Elexacaftor-Tezacaftor-Ivacaftor for Cystic Fibrosis with a Single Phe508del Allele
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu klinické zkoušky, fáze III, časopisecké články, multicentrická studie, randomizované kontrolované studie, Research Support, N.I.H., Extramural, práce podpořená grantem
Grantová podpora
U54 TR001368
NCATS NIH HHS - United States
P30 DK089507
NIDDK NIH HHS - United States
R35 HL135816
NHLBI NIH HHS - United States
P20 GM130423
NIGMS NIH HHS - United States
UL1 TR002319
NCATS NIH HHS - United States
U01 TR002487
NCATS NIH HHS - United States
P30 DK072482
NIDDK NIH HHS - United States
PubMed
31697873
PubMed Central
PMC7282384
DOI
10.1056/nejmoa1908639
Knihovny.cz E-zdroje
- MeSH
- aktivátory chloridových kanálů aplikace a dávkování škodlivé účinky MeSH
- aminofenoly aplikace a dávkování škodlivé účinky MeSH
- benzodioxoly aplikace a dávkování škodlivé účinky MeSH
- chinolony aplikace a dávkování škodlivé účinky MeSH
- chloridy analýza MeSH
- cystická fibróza farmakoterapie genetika patofyziologie MeSH
- dítě MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- fixní kombinace léků MeSH
- genotyp MeSH
- indoly aplikace a dávkování škodlivé účinky MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mutace * MeSH
- pot chemie MeSH
- protein CFTR genetika MeSH
- pyrazoly aplikace a dávkování škodlivé účinky MeSH
- pyridiny aplikace a dávkování škodlivé účinky MeSH
- pyrrolidiny aplikace a dávkování škodlivé účinky MeSH
- usilovný výdechový objem MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze III MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Research Support, N.I.H., Extramural MeSH
- Názvy látek
- aktivátory chloridových kanálů MeSH
- aminofenoly MeSH
- benzodioxoly MeSH
- CFTR protein, human MeSH Prohlížeč
- chinolony MeSH
- chloridy MeSH
- elexacaftor MeSH Prohlížeč
- fixní kombinace léků MeSH
- indoly MeSH
- ivacaftor MeSH Prohlížeč
- protein CFTR MeSH
- pyrazoly MeSH
- pyridiny MeSH
- pyrrolidiny MeSH
- tezacaftor MeSH Prohlížeč
BACKGROUND: Cystic fibrosis is caused by mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein, and nearly 90% of patients have at least one copy of the Phe508del CFTR mutation. In a phase 2 trial involving patients who were heterozygous for the Phe508del CFTR mutation and a minimal-function mutation (Phe508del-minimal function genotype), the next-generation CFTR corrector elexacaftor, in combination with tezacaftor and ivacaftor, improved Phe508del CFTR function and clinical outcomes. METHODS: We conducted a phase 3, randomized, double-blind, placebo-controlled trial to confirm the efficacy and safety of elexacaftor-tezacaftor-ivacaftor in patients 12 years of age or older with cystic fibrosis with Phe508del-minimal function genotypes. Patients were randomly assigned to receive elexacaftor-tezacaftor-ivacaftor or placebo for 24 weeks. The primary end point was absolute change from baseline in percentage of predicted forced expiratory volume in 1 second (FEV1) at week 4. RESULTS: A total of 403 patients underwent randomization and received at least one dose of active treatment or placebo. Elexacaftor-tezacaftor-ivacaftor, relative to placebo, resulted in a percentage of predicted FEV1 that was 13.8 points higher at 4 weeks and 14.3 points higher through 24 weeks, a rate of pulmonary exacerbations that was 63% lower, a respiratory domain score on the Cystic Fibrosis Questionnaire-Revised (range, 0 to 100, with higher scores indicating a higher patient-reported quality of life with regard to respiratory symptoms; minimum clinically important difference, 4 points) that was 20.2 points higher, and a sweat chloride concentration that was 41.8 mmol per liter lower (P<0.001 for all comparisons). Elexacaftor-tezacaftor-ivacaftor was generally safe and had an acceptable side-effect profile. Most patients had adverse events that were mild or moderate. Adverse events leading to discontinuation of the trial regimen occurred in 1% of the patients in the elexacaftor-tezacaftor-ivacaftor group. CONCLUSIONS: Elexacaftor-tezacaftor-ivacaftor was efficacious in patients with cystic fibrosis with Phe508del-minimal function genotypes, in whom previous CFTR modulator regimens were ineffective. (Funded by Vertex Pharmaceuticals; VX17-445-102 ClinicalTrials.gov number, NCT03525444.).
Zobrazit více v PubMed
O’Sullivan BP, Freedman SD. Cystic fibrosis. Lancet 2009;373:1891–904. PubMed
Elborn JS. Cystic fibrosis. Lancet 2016;388:2519–31. PubMed
Sanders DB, Fink AK. Background and epidemiology. Pediatr Clin North Am 2016;63:567–84. PubMed PMC
Rowe SM, Miller S, Sorscher EJ. Cystic fibrosis. N Engl J Med 2005;352:1992–2001. PubMed
Quinton PM. Cystic fibrosis: impaired bicarbonate secretion and mucoviscidosis. Lancet 2008;372:415–7. PubMed
Marshall B, Faro A, Fink AK, et al. Cystic fibrosis patient registry: 2017 annual data report. Bethesda, MD: Cystic Fibrosis Foundation, 2018.
Dalemans W, Barbry P, Champigny G, et al. Altered chloride ion channel kinetics associated with the delta F508 cystic fibrosis mutation. Nature 1991;354:526–8. PubMed
Lukacs GL, Chang XB, Bear C, et al. The delta F508 mutation decreases the stability of cystic fibrosis transmembrane conductance regulator in the plasma membrane: determination of functional half-lives on transfected cells. J Biol Chem 1993;268:21592–8. PubMed
Wainwright CE, Elborn JS, Ramsey BW, et al. Lumacaftor–ivacaftor in patients with cystic fibrosis homozygous for Phe508del CFTR. N Engl J Med 2015;373:220–31. PubMed PMC
Ramsey BW, Davies J, McElvaney NG, et al. A CFTR potentiator in patients with cystic fibrosis and the G551D mutation. N Engl J Med 2011;365:1663–72. PubMed PMC
Taylor-Cousar JL, Munck A, McKone EF, et al. Tezacaftor–ivacaftor in patients with cystic fibrosis homozygous for Phe508del. N Engl J Med 2017;377:2013–23. PubMed
Rowe SM, Daines C, Ringshausen FC, et al. Tezacaftor–ivacaftor in residual-function heterozygotes with cystic fibrosis. N Engl J Med 2017;377:2024–35. PubMed PMC
Boyle MP, De Boeck K. A new era in the treatment of cystic fibrosis: correction of the underlying CFTR defect. Lancet Respir Med 2013;1:158–63. PubMed
A study to evaluate the efficacy and safety of VX-661 in combination with ivacaftor in subjects aged 12 years and older with cystic fibrosis, heterozygous for the F508del-CFTR mutation: study results. Bethesda, MD: National Institutes of Health, ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/results/NCT02516410).
Rowe SM, McColley SA, Rietschel E, et al. Lumacaftor/ivacaftor treatment of patients with cystic fibrosis heterozygous for F508del-CFTR. Ann Am Thorac Soc 2017;14:213–9. PubMed PMC
Davies JC, Moskowitz SM, Brown C, et al. VX-659-tezacaftor–ivacaftor in patients with cystic fibrosis and one or two Phe508del alleles. N Engl J Med 2018;379:1599–611. PubMed PMC
Taylor-Cousar JL, Mall MA, Ramsey BW, et al. Clinical development of triple-combination CFTR modulators for cystic fibrosis patients with one or two F508del alleles. ERJ Open Res 2019;5(2):00082–2019. PubMed PMC
Keating D, Marigowda G, Burr L, et al. VX-445-tezacaftor–ivacaftor in patients with cystic fibrosis and one or two Phe508del alleles. N Engl J Med 2018;379:1612–20. PubMed PMC
Clancy JP. Rapid therapeutic advances in CFTR modulator science. Pediatr Pulmonol 2018;53:Suppl 3:S4–S11. PubMed PMC
Kerem E, Reisman J, Corey M, Canny GJ, Levison H. Prediction of mortality in patients with cystic fibrosis. N Engl J Med 1992;326:1187–91. PubMed
Amadori A, Antonelli A, Balteri I, Schreiber A, Bugiani M, De Rose V. Recurrent exacerbations affect FEV(1) decline in adult patients with cystic fibrosis. Respir Med 2009;103:407–13. PubMed
De Boer K, Vandemheen KL, Tullis E, et al. Exacerbation frequency and clinical outcomes in adult patients with cystic fibrosis. Thorax 2011;66:680–5. PubMed
Konstan MW, Wagener JS, Vandevanter DR, et al. Risk factors for rate of decline in FEV1 in adults with cystic fibrosis. J Cyst Fibros 2012;11:405–11. PubMed PMC
Sanders DB, Zhao Q, Li Z, Farrell PM. Poor recovery from cystic fibrosis pulmonary exacerbations is associated with poor long-term outcomes. Pediatr Pulmonol 2017;52:1268–75. PubMed PMC
Sawicki GS, McKone EF, Pasta DJ, et al. Sustained benefit from ivacaftor demonstrated by combining clinical trial and cystic fibrosis patient registry data. Am J Respir Crit Care Med 2015;192:836–42. PubMed
Volkova N, Moy K, Evans J, et al. Disease progression in patients with cystic fibrosis treated with ivacaftor: data from national US and UK registries. J Cyst Fibros 2019. June 10 (Epub ahead of print). PubMed
Rowe SM, Heltshe SL, Gonska T, et al. Clinical mechanism of the cystic fibrosis transmembrane conductance regulator potentiator ivacaftor in G551D-mediated cystic fibrosis. Am J Respir Crit Care Med 2014;190:175–84. PubMed PMC
Bessonova L, Volkova N, Higgins M, et al. Data from the US and UK cystic fibrosis registries support disease modification by CFTR modulation with ivacaftor. Thorax 2018;73:731–40. PubMed PMC
Farrell PM, Rosenstein BJ, White TB, et al. Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report. J Pediatr 2008;153(2):S4–S14. PubMed PMC
Habib AR, Kajbafzadeh M, Desai S, Yang CL, Skolnik K, Quon BS. A systematic review of the clinical efficacy and safety of CFTR modulators in cystic fibrosis. Sci Rep 2019;9:7234. PubMed PMC
Lieberman J, Rodbard S. Low blood pressure in young adults with cystic fibrosis: an effect of chronic salt loss in sweat? Ann Intern Med 1975;82:806–8. PubMed
Heijerman HG, McKone EF, Downey DG, et al. Efficacy and safety of the elexacaftor plus tezacaftor plus ivacaftor combination regimen in people with cystic fibrosis homozygous for the F508del mutation: a double-blind, randomised, phase 3 trial. Lancet 2019. October 31 (Epub ahead of print). PubMed PMC
Building global development strategies for cf therapeutics during a transitional cftr modulator era
ClinicalTrials.gov
NCT03525444