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Winiarska HM, Springer D, Wojtaś F, Wysocka E, Cofta S. CFTR Modulators Therapy Efficacy in Reducing Cystic Fibrosis (CF) Exacerbation and Improving Selected Spirometry Parameters: A Real-Life Study in a Single-Centre Polish Population. J Clin Med 2024; 13:4491. [PMID: 39124756 PMCID: PMC11312460 DOI: 10.3390/jcm13154491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/10/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Cystic fibrosis is a genetically determined disease that significantly influences and shortens life. Treatment with CFTR modulators (CFTR-T) is a new hope for patients. It can change the predictive values of a poor prognosis (e.g., exacerbation rate and FEV1 value). The aim of the study was to analyse exacerbation incidence and spirometry data before and after one year (+/- 2 weeks) of CFTR-T in 85 CF patients at the CF Centre in Poznań. To our knowledge, this is the first analysis of CFTR-T efficiency in the Central-Eastern Europe population. Methods: We retrospectively analysed the spirometry and exacerbation data of 85 CF adult patients (both men and women), who in the middle of 2022 began treatment with CFTR modulators. Results: The one-year ratio of hospitalisation caused by severe exacerbations lowered from 1.25 to 0.21 per patient per year. We also saw a 66% decline in ambulatory exacerbations. The median FEV1% increased by 9.60% in absolute values and by 460 mL. Even in the group with very severe obstruction (FEV1 < 35%), there was an increase in median FEV1% of 5.9 in absolute values. We also proved the increase in FVC% (median 17.10% in absolute value and 600 mL) in the study group. Conclusions: After one year of treatment, an impressive improvement was observed in two important predictive values of poor prognosis: exacerbation rate and FEV1 values. Further observation is needed to determine how long the improvement will be present and its influence on quality of life and life expectancy.
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Affiliation(s)
- Hanna M. Winiarska
- Department of Pulmonology, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, 84 Szamarzewskiego St, 60-569 Poznań, Poland; (D.S.); (F.W.); (S.C.)
| | - Daria Springer
- Department of Pulmonology, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, 84 Szamarzewskiego St, 60-569 Poznań, Poland; (D.S.); (F.W.); (S.C.)
| | - Filip Wojtaś
- Department of Pulmonology, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, 84 Szamarzewskiego St, 60-569 Poznań, Poland; (D.S.); (F.W.); (S.C.)
| | - Ewa Wysocka
- Chair and Department of Laboratory Diagnostics, Poznan University of Medical Sciences, 84 Szamarzewskiego St, 60-569 Poznań, Poland;
| | - Szczepan Cofta
- Department of Pulmonology, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, 84 Szamarzewskiego St, 60-569 Poznań, Poland; (D.S.); (F.W.); (S.C.)
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2
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Lee MLT, Whitmore GA. Semiparametric predictive inference for failure data using first-hitting-time threshold regression. LIFETIME DATA ANALYSIS 2023; 29:508-536. [PMID: 36624222 DOI: 10.1007/s10985-022-09583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 11/29/2022] [Indexed: 06/13/2023]
Abstract
The progression of disease for an individual can be described mathematically as a stochastic process. The individual experiences a failure event when the disease path first reaches or crosses a critical disease level. This happening defines a failure event and a first hitting time or time-to-event, both of which are important in medical contexts. When the context involves explanatory variables then there is usually an interest in incorporating regression structures into the analysis and the methodology known as threshold regression comes into play. To date, most applications of threshold regression have been based on parametric families of stochastic processes. This paper presents a semiparametric form of threshold regression that requires the stochastic process to have only one key property, namely, stationary independent increments. As this property is frequently encountered in real applications, this model has potential for use in many fields. The mathematical underpinnings of this semiparametric approach for estimation and prediction are described. The basic data element required by the model is a pair of readings representing the observed change in time and the observed change in disease level, arising from either a failure event or survival of the individual to the end of the data record. An extension is presented for applications where the underlying disease process is unobservable but component covariate processes are available to construct a surrogate disease process. Threshold regression, used in combination with a data technique called Markov decomposition, allows the methods to handle longitudinal time-to-event data by uncoupling a longitudinal record into a sequence of single records. Computational aspects of the methods are straightforward. An array of simulation experiments that verify computational feasibility and statistical inference are reported in an online supplement. Case applications based on longitudinal observational data from The Osteoarthritis Initiative (OAI) study are presented to demonstrate the methodology and its practical use.
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Affiliation(s)
- Mei-Ling Ting Lee
- Department of Epidemiology and Biostatistics, University of Maryland, EPIB Suite 2234R, SPH Building 255, 4200 Valley Drive, College Park, MD, 20742, USA
| | - G A Whitmore
- Desautels Faculty of Management, McGill University, 1001 Sherbrooke St W, Montreal, QC, H3A 1G5, Canada.
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3
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Milinic T, McElvaney OJ, Goss CH. Diagnosis and Management of Cystic Fibrosis Exacerbations. Semin Respir Crit Care Med 2023; 44:225-241. [PMID: 36746183 PMCID: PMC10131792 DOI: 10.1055/s-0042-1760250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
With the improving survival of cystic fibrosis (CF) patients and the advent of highly effective cystic fibrosis transmembrane conductance regulator (CFTR) therapy, the clinical spectrum of this complex multisystem disease continues to evolve. One of the most important clinical events for patients with CF in the course of this disease is acute pulmonary exacerbation (PEx). Clinical and microbial epidemiology studies of CF PEx continue to provide important insight into the disease course, prognosis, and complications. This work has now led to several large-scale clinical trials designed to clarify the treatment paradigm for CF PEx. The primary goal of this review is to provide a summary and update of the pathophysiology, clinical and microbial epidemiology, outcome and treatment of CF PEx, biomarkers for exacerbation, and the impact of highly effective modulator therapy on these events moving forward.
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Affiliation(s)
- Tijana Milinic
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Oliver J McElvaney
- Cysic Fibrosis Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, Washington
| | - Christopher H Goss
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
- Cysic Fibrosis Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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4
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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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5
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Meldrum OW, Belchamber KB, Chichirelo-Konstantynovych KD, Horton KL, Konstantynovych TV, Long MB, McDonnell MJ, Perea L, Garcia-Basteiro AL, Loebinger MR, Duarte R, Keir HR. ERS International Congress 2021: highlights from the Respiratory Infections Assembly. ERJ Open Res 2022; 8:00642-2021. [PMID: 35615420 PMCID: PMC9124871 DOI: 10.1183/23120541.00642-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/12/2022] [Indexed: 12/15/2022] Open
Abstract
The European Respiratory Society International Congress 2021 took place virtually for the second year running due to the coronavirus pandemic. The Congress programme featured more than 400 sessions and 3000 abstract presentations, covering the entire field of respiratory science and medicine. In this article, early career members of the Respiratory Infections Assembly summarise a selection of sessions across a broad range of topics, including presentations on bronchiectasis, non-tuberculosis mycobacteria, tuberculosis, cystic fibrosis and COVID-19.
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Affiliation(s)
- Oliver W. Meldrum
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | - Katie L. Horton
- Primary Ciliary Dyskinesia Centre, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Academic Unit of Clinical and Experimental Medicine, University of Southampton Faculty of Medicine, Southampton, UK
| | | | - Merete B. Long
- Division of Molecular and Clinical Medicine, Medical School, University of Dundee, Dundee, UK
| | - Melissa J. McDonnell
- Galway University Hospitals and National University of Ireland (NUIG), Galway, Ireland
| | | | - Alberto L. Garcia-Basteiro
- ISGlobal, Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saude de Manhiça, Maputo, Mozambique
| | - Michael R. Loebinger
- Host Defence Unit, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Raquel Duarte
- Pulmonology Unit, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Holly R. Keir
- Division of Molecular and Clinical Medicine, Medical School, University of Dundee, Dundee, UK
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6
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Projecting the impact of delayed access to elexacaftor/tezacaftor/ivacaftor for people with Cystic Fibrosis. J Cyst Fibros 2021; 20:243-249. [DOI: 10.1016/j.jcf.2020.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/25/2020] [Accepted: 07/25/2020] [Indexed: 01/28/2023]
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7
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Scotet V, L’Hostis C, Férec C. The Changing Epidemiology of Cystic Fibrosis: Incidence, Survival and Impact of the CFTR Gene Discovery. Genes (Basel) 2020; 11:E589. [PMID: 32466381 PMCID: PMC7348877 DOI: 10.3390/genes11060589] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 01/03/2023] Open
Abstract
Significant advances in the management of cystic fibrosis (CF) in recentdecades have dramatically changed the epidemiology and prognosis of this serious disease, which is no longer an exclusively pediatric disease. This paper aims to review the changes in the incidence and survival of CF and to assess the impact of the discovery of the responsible gene (the CFTR gene) on these changes. The incidence of CF appears to be decreasing in most countries andpatient survival, which can be monitored by various indicators, has improved substantially, with an estimated median age of survivalof approximately50 years today. Cloning of the CFTR gene 30 years ago and efforts to identify its many mutations have greatly improved the management of CF. Implementation of genetic screening policies hasenabled earlier diagnosis (via newborn screening), in addition to prevention within families or in the general population in some areas (via prenatal diagnosis, family testing or population carrier screening). In the past decade, in-depth knowledge of the molecular bases of CF has also enabled the emergenceof CFTR modulator therapies which have led to major clinical advances in the treatment of CF. All of these phenomena have contributed to changing the face of CF. The advent of targeted therapies has paved the way for precision medicine and is expected to further improve survival in the coming years.
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Affiliation(s)
- Virginie Scotet
- Inserm, University of Brest, EFS, UMR 1078, GGB, F-29200 Brest, France; (C.L.); (C.F.)
| | - Carine L’Hostis
- Inserm, University of Brest, EFS, UMR 1078, GGB, F-29200 Brest, France; (C.L.); (C.F.)
| | - Claude Férec
- Inserm, University of Brest, EFS, UMR 1078, GGB, F-29200 Brest, France; (C.L.); (C.F.)
- Department of Molecular Genetics, University Hospital of Brest, F-29200 Brest, France
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8
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Abstract
With the improving survival of cystic fibrosis (CF) patients and the advent of highly effective cystic fibrosis transmembrane conductance regulator therapy, the clinical spectrum of this complex multisystem disease continues to evolve. One of the most important clinical events for patients with CF in the course of this disease is an acute pulmonary exacerbation. Clinical and microbial epidemiology studies of CF pulmonary exacerbations continue to provide important insight into the disease course, prognosis, and complications. This work has now led to a number of large scale clinical trials with the goal of improving the treatment paradigm for CF pulmonary exacerbation. The primary goal of this review is to provide a summary of the pathophysiology, the clinical epidemiology, microbial epidemiology, outcome and the treatment of CF pulmonary exacerbation.
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Affiliation(s)
- Christopher H Goss
- CFF Therapeutics Development Network Coordinating Center, Department of Pediatrics, Seattle Children's Research Institute, Seattle, Washington.,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine and Pediatrics, University of Washington School of Medicine, Seattle, Washington
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