Improvement in Lung Clearance Index and Chest Computed Tomography Scores with Elexacaftor/Tezacaftor/Ivacaftor Treatment in People with Cystic Fibrosis Aged 12 Years and Older - The RECOVER Trial
Rationale: Clinical trials have shown that use of elexacaftor/tezacaftor/ivacaftor (ETI) is associated with improvements in sweat chloride, pulmonary function, nutrition, and quality of life in people with cystic fibrosis (CF). Little is known about the impact of ETI on ventilation inhomogeneity and lung structure. Objectives: RECOVER is a real-world study designed to measure the impact of ETI in people with CF. The primary endpoints were lung clearance (lung clearance index; LCI2.5) and FEV1. Secondary endpoints included spirometry-controlled chest computed tomography (CT) scores. Methods: The study was conducted in seven sites in Ireland and the United Kingdom. Participants ages 12 years and older who were homozygous for the F508del mutation (F508del/F508del) or heterozygous for F508del and a minimum-function mutation (F508del/MF) were recruited before starting ETI and were followed up over 12 months. LCI2.5 was measured using nitrogen multiple breath washout (MBW) at baseline and at 6 and 12 months. Spirometry was performed as per the criteria of the American Thoracic Society and the European Respiratory Society. Spirometry-controlled chest CT scans were performed at baseline and at 12 months. CT scans were scored using the Perth Rotterdam Annotated Grid Morphometric Analysis (PRAGMA) system. Other outcome measures include weight, height, Cystic Fibrosis Quality of Life Questionnaire-Revised (CFQ-R), and sweat chloride. Measurements and Main Results: One hundred seventeen people with CF ages 12 and older were recruited to the study. Significant improvements were seen in LCI scores (-2.5; 95% confidence interval [CI], -3.0, -2.0) and in the percents predicted for FEV1 (8.9; 95% CI, 7.0, 10.9), FVC (6.6; 95% CI, 4.9, 8.3), and forced expiratory flow between 25% and 75% of expired volume (12.4; 95% CI, 7.8, 17.0). Overall PRAGMA-CF scores reflecting airway disease improved significantly (-3.46; 95% CI, -5.23, -1.69). Scores for trapped air, mucus plugging, and bronchial wall thickening improved significantly, but bronchiectasis scores did not. Sweat chloride levels decreased in both F508del/F508del (-43.1; 95% CI, -47.4, -38.9) and F508del/MF (-42.8; 95% CI, -48.5, -37.2) groups. Scores on the Respiratory Domain of the CFQ-R improved by 14.2 points (95% CI, 11.3, 17.2). At 1 year, sweat chloride levels were significantly lower for the F508del/F508del group compared with scores for the F508del/MF group (33.93 vs. 53.36, P < 0.001). Conclusions: ETI is associated with substantial improvements in LCI2.5, spirometry, and PRAGMA-CF CT scores in people with CF ages 12 years and older. ETI led to improved nutrition and quality of life. People in the F508del/F508del group had significantly lower sweat chloride on ETI treatment compared with the F508del/MF group. Clinical trial registered with www.clinicaltrials.gov (NCT04602468).
| Errataetall: |
CommentIn: Am J Respir Crit Care Med. 2023 Nov 1;208(9):911-913. - PMID 37756441 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:208 |
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| Enthalten in: |
American journal of respiratory and critical care medicine - 208(2023), 9 vom: 01. Nov., Seite 917-929 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
McNally, Paul [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 13.11.2023 Date Revised 13.11.2023 published: Print ClinicalTrials.gov: NCT04602468 CommentIn: Am J Respir Crit Care Med. 2023 Nov 1;208(9):911-913. - PMID 37756441 Citation Status MEDLINE |
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| doi: |
10.1164/rccm.202308-1317OC |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM362004056 |
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| 100 | 1 | |a McNally, Paul |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Improvement in Lung Clearance Index and Chest Computed Tomography Scores with Elexacaftor/Tezacaftor/Ivacaftor Treatment in People with Cystic Fibrosis Aged 12 Years and Older - The RECOVER Trial |
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| 500 | |a Date Revised 13.11.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a ClinicalTrials.gov: NCT04602468 | ||
| 500 | |a CommentIn: Am J Respir Crit Care Med. 2023 Nov 1;208(9):911-913. - PMID 37756441 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Rationale: Clinical trials have shown that use of elexacaftor/tezacaftor/ivacaftor (ETI) is associated with improvements in sweat chloride, pulmonary function, nutrition, and quality of life in people with cystic fibrosis (CF). Little is known about the impact of ETI on ventilation inhomogeneity and lung structure. Objectives: RECOVER is a real-world study designed to measure the impact of ETI in people with CF. The primary endpoints were lung clearance (lung clearance index; LCI2.5) and FEV1. Secondary endpoints included spirometry-controlled chest computed tomography (CT) scores. Methods: The study was conducted in seven sites in Ireland and the United Kingdom. Participants ages 12 years and older who were homozygous for the F508del mutation (F508del/F508del) or heterozygous for F508del and a minimum-function mutation (F508del/MF) were recruited before starting ETI and were followed up over 12 months. LCI2.5 was measured using nitrogen multiple breath washout (MBW) at baseline and at 6 and 12 months. Spirometry was performed as per the criteria of the American Thoracic Society and the European Respiratory Society. Spirometry-controlled chest CT scans were performed at baseline and at 12 months. CT scans were scored using the Perth Rotterdam Annotated Grid Morphometric Analysis (PRAGMA) system. Other outcome measures include weight, height, Cystic Fibrosis Quality of Life Questionnaire-Revised (CFQ-R), and sweat chloride. Measurements and Main Results: One hundred seventeen people with CF ages 12 and older were recruited to the study. Significant improvements were seen in LCI scores (-2.5; 95% confidence interval [CI], -3.0, -2.0) and in the percents predicted for FEV1 (8.9; 95% CI, 7.0, 10.9), FVC (6.6; 95% CI, 4.9, 8.3), and forced expiratory flow between 25% and 75% of expired volume (12.4; 95% CI, 7.8, 17.0). Overall PRAGMA-CF scores reflecting airway disease improved significantly (-3.46; 95% CI, -5.23, -1.69). Scores for trapped air, mucus plugging, and bronchial wall thickening improved significantly, but bronchiectasis scores did not. Sweat chloride levels decreased in both F508del/F508del (-43.1; 95% CI, -47.4, -38.9) and F508del/MF (-42.8; 95% CI, -48.5, -37.2) groups. Scores on the Respiratory Domain of the CFQ-R improved by 14.2 points (95% CI, 11.3, 17.2). At 1 year, sweat chloride levels were significantly lower for the F508del/F508del group compared with scores for the F508del/MF group (33.93 vs. 53.36, P < 0.001). Conclusions: ETI is associated with substantial improvements in LCI2.5, spirometry, and PRAGMA-CF CT scores in people with CF ages 12 years and older. ETI led to improved nutrition and quality of life. People in the F508del/F508del group had significantly lower sweat chloride on ETI treatment compared with the F508del/MF group. Clinical trial registered with www.clinicaltrials.gov (NCT04602468) | ||
| 650 | 4 | |a Clinical Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a computed tomography | |
| 650 | 4 | |a cystic fibrosis | |
| 650 | 4 | |a elexacaftor/tezacaftor/ivacaftor | |
| 650 | 4 | |a lung clearance index | |
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| 650 | 7 | |a elexacaftor |2 NLM | |
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| 700 | 1 | |a Lester, Karen |e verfasserin |4 aut | |
| 700 | 1 | |a Stone, Gavin |e verfasserin |4 aut | |
| 700 | 1 | |a Elnazir, Basil |e verfasserin |4 aut | |
| 700 | 1 | |a Williamson, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Cox, Des |e verfasserin |4 aut | |
| 700 | 1 | |a Linnane, Barry |e verfasserin |4 aut | |
| 700 | 1 | |a Kirwan, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Rea, David |e verfasserin |4 aut | |
| 700 | 1 | |a O'Regan, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Semple, Tom |e verfasserin |4 aut | |
| 700 | 1 | |a Saunders, Clare |e verfasserin |4 aut | |
| 700 | 1 | |a Tiddens, Harm A W M |e verfasserin |4 aut | |
| 700 | 1 | |a McKone, Edward |e verfasserin |4 aut | |
| 700 | 1 | |a Davies, Jane C |e verfasserin |4 aut | |
| 700 | 0 | |a RECOVER Study Group |e verfasserin |4 aut | |
| 700 | 1 | |a Lewis, Colin |e investigator |4 oth | |
| 700 | 1 | |a Persaud, Thara |e investigator |4 oth | |
| 700 | 1 | |a McQuaid, Aisling |e investigator |4 oth | |
| 700 | 1 | |a Twomey, Eilish |e investigator |4 oth | |
| 700 | 1 | |a Lambe, Aideen |e investigator |4 oth | |
| 700 | 1 | |a Dodd, Johnathan |e investigator |4 oth | |
| 700 | 1 | |a Short, Christopher |e investigator |4 oth | |
| 700 | 1 | |a Downey, Damian |e investigator |4 oth | |
| 700 | 1 | |a Keown, Karen |e investigator |4 oth | |
| 700 | 1 | |a Broderick, Benat |e investigator |4 oth | |
| 700 | 1 | |a Heffernan, Caroline |e investigator |4 oth | |
| 700 | 1 | |a Thornton, Carolyn |e investigator |4 oth | |
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