Impact of CFTR modulator use on outcomes in people with severe cystic fibrosis lung disease

Abstract

Drug compounds that augment the production and activity of the cystic fibrosis (CF) transmembrane regulator (CFTR) have revolutionised CF care. Many adults and some children with CF suffer advanced and severe lung disease or await lung transplantation. While the hope is that these drug compounds will prevent lung damage when started early in life, there is an ongoing need to care for people with advanced lung disease. The focus of this review is the accumulating data from clinical trials and case series regarding the benefits of CFTR modulator therapy in people with advanced pulmonary disease. We address the impact of treatment with ivacaftor, lumacaftor/ivacaftor, tezacaftor/ivacaftor and elexacaftor/tezacaftor/ivacaftor on lung function, pulmonary exacerbations, nutrition and quality of life. Adverse events of the different CFTR modulators, as well as the potential for drug-drug interactions, are discussed.

FIGURE 1

A summary of interactions between cystic fibrosis transmembrane regulator modulators and other drugs/compounds and cytochrome P450 3A4 (CYP3A). Blue arrows: induction of the cytochrome; yellow arrow: inhibition of the cytochrome; curved arrow: metabolism of a drug by the cytochrome. Adapted from [–32].