx and hospitalization by year in people with CF treated with ELX/TEZ/IVA ( n = 11,951). (A) Risk of PEx in subgroup with 5 years of non-missing pre-treatment data; (B) risk of hospitalization for any reason in subgroup with 5 years of non-missing pre-treatment data. For both outcomes, annualized mean is presented to account for variable exposure duration during the post-treatment period. CF: cystic fibrosis; CI: confidence interval; ELX/TEZ/IVA: elexacaftor/tezacaftor/ivacaftor; PEx: pulmonary exacerbations.CC-BY-NC-ND · From the PDF
Fig. 2 Mean ppFEV by year in people with CF treated with ELX/TEZ/IVA ( n
Fig. 2 Mean ppFEV by year in people with CF treated with ELX/TEZ/IVA ( nCC-BY-NC-ND · From the PDF
Fig. 3 Prevalence of selected pulmonary pathogens of (A) Pseudomonas aeruginosa , (B) Staphylococcus aureus , (C) Burkholderia cepacia complex, and (D) Aspergillus by year in people with CF treated with ELX/TEZ/IVA ( n = 9311).
Fig. 3 Prevalence of selected pulmonary pathogens of (A) Pseudomonas aeruginosa , (B) Staphylococcus aureus , (C) Burkholderia cepacia complex, and (D) Aspergillus by year in people with CF treated with ELX/TEZ/IVA ( n = 9311).CC-BY-NC-ND · From the PDF

Verification

Claims the paper makes

63 Own result · 11 Own method · 11 Own interpretation · 7 Not checked yet · 3 Partly supported · 3 No full text of the sources · 2 No basis given · 1 Supported · 1 Supported so far · 1 Mixed support · accuracy not yet measured

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Show all 75 claims

  • Probably not a substantial claim. 14
  • It may state two separate claims as one. 16
  • The quote only partly states this claim. 1
28 of 28
  • The paper relies on this without support.

    The 2019 CFFPR data for all people with CF aged ≥12 years with ≥1 F508del allele represent the population who would initially become eligible for ELX/TEZ/IVA treatment.

    “which was then compared with the period before ELX/TEZ/IVA availability (2019 CFFPR data for all people with CF aged ≥12 years with ≥1 F508del allele, representing the population who would initially become eligible for ELX/TEZ/IVA treatment).”
  • The paper relies on this without support.

    The US CFFPR accurately and completely records ELX/TEZ/IVA initiation, outcomes, and covariates for the study population.

    “For this interim analysis, the data source was the US Cystic Fibrosis Foundation Patient Registry (CFFPR).”
  • The paper relies on this without support.

    The reduced availability of bacterial cultures during the SARS-CoV-2 pandemic does not bias the comparison of pathogen prevalence before and after ELX/TEZ/IVA initiation.

    “In the post-treatment period, which coincided with the SARS-CoV-2 pandemic, the availability of bacterial culture was 87.8% in Year 1 and 89.0% in Year 2.”
  • The paper relies on this without support.

    Data in the US CFFPR are accurate and complete enough to estimate the outcomes studied.

    “We analyzed data collected during routine clinical practice, where there are no standardized assessments as is common in clinical studies with primary data collection.”
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Metadata

Authors
Bower, J. K., Volkova, N., Ahluwalia, N., Sahota, G., Xuan, F., Chin, A., Weinstock, T. G., Ostrenga, J., & Elbert, A.
Affiliations
  • Vertex Pharmaceuticals (United States) (US)
  • Cystic Fibrosis Foundation (US)
Corresponding author
Bower, Julie K.
Venue
Journal of Cystic Fibrosis
Publisher
Elsevier BV
Published
2023-07
Volume
22
Issue
4
Pages
730-737
ISSN
1569-1993 (ISSN-L)
OpenAlex
W4353046996
Cited by
140
References
22
Citations by year
2026: 35 · 2025: 51 · 2024: 33 · 2023: 21
FWCI
25.67
Type
journal article
Language
en
Open access
Locations
  • Journal of Cystic Fibrosis (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
Vertex Pharmaceuticals Incorporated
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Inhalation and Respiratory Drug Delivery
Keywords
elexacaftor/tezacaftor/ivacaftor, CFTR modulator therapy, F508del-CFTR, pulmonary exacerbations, hospitalization reduction, FEV1 decline, pathogenic bacteria, body mass index, liver function tests, lung transplantation, long-term safety, real-world effectiveness
MeSH terms
Aminophenols, Cystic Fibrosis, Humans, Indoles, Mutation, Pyrazoles, Pyridines, Pyrrolidines, Registries, Quinolones, Cystic Fibrosis Transmembrane Conductance Regulator, Benzodioxoles, Chloride Channel Agonists

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