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Sawicki GS, Goodman A, Bacon C, Collins L, Greenberg J, Duncan C, Frederick C, Luebbert S, Mazuera S, Polineni D, Stark LL, George C, Riekert KA. Partners in research: The success with therapies research consortium and the CF community unite to improve self-management. J Cyst Fibros 2023; 22:830-835. [PMID: 37137747 DOI: 10.1016/j.jcf.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND The daily treatment regimen for an individual with cystic fibrosis (CF) can take more than 2 h to complete, and chronic treatment adherence rates are low. Developing partnerships between CF clinical researchers and the CF community is essential in developing acceptable, feasible, and effective strategies to improve self-management and adherence. METHODS The Success with Therapies Research Consortium (STRC) was formed as a multi-center US collaborative to conduct rigorous research studies of adherence to CF treatments. A multidisciplinary team of researchers from 15 sites, collaborating with members of the CF community, is charged with developing, implementing, and disseminating real-world, patient-centered interventions for people living with CF. RESULTS Since 2014, the STRC has conducted 8 studies. The CF community, people with CF (pwCF), and caregivers have come to serve in multiple valuable capacities on the STRC, including as members of the Steering Committee and Co-Principal Investigators. Additionally, while people with CF are irreplaceable participants in STRC studies, their influence, and that of their families and healthcare professionals, extends beyond the traditional research participant role. CONCLUSIONS Engaging broadly with the CF community is the optimal model for developing interventions to support those living with CF in sustaining daily care. Input and direct involvement from people with CF, their families, and their caregivers has enabled the STRC to advance its mission through innovative clinical research approaches.
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Affiliation(s)
- Gregory S Sawicki
- Division of Pulmonary Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA 02115, USA.
| | - Andrea Goodman
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Callie Bacon
- Division of Pulmonary Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA 02115, USA
| | - Lauren Collins
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100 N, Bethesda, MD 20814
| | - Jonathan Greenberg
- Division of Pulmonary Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA 02115, USA
| | - Christina Duncan
- Department of Psychology, West Virginia University, 53 Campus Drive, Morgantown, WV 26506
| | - Carla Frederick
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences of the University of Buffalo, 1001 Main Street, Conventus Building, 4th floor, Buffalo, NY 14023, USA
| | - Shelby Luebbert
- Community Member, STRC Steering Committee, c/o Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100 N, Bethesda, MD 20814, USA
| | - Sylvia Mazuera
- Community Member, STRC Steering Committee, c/o Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100 N, Bethesda, MD 20814, USA
| | - Deepika Polineni
- Department of Pediatrics, Washington University in St. Louis, 660 S. Euclid Ave., MSC 8116-43-14, St. Louis, MO 63110, USA
| | - Lori L Stark
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Cynthia George
- Cystic Fibrosis Foundation, 4550 Montgomery Avenue, Suite 1100 N, Bethesda, MD 20814
| | - Kristin A Riekert
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
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Standards of care for CFTR variant-specific therapy (including modulators) for people with cystic fibrosis. J Cyst Fibros 2023; 22:17-30. [PMID: 36916675 DOI: 10.1016/j.jcf.2022.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022]
Abstract
Cystic fibrosis (CF) has entered the era of variant-specific therapy, tailored to the genetic variants in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene. CFTR modulators, the first variant-specific therapy available, have transformed the management of CF. The latest standards of care from the European CF Society (2018) did not include guidance on variant-specific therapy, as CFTR modulators were becoming established as a novel therapy. We have produced interim standards to guide healthcare professionals in the provision of variant-specific therapy for people with CF. Here we provide evidence-based guidance covering the spectrum of care, established using evidence from systematic reviews and expert opinion. Statements were reviewed by key stakeholders using Delphi methodology, with agreement (≥80%) achieved for all statements after one round of consultation. Issues around accessibility are discussed and there is clear consensus that all eligible people with CF should have access to variant-specific therapy.
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Keogh RH, Cosgriff R, Andrinopoulou ER, Brownlee KG, Carr SB, Diaz-Ordaz K, Granger E, Jewell NP, Lewin A, Leyrat C, Schlüter DK, van Smeden M, Szczesniak RD, Connett GJ. Projecting the impact of triple CFTR modulator therapy on intravenous antibiotic requirements in cystic fibrosis using patient registry data combined with treatment effects from randomised trials. Thorax 2022; 77:873-881. [PMID: 34556554 PMCID: PMC8940731 DOI: 10.1136/thoraxjnl-2020-216265] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 08/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-threatening genetic disease, affecting around 10 500 people in the UK. Precision medicines have been developed to treat specific CF-gene mutations. The newest, elexacaftor/tezacaftor/ivacaftor (ELEX/TEZ/IVA), has been found to be highly effective in randomised controlled trials (RCTs) and became available to a large proportion of UK CF patients in 2020. Understanding the potential health economic impacts of ELEX/TEZ/IVA is vital to planning service provision. METHODS We combined observational UK CF Registry data with RCT results to project the impact of ELEX/TEZ/IVA on total days of intravenous (IV) antibiotic treatment at a population level. Registry data from 2015 to 2017 were used to develop prediction models for IV days over a 1-year period using several predictors, and to estimate 1-year population total IV days based on standards of care pre-ELEX/TEZ/IVA. We considered two approaches to imposing the impact of ELEX/TEZ/IVA on projected outcomes using effect estimates from RCTs: approach 1 based on effect estimates on FEV1% and approach 2 based on effect estimates on exacerbation rate. RESULTS ELEX/TEZ/IVA is expected to result in significant reductions in population-level requirements for IV antibiotics of 16.1% (~17 800 days) using approach 1 and 43.6% (~39 500 days) using approach 2. The two approaches require different assumptions. Increased understanding of the mechanisms through which ELEX/TEZ/IVA acts on these outcomes would enable further refinements to our projections. CONCLUSIONS This work contributes to increased understanding of the changing healthcare needs of people with CF and illustrates how Registry data can be used in combination with RCT evidence to estimate population-level treatment impacts.
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Affiliation(s)
- Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Siobhán B Carr
- Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Karla Diaz-Ordaz
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Granger
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Nicholas P Jewell
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Alex Lewin
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Clemence Leyrat
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniela K Schlüter
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rhonda D Szczesniak
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Gary J Connett
- National Institute for Health Research, Southampton Respiratory Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Regard L, Martin C, Burnet E, Da Silva J, Burgel PR. CFTR Modulators in People with Cystic Fibrosis: Real-World Evidence in France. Cells 2022; 11:cells11111769. [PMID: 35681464 PMCID: PMC9179538 DOI: 10.3390/cells11111769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 01/18/2023] Open
Abstract
Cystic fibrosis (CF) is a rare genetic multisystemic disease, the manifestations of which are due to mutations in the gene encoding the CF transmembrane conductance regulator (CFTR) protein and can lead to respiratory insufficiency and premature death. CFTR modulators, which were developed in the past decade, partially restore CFTR protein function. Their clinical efficacy has been demonstrated in phase 3 clinical trials, particularly in terms of lung function and pulmonary exacerbations, nutritional status, and quality of life in people with gating mutations (ivacaftor), homozygous for the F508del mutation (lumacaftor/ivacaftor and tezacaftor/ivacaftor), and in those with at least one F508del mutation (elexacaftor/tezacaftor/ivacaftor). However, many questions remain regarding their long-term safety and effectiveness, particularly in patients with advanced lung disease, liver disease, renal insufficiency, or problematic bacterial colonization. The impact of CFTR modulators on other important outcomes such as concurrent treatments, lung transplantation, chest imaging, or pregnancies also warrants further investigation. The French CF Reference Network includes 47 CF centers that contribute patient data to the comprehensive French CF Registry and have conducted nationwide real-world studies on CFTR modulators. This review seeks to summarize the results of these real-world studies and examine their findings against those of randomized control trials.
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Affiliation(s)
- Lucile Regard
- French Cystic Fibrosis National Reference Center, Department of Respiratory Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.R.); (C.M.); (E.B.); (J.D.S.)
- Institut Cochin, Université de Paris Cité, INSERM U1016, 75014 Paris, France
- ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Clémence Martin
- French Cystic Fibrosis National Reference Center, Department of Respiratory Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.R.); (C.M.); (E.B.); (J.D.S.)
- Institut Cochin, Université de Paris Cité, INSERM U1016, 75014 Paris, France
- ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Espérie Burnet
- French Cystic Fibrosis National Reference Center, Department of Respiratory Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.R.); (C.M.); (E.B.); (J.D.S.)
- Institut Cochin, Université de Paris Cité, INSERM U1016, 75014 Paris, France
- ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Jennifer Da Silva
- French Cystic Fibrosis National Reference Center, Department of Respiratory Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.R.); (C.M.); (E.B.); (J.D.S.)
- ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
| | - Pierre-Régis Burgel
- French Cystic Fibrosis National Reference Center, Department of Respiratory Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; (L.R.); (C.M.); (E.B.); (J.D.S.)
- Institut Cochin, Université de Paris Cité, INSERM U1016, 75014 Paris, France
- ERN Lung Cystic Fibrosis Network, Frankfurt, Germany
- Correspondence: ; Tel.: +33-1-58-41-23-67; Fax: +33-1-46-33-82-53
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Goetz DM, Savant AP. Review of CFTR modulators 2020. Pediatr Pulmonol 2021; 56:3595-3606. [PMID: 34407318 DOI: 10.1002/ppul.25627] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 12/21/2022]
Abstract
Cystic fibrosis transmembrane conductance regulator (CFTR) modulators are small molecules that directly impact the CFTR protein, improving the function of the CFTR chloride and bicarbonate channel. Beginning in 2012 with the Food and Drug Administration approval of the first CFTR modulator, ivacaftor, this class of medications has had largely positive effects on many outcomes in people with cystic fibrosis (PwCF), including lung function, growth, and other clinical parameters. There have been continued exciting developments in the current research on CFTR modulators, expanding beyond original studies. This first part of a three-part cystic fibrosis (CF) year in review 2020 will focus on research on CFTR modulators. In addition to reviewing new clinical insights, we describe work done on novel outcomes, adverse effects, issues related to cost, and next steps for clinical trials. The review focuses on articles from Pediatric Pulmonology published in 2020, but it includes articles from other journals that are of particular interest to clinicians. New developments in CF research continue to be brought forth to the CF community, deepening the understanding of this disease and improving clinical care.
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Affiliation(s)
- Danielle M Goetz
- Department of Pediatrics, University at Buffalo School of Medicine, New York, New York, USA
| | - Adrienne P Savant
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Bengtson CD, He J, Kim MD, Salathe MA. Cystic Fibrosis-related Diabetes Is Associated with Worse Lung Function Trajectory despite Ivacaftor Use. Am J Respir Crit Care Med 2021; 204:1343-1345. [PMID: 34469275 DOI: 10.1164/rccm.202104-1060le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Jianghua He
- The University of Kansas Medical Center Kansas City, Kansas
| | - Michael D Kim
- The University of Kansas Medical Center Kansas City, Kansas
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7
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Reix P, Tatopoulos A, Ioan I, Le Bourgeois M, Bui S, Choukroun ML, Bessaci-Kabouya K, Gerardin M, Bokov P, Da Silva J, Paillasseur JL, Burgel PR. Real-world assessment of LCI following lumacaftor-ivacaftor initiation in adolescents and adults with cystic fibrosis. J Cyst Fibros 2021; 21:155-159. [PMID: 34183285 DOI: 10.1016/j.jcf.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/05/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
Lung clearance index (LCI) is a biomarker of ventilation inhomogeneity. Data are scarce on its usefulness in daily practice for monitoring the effects of treatments in older children and adults with CF. In this French observational study of lumacaftor-ivacaftor, 63 of 845 patients (7.5%) had available LCI performed at baseline and at six (M6; n=34) or 12 months (M12; n=46) after lumacaftor-ivacaftor initiation. At inclusion, median [IQR] age was 16 years [13-17], ppFEV1 was 72.8 [59.6-80.7], and LCI was 12.3 [10.3-15.0]. At both M6 and M12, no statistically significant LCI increases of 0.13 units or 1.34% (95% CI: -4.85-7.53) and 0.6 units or 6.66% (95% CI: -0.03-13.5) were observed. Discordant results between LCI and ppFEV1 were observed in one-third of the patients. In daily practice, LCI monitoring in adolescents and young adults with moderate lung disease gives results that are more heterogenous than those reported in children with milder disease.
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Affiliation(s)
- Philippe Reix
- Cystic Fibrosis Center, Hospices Civils de Lyon, Lyon, France; UMR 5558 CNRS Equipe EMET Université Claude Bernard Lyon 1 Lyon, France.
| | - Aurélie Tatopoulos
- Pediatric Cystic Fibrosis Center, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Iulia Ioan
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'Enfants, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Muriel Le Bourgeois
- Pediatric Respiratory Disease and Cystic Fibrosis Center National Reference Cystic Fibrosis Reference Center, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Stéphanie Bui
- Pediatric Respiratory Disease and Cystic Fibrosis Center and CIC 1401, CHU de Bordeaux, Bordeaux, France
| | - Marie Luce Choukroun
- Service d'explorations fonctionnelles respiratoires pédiatriques, CHU de Bordeaux, Bordeaux, France
| | - Katia Bessaci-Kabouya
- Department of Pediatrics A and Cystic Fibrosis Center, American Memorial Hospital, Reims, France
| | - Michele Gerardin
- Pediatric Cystic Fibrosis center, Hôpital Robert Debré, AP-HP, Paris, France
| | - Plamen Bokov
- Service de Physiologie Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France; Université de Paris, UMR1141, Equipe NeoPhen, INSERM co-tutelle, Paris, France
| | - Jennifer Da Silva
- Université de Paris, Institut Cochin, Inserm, Paris U1016, France; ERN-Lung CF network, France; URC-CIC Paris Descartes Necker Cochin, AP-HP, Hôpital Cochin, Paris, France
| | | | - Pierre Regis Burgel
- Université de Paris, Institut Cochin, Inserm, Paris U1016, France; ERN-Lung CF network, France; Respiratory Medicine and National Cystic Fibrosis Reference Center, Cochin Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
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Mehta Z, Kamal KM, Miller R, Covvey JR, Giannetti V. Adherence to cystic fibrosis transmembrane conductance regulator (CFTR) modulators: analysis of a national specialty pharmacy database. J Drug Assess 2021; 10:62-67. [PMID: 33968464 PMCID: PMC8078929 DOI: 10.1080/21556660.2021.1912352] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/31/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There have been significant advances in Cystic Fibrosis (CF) treatment, with the introduction of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulators. Adherence is an important goal for CF management, as nonadherence is linked to poor health outcomes. OBJECTIVE To calculate the medication adherence in patients taking CFTR modulators using a national specialty pharmacy database. METHODS This retrospective observational cohort study utilized de-identified specialty pharmacy data from September 2017 to August 2018 to assess medication adherence for three CFTR modulators: ivacaftor, lumacaftor/ivacaftor, and tezacaftor/ivacaftor & ivacaftor. The primary outcome was proportion of days covered (PDC) for each medication, with mean PDC values compared across age groups and insurance characteristics. All analyses were performed using the SAS 9.4 University Edition (SAS Institute, Cary, NC). RESULTS A total of 2,548 patients were analyzed, including 1,289 (50.59%) patients on lumacaftor/ivacaftor, 784 (30.77%) on ivacaftor, and 475 (18.64%) on tezacaftor/ivacaftor & ivacaftor. The mean PDC value for all CFTR modulators was above 0.80. Tezacaftor/ivacaftor & ivacaftor had the highest overall PDC of 0.92, while PDC values for both lumacaftor/ivacaftor and ivacaftor were 0.84. Children/adolescents on lumacaftor/ivacaftor (p = 0.0001) and tezacaftor/ivacaftor & ivacaftor (p = 0.001) had significantly higher mean PDC values compared to adults but not for ivacaftor (p = 0.3744). No statistical differences were seen in PDC across insurance characteristics. CONCLUSION To the best of our knowledge, this is the first study to assess the adherence of three CFTR modulators using a large nationwide specialty database. With high acquisition costs of CFTR modulator therapies, there is a need to improve rates of adherence in patients with CF.
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Affiliation(s)
- Zumi Mehta
- Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Khalid M. Kamal
- Department of Pharmaceutical Systems and Policy, Health Sciences Center, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | | | - Jordan R. Covvey
- Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Vincent Giannetti
- Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA, USA
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9
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Burgel PR, Durieu I, Chiron R, Mely L, Prevotat A, Murris-Espin M, Porzio M, Abely M, Reix P, Marguet C, Macey J, Sermet-Gaudelus I, Corvol H, Bui S, Biouhee T, Hubert D, Munck A, Lemonnier L, Dehillotte C, Silva JD, Paillasseur JL, Martin C. Clinical response to lumacaftor-ivacaftor in patients with cystic fibrosis according to baseline lung function. J Cyst Fibros 2021; 20:220-227. [DOI: 10.1016/j.jcf.2020.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023]
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10
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Poulimeneas D, Grammatikopoulou MG, Devetzi P, Petrocheilou A, Kaditis AG, Papamitsou T, Doudounakis SE, Vassilakou T. Adherence to Dietary Recommendations, Nutrient Intake Adequacy and Diet Quality among Pediatric Cystic Fibrosis Patients: Results from the GreeCF Study. Nutrients 2020; 12:nu12103126. [PMID: 33066268 PMCID: PMC7602117 DOI: 10.3390/nu12103126] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 01/19/2023] Open
Abstract
Nutrition is an important component of cystic fibrosis (CF) therapy, with a high-fat diet being the cornerstone of treatment. However, adherence to the dietary recommendations for CF appears suboptimal and burdensome for most children and adolescents with CF, leading to malnutrition, inadequate growth, compromised lung function and increased risk for respiratory infections. A cross-sectional approach was deployed to examine the degree of adherence to the nutrition recommendations and diet quality among children with CF. A total of 76 children were recruited from Aghia Sophia’s Children Hospital, in Athens, Greece. In their majority, participants attained their ideal body weight, met the recommendations for energy and fat intake, exceeding the goal for saturated fatty acids consumption. Carbohydrate and fiber intake were suboptimal and most participants exhibited low or mediocre adherence to the Mediterranean diet prototype. It appears that despite the optimal adherence to the energy and fat recommendations, there is still room for improvement concerning diet quality and fiber intake.
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Affiliation(s)
- Dimitrios Poulimeneas
- Department of Public Health Policy, School of Public Health, University of West Attica, 196, Alexandras Avenue, GR-11521 Athens, Greece;
- Department of Nutrition and Dietetics, Harokopio University, E. Venizelou 70, GR-17671 Athens, Greece
| | - Maria G. Grammatikopoulou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, GR-57001 Thessaloniki, Greece; (M.G.G.); (P.D.)
| | - Panagiota Devetzi
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, GR-57001 Thessaloniki, Greece; (M.G.G.); (P.D.)
- Faculty of Biotechnology, Universidade Católica Portuguesa, Rua de Diogo Botelho, 1327, 4169-005 Porto, Portugal
| | - Argyri Petrocheilou
- Cystic Fibrosis Department, Agia Sophia Children’s Hospital, Thivon 1, GR-11527 Athens, Greece; (A.P.); (A.G.K.); (S.E.D.)
| | - Athanasios G. Kaditis
- Cystic Fibrosis Department, Agia Sophia Children’s Hospital, Thivon 1, GR-11527 Athens, Greece; (A.P.); (A.G.K.); (S.E.D.)
- Division of Pediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children’s Hospital, Thivon 1, GR-11527 Athens, Greece
| | - Theodora Papamitsou
- Laboratory of Histology and Embryology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, GR-54124 Thessaloniki, Greece
- Correspondence: (T.P.); (T.V.)
| | - Stavros E. Doudounakis
- Cystic Fibrosis Department, Agia Sophia Children’s Hospital, Thivon 1, GR-11527 Athens, Greece; (A.P.); (A.G.K.); (S.E.D.)
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 196, Alexandras Avenue, GR-11521 Athens, Greece;
- Correspondence: (T.P.); (T.V.)
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Changing landscape: psychological care in the era of cystic fibrosis transmembrane conductance regulator modulators. Curr Opin Pulm Med 2020; 26:696-701. [PMID: 32941351 DOI: 10.1097/mcp.0000000000000727] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The current review provides an overview of key psychological issues and challenges for the cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulator era of care. It discusses research from diagnosis and beyond, to patient-team communication with a particular focus on medical trials, adherence and living with CFTR modulators. RECENT FINDINGS The impact of the diagnosis on parents is immense and the complexity of treatment now and in the future, are a challenge for both parents and teams. Communicating digitally is starting to become daily practice for many in CF care, with coronavirus disease 2019 accelerating this process. Participating in trials has a psychological impact, but most of all the (delayed) access and timing of accessing CFTR modulators is an important theme. Adherence remains of significance, both to 'old' and 'new' treatments. Living with CF in the era of CFTR modulators is beginning to impact on patients' quality of life, including new possibilities, opportunities and challenges. SUMMARY Psychological care needs to engage and keep pace with the rapid medical changes. Some care priorities remain the same, including psychological screening and assessment, as well as psychoeducation, communication training and psychotherapy. The presence of CF psychologist in the CF clinic remains as important as ever.
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