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Solomon GM, Linnemann RW, Rich R, Streby A, Buehler B, Hunter E, Vijaykumar K, Hunt WR, Brewington JJ, Rab A, Bai SP, Westbrook AL, McNicholas-Bevensee C, Hong J, Manfredi C, Barilla C, Suzuki S, Davis BR, Sorscher EJ. Evaluation of elexacaftor-tezacaftor-ivacaftor treatment in individuals with cystic fibrosis and CFTR N1303K in the USA: a prospective, multicentre, open-label, single-arm trial. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00205-4. [PMID: 39208836 DOI: 10.1016/s2213-2600(24)00205-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND CFTR modulators are approved for approximately 90% of people with cystic fibrosis in the USA and provide substantial clinical benefit. N1303K (Asn1303Lys), one of the most common class 2 CFTR defects, has not been approved for these therapies by any regulatory agency. Preclinical investigation by our laboratories showed N1303K CFTR activation with elexacaftor-tezacaftor-ivacaftor (ETI). In this trial, we evaluate whether ETI improves CFTR function, measured by sweat chloride and other clinical outcomes, in people with cystic fibrosis and CFTRN1303K. METHODS In this prospective, open-label, single-arm trial, participants aged 12 years or older with cystic fibrosis encoding at least one N1303K variant and at least one CFTRN1303K allele who were ineligible for modulator therapy by US Food and Drug Administration labelling were given ETI for 28 days followed by a 28-day washout period at two cystic fibrosis centres in the USA. Participants received two orally administered pills of 100 mg elexacaftor, 50 mg tezacaftor, and 75 mg ivacaftor once daily in the morning, and 150 mg ivacaftor once daily in the evening. The primary endpoint was mean change in sweat chloride from baseline up to day 28 compared with mixed-effects models. Secondary endpoints were changes in percentage of predicted FEV1 (ppFEV1), Cystic Fibrosis Questionnaire-Revised (CFQ-R) respiratory domain, BMI, and weight after ETI therapy. Safety was assessed in all participants who received at least one dose of the study drug and primary and secondary analyses were performed in all participants who took the study drug per protocol. The trial was registered at ClinicalTrials.gov (NCT03506061) and remains open for reporting purposes. FINDINGS Between June 7, 2022, and Oct 20, 2023, 20 participants (ten male and ten female) were enrolled and received ETI treatment. One participant was lost to follow-up but was included in intention-to-treat analyses. At 28 days, the mean sweat chloride reduction was -1·1 mmol/L (95% CI -5·3 to 3·1; p=0·61) with only one participant showing a sweat chloride decrease greater than 15 mmol/L. There was a mean increase in ppFEV1 from baseline at day 28 of 9·5 percentage points (6·7-12·3; p<0·0001) with 15 (75%) participants showing at least a 5% increase in ppFEV1. Improvements were also identified in mean CFQ-R respiratory domain score (20·8 increase [95% CI 11·9-29·8]; p<0·0001), BMI (0·4 kg/m2 increase [0·2-0·7]; p=0·0017), and weight (1·0 kg increase [0·4-1·7]; p=0·0020) after 28 days of ETI treatment. 14 (70%) of 20 participants had adverse events (12 [60%] mild, one [5%] moderate), with one (5%) serious adverse event of hospitalisation attributed to pneumonia. No deaths were recorded in the study. INTERPRETATION Individuals with CFTRN1303K showed no change in sweat chloride after 28 days of treatment with ETI. However, there were improvements in secondary clinical endpoints, which suggest clinical efficacy. Our approach provides support for the use of in vitro model systems to inform clinical trials for rare CFTR variants. FUNDING The Cystic Fibrosis Foundation and the US National Institutes of Health.
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Affiliation(s)
| | - Rachel W Linnemann
- Emory University, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Rachel Rich
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Cristina Barilla
- University of Alabama at Birmingham, Birmingham, AL, USA; University of Texas Health Science Center, Houston, TX, USA
| | - Shingo Suzuki
- University of Alabama at Birmingham, Birmingham, AL, USA; University of Texas Health Science Center, Houston, TX, USA
| | - Brian R Davis
- University of Alabama at Birmingham, Birmingham, AL, USA; University of Texas Health Science Center, Houston, TX, USA
| | - Eric J Sorscher
- Emory University, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
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Savant AP, McColley SA. Cystic fibrosis year in review 2019: Section 3 multisystem-based care and research. Pediatr Pulmonol 2023; 58:697-703. [PMID: 33210843 DOI: 10.1002/ppul.25158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 11/08/2022]
Abstract
During the year 2019, numerous research studies and other reports were published that are interesting and instructive to professionals who care for people with cystic fibrosis (CF) and their families. This report is the third of 3 CF year in review articles and focuses on the multisystem manifestations of CF care. Previous articles have addressed cystic fibrosis transmembrane regulator modulators and reports on CF pulmonary disease and airway infections. It is an exciting time to be involved in care and research that aims to improve care for people with CF and their families.
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Affiliation(s)
- Adrienne P Savant
- Division of Pulmonary Medicine, Children's Hospital of New Orleans, New Orleans, Louisiana, USA.,Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Clinical Research, Stanley Manne Children's Research Institute, Chicago, Illinois, USA.,Division of Pulmonary Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Nenna R, Slaats M, Ersu R, Lo D, Seglani S, Nissenbaum C, Horsley AR, Proesmans M, Petrarca L, Williams E, Dassios T, Ardura-Garcia C, Duijts L, Marczak H, Snijders D, Rottier R, Chao CM, Pijnenburg MW, Grigg J. ERS International Congress, Madrid, 2019: highlights from the Paediatric Assembly. ERJ Open Res 2020; 6:00063-2020. [PMID: 32714968 PMCID: PMC7369464 DOI: 10.1183/23120541.00063-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/31/2020] [Indexed: 12/18/2022] Open
Abstract
In this article, the Group Chairs and the Early Career Members of the Paediatric Assembly of the European Respiratory Society (ERS) highlight some of the most interesting findings in the field of paediatrics presented at the 2019 ERS International Congress, which was held in Madrid, Spain. The main findings from each group are summarised at the end of each chapter.
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Affiliation(s)
- Raffaella Nenna
- Maternal–Infantile and Urological Science Dept, “Sapienza” University of Rome, Rome, Italy
| | - Monique Slaats
- Dept of Paediatric Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Refika Ersu
- Dept of Paediatric Pulmonology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - David Lo
- Dept of Paediatric Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
- Dept of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Sejal Seglani
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK
| | - Claire Nissenbaum
- University of Manchester, Manchester, UK
- Manchester University Foundation NHS Trust, Manchester, UK
| | - Alex R. Horsley
- University of Manchester, Manchester, UK
- Manchester University Foundation NHS Trust, Manchester, UK
| | | | - Laura Petrarca
- Maternal–Infantile and Urological Science Dept, “Sapienza” University of Rome, Rome, Italy
| | - Emma Williams
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Theodore Dassios
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Liesbeth Duijts
- Erasmus MC–Sophia, University Medical Centre Rotterdam, Dept of Paediatrics, Division of Paediatric Pulmonology and Allergology, Rotterdam, The Netherlands
| | - Honorata Marczak
- Dept of Paediatric Pneumonology and Allergy, Medical University of Warsaw, Warszaw, Poland
| | - Deborah Snijders
- Dipartimento Salute della Donna e del Bambino, Università degli Studi di Padova, Padua, Italy
| | - Robbert Rottier
- Dept of Pediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
- Dept of Cell Biology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cho-Ming Chao
- Cardio-Pulmonary Institute, German Center for Lung Research, Department of Internal Medicine II, Universities of Gießen and Marburg Lung Center, Gießen, Germany
- University Children's Hospital Gießen, Dept of General Pediatrics and Neonatology, Justus-Liebig-University, Gießen, Germany
| | - Marielle W. Pijnenburg
- Erasmus MC–Sophia, University Medical Centre Rotterdam, Dept of Paediatrics, Division of Paediatric Pulmonology and Allergology, Rotterdam, The Netherlands
| | - Jonathan Grigg
- Centre for Paediatrics, Queen Mary University London, London, UK
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