In the original article [1], there was a mistake in Table 1 as published. Reference citation [34] was wrong. The corrected Table 1 appears below. The authors state that the scientific conclusions are unaffected. The original article has been updated.
Table 1.
Summary of characteristics and results of cohort or survey studies with full manuscript.
| Ref | Study Design & Location | Population a | n | Recruitment Period & Follow-Up Duration | Overall Adverse Events (AE) b,c | Dose Modification, Interruption, or Discontinuation Due to AE b,c | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Ivacaftor | ||||||||||
| [29] | Prospective Cohort d United States |
Baseline Age Pediatric and Adult - Mean: 33 yr - Range: 10–61 yr CFTR Genotype ≥1 copy G551D Baseline ppFEV1 Mean: 30% |
44 |
Recruitment Period Prior to commercial availability Follow-Up Duration NS |
AE in n = 38 (86%): | n | % | Discontinuation: | n | % |
| - Pulmonary exacerbation - Hemoptysis - Increased sputum - Increased cough - URTI - Dyspnea - Abnormal respiration - Respiratory tract congestion - Headache - Rash |
20 7 7 6 6 3 3 3 5 4 |
45 16 16 14 14 7 7 7 11 9 |
- Severe abdominal pain - Dizziness/tinnitus |
1 1 |
2 2 |
|||||
|
SAE in n = 14 (32%): |
||||||||||
| - Pulmonary exacerbation - Hemoptysis - Pneumothorax - Acute respiratory failure - URTI - Abdominal pain - Gastroenteritis - Abnormal LFTs - Syncope - Secondary adrenocortical insufficiency |
NS NS NS NS NS NS NS NS NS NS |
- - - - - - - - - - |
||||||||
| [55] | Prospective Cohort United States Canada Italy |
Baseline Age Pediatric and Adult - Mean: 17 yr - Range: 5–61 yr CFTR Genotype ≥1 gating mutation Baseline ppFEV1 Mean: 86% |
23 |
Recruitment Period Mar 2014 to Aug 2015 Follow-Up Duration 3 mo |
49 AE in n = 21 (91%): | n | % | None reported | ||
| - Respiratory, unspecified - Gastrointestinal, unspecified - Infection, unspecified - Headache - Weakness - Dizziness - Fatigue |
NS NS NS NS NS NS NS |
- - - - - - - |
||||||||
| 5 SAE in n = 3 (13%): | n | % | ||||||||
| - Respiratory infection - Acute changes in metabolic and liver status |
4 1 |
17 4 |
||||||||
| [56] | Retrospective Cohort United Kingdom (1 center) |
Baseline Age Pediatric - Mean: 9 yr - Range: 6–14 yr CFTR Genotype 1 copy G551D Baseline ppFEV1 Mean: 68% e |
4 |
Recruitment Period Jan 2013 to Jun 2015 Follow-Up Duration Mean: 24 mo |
- Transaminitis (<3 x ULN) |
n 1 |
% 25 |
None reported | ||
| [57] | Retrospective Cohort Scotland (11 centers) |
Baseline Age Pediatric - Median: 9 yr CFTR Genotype ≥1 copy G551D Baseline ppFEV1 Mean: 85% |
26 |
Recruitment Period NS (Jan 2013 to Mar 2013 for 85%) Follow-Up Duration Mean: 17 mo |
n | % | None reported | |||
|
- Headache - Swollen ear - Cataracts |
1 1 2 |
4 4 17 f |
||||||||
| [58] | Retrospective Cohort France (25 centers) |
Baseline Age Pediatric and Adult - Median: 18 yr - Range: 6–52 yr CFTR Genotype ≥1 copy G551D Baseline ppFEV1 Mean: 72% |
57 |
Recruitment Period Pre-1 Jun 2013 up to 30 Sep 2014 Follow-Up Duration Up to 2 yr |
34 AE in n = 21 (37%): | n | % | Interruption in n = 7 (12%): | n | % |
| - Transaminitis - Rhinopharyngitis - Asthma - Fever - Chest pain - Abdominal pain - Nausea or vomiting - Intestinal dysmotility - Headache - Fatigue - Rash or eczema - Depression - Myalgia - Arthritis - Breast hypertrophy - Orchitis - Atrial fibrillation |
3 NS NS NS NS NS NS NS NS NS NS NS NS NS NS NS NS |
5 - - - - - - - - - - - - - - - - |
- Hepatitis - Rhinopharyngitis - Abdominal pain - Vomiting - Headache - Rash - Severe depression |
NS NS NS NS NS NS NS |
- - - - - - - |
|||||
| Discontinuation: | ||||||||||
| - Transaminitis - Liver cirrhosis diagnosis |
1 1 |
2 2 |
||||||||
| [30] | Retrospective Cohort d Germany (multicenter) |
Baseline Age Adult - Mean: 34 yr CFTR Genotype ≥1 copy G551D Baseline ppFEV1 Mean: 25% |
14 |
Recruitment Period Sep 2012 to Apr 2013 Follow-Up Duration Mean: 235 days |
- Increased bronchial and nasal secretions - Headache - Worsening RLS - Abdominal pain - Hyperbilirubinemia (mild) - Transaminitis (<3 to 4x ULN) |
n 3 1 1 1 1 1 |
% 21 7 7 7 7 7 |
Discontinuation: - Increased bronchial and nasal secretions * * Trial of reduced dose before discontinuation |
n 1 |
% 7 |
| Lumacaftor/Ivacaftor | ||||||||||
| [41] | Prospective Cohort France (1 center) |
Baseline Age Pediatric - Mean: 16 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 87% |
32 |
Recruitment Period Mar 2016 to Dec 2016 Follow-Up Duration 4 h post-first dose |
- Acute drop in ppFEV1 - Wheeze |
n 32 3 |
% 100 9 |
None reported | ||
| [42] | Prospective Cohort France (47 centers) |
Baseline Age Pediatric and Adult - Mean: 22 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 65% |
845 |
Recruitment Period 1 Jan 2016 to 31 Dec 2016 Follow-Up Duration 12 mo |
AE in n = 494 (59%): | n | % | Interruption: | n | % |
| - Respiratory - Digestive - Menstrual abnormality - Fatigue - Headache - CK > 5xULN - Transaminitis (> 3xULN) |
316 181 53 37 19 20 5 |
37 21 6 4 2 2 0.6 |
- Respiratory - ‘Non-respiratory’ Discontinuation: Respiratory - Chest tightness/dyspnea - Bronchospasm - Increased cough/sputum - Hemoptysis - Pneumothorax Non-respiratory - Diarrhea, abdominal pain - CK >10xULN + myalgia - Fatigue - Headache - Depression - Metrorrhagia - Transaminitis (>6xULN) - Cutaneous rash - Tachycardia |
16 8 n 38 24 9 2 1 18 5 5 4 4 3 2 1 1 |
2 1 % 5 3 1 0.2 0.1 2 0.6 0.6 0.5 0.5 0.4 0.2 0.1 0.1 |
|||||
| [59] | Prospective Cohort United States (1 center) |
Baseline Age Pediatric and Adult - Mean: 23 yr - Range: 12–48 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 70% |
26 |
Recruitment Period NS Follow-Up Duration 6 mo |
See Discontinuation |
Discontinuation: - Transaminitis - Unspecified AE |
n 1 4 |
% 4 15 |
||
| [31] | Prospective Cohort d Switzerland (1 center) |
Baseline Age Adult - Mean NR CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Median: 30% |
20 |
Recruitment Period Jan 2016 to Jan 2017 Follow-Up Duration 1 mo |
n | % | Reduced dose: | n | % | |
| - Dyspnea - 3 h - 24 h - 1 mo - Chest tightness - 3 h - 24 h - 1 mo - Increased sputum - 3 h - 24 h - 1 mo - Pulmonary exacerbation - 1 mo |
0 1 1 1 10 1 1 8 3 2 |
- 5 5 5 50 5 5 40 15 10 |
- Respiratory intolerance Discontinuation: - Chest tightness (at 24 h) |
3 1 |
15 5 |
|||||
| [32] | Prospective Cohort Australia (1 center) |
Baseline Age Adult - Mean: 27 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Median: 36% |
12 |
Recruitment Period Jan 2016 to Oct 2016 Follow-Up Duration 1 mo |
n | % | Discontinuation: | n | % | |
| - Acute drop in ppFEV1 - Respiratory AE overall - 4 h - 24 h - 1 mo - Dyspnea - 4 h - 24 h - 1 mo - Chest tightness - 4 h - 24 h - 1 mo - Increased sputum - 4 h - 24 h - 1 mo - Pulmonary exacerbation |
12 5 10 8 2 6 7 4 8 5 0 2 1 6 |
100 42 83 67 17 50 58 33 67 42 - 17 8 50 |
- Chest tightness/dyspnea * * n = 2 discontinued after 1mo follow-up (5 wk and 9 wk) |
3 | 25 | |||||
| [33] | Prospective Cohort France (11 centers) |
Baseline Age Adult - Mean: 31 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 32% |
53 |
Recruitment Period Jan 2016 to Jun 2016 Follow-Up Duration 3 mo |
AE in n = 34 (63%): | n | % | Discontinuation: | n | % |
| - Abnormal respiration - Dyspnea - Increased cough - Abdominal pain, nausea, diarrhea, or vomiting - Fatigue - Rash - Pruritus - Breast tension |
13 11 3 9 2 1 1 1 |
25 21 6 17 4 2 2 2 |
- Respiratory intolerance - Vomiting - Fatigue |
13 1 1 |
25 2 2 |
|||||
| [25] | Prospective Cohort d,g Australia (1 center) |
Baseline Age Adult - Mean: 27 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 36% |
10 |
Recruitment Period NS Follow-Up Duration 52 wk |
AE in n = 6 (60%): | n | % | None reported | ||
| - Chest tightness/dyspnea - Headache |
6 2 |
60 20 |
||||||||
| [43] | Retrospective Cohort Ireland (1 center) |
Baseline Age Pediatric - Mean: 14 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 77% |
15 |
Recruitment Period Sep 2016 to Aug 2017 Follow-Up Duration NS |
n | % | None reported | |||
| - Acute drop in ppFEV1 - Chest tightness - Increased sputum |
14 2 2 |
93 13 13 |
||||||||
| [44] | Retrospective Cohort United States (1 center) |
Baseline Age Pediatric and Adult - Mean: 25 yr - Range: 12–59 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 67% |
116 |
Recruitment Period NS Follow-Up Duration Up to 11 mo |
AE in n = 46 (40%): | n | % | Reduced dose: | n | % |
| - Chest tightness - Dyspnea - Increased cough - Diarrhea - Nausea - Decreased appetite - Rash |
23 12 10 5 3 2 2 |
20 10 9 4 3 2 2 |
- AE not specified Discontinuation: - Reasons not specified h |
10 20 |
9 17 |
|||||
| [60] | Retrospective Cohort Greece (1 center) |
Baseline Age Pediatric and Adult - Mean: 16 yr i - Range: 12–23 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean 92% i |
62 |
Recruitment Period Mar 2016 to Aug 2017 Follow-Up Duration 12 mo |
- Chest tightness |
n 2 |
% 3 |
Discontinuation: - Transaminitis - Cataract |
n 1 1 |
% 2 2 |
| [34] | Retrospective Cohort d Spain (multicenter) |
Baseline Age Pediatric and Adult - Mean: 27 yr - Range: 10–45 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 32% |
20 |
Recruitment Period 2016 Follow-Up Duration 6 mo |
AE in n = 15 (75%): | n | % | Discontinuation: | n | % |
| - Chest tightness - Dyspnea - Headache - Weight loss - ‘Sickness’ (not defined) - Asthenia - Abdominal pain - Transaminitis |
9 8 5 5 3 3 2 2 |
45 40 25 25 15 15 10 10 |
- Decreased ppFEV1 - AE not specified |
1 6 |
5 30 |
|||||
| [45] | Retrospective Cohort Canada (1 center) |
Baseline Age Adult - Median: 32 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Median: 40% |
22 |
Recruitment Period Apr 2016 to Jun 2018 Follow-Up Duration Median: 10 mo |
AE in n = 19 (86%): | n | % | Discontinuation: | n | % |
| - Chest tightness - Wheeze - Dyspnea - Increased sputum - Increased cough - Flu-like symptoms - Elevated blood pressure - Headache - Nausea - Elevated AST - Anxiety - Bradycardia - Pleuritic chest pain |
14 4 3 3 2 1 5 4 2 1 1 1 1 |
64 18 14 14 9 5 23 18 9 5 5 5 5 |
- Respiratory symptoms - Asymptomatic hypertension - Symptomatic hypertension - Headache - Hypertensive emergency - Anxiety |
3 2 1 1 1 |
14 9 5 5 5 |
|||||
| [61] | Retrospective Cohort United States (1 center) |
Baseline Age Adult - Mean NR CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
82 |
Recruitment Period Jul 2015 to Jun 2016 Follow-Up Duration 12 mo |
See Discontinuation |
Discontinuation: Total overall: - Chest tightness * - Diarrhea ** - Abdominal pain - Nausea ** - Dysphagia - Elevated LFTs - Pericarditis - Allergic reaction ** - Suspected Stevens–Johnson syndrome * n = 3 also had significant drop in ppFEV1 ** n = 1 also discontinued due to chest tightness |
n 17 11 2 1 1 1 1 1 1 1 |
% 21 13 2 1 1 1 1 1 1 1 |
||
| [26] | Retrospective Cohort d,g Australia (7 centers) |
Baseline Age Adult - Mean: 31 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 37% |
72 |
Recruitment Period Nov 2015 to Mar 2017 Follow-Up Duration 12 mo |
n | % | Discontinuation: | n | % | |
| - Chest tightness/dyspnea - Increased sputum - Decrease in ppFEV1 - Headache - Fatigue - Nausea - Rash |
40 4 2 2 5 1 2 |
56 6 3 3 7 1 3 |
- Chest tightness/dyspnea | 22 | 31 | |||||
| [27] | Case Series (Survey) j International (31 centers) |
Baseline Age Adult - Mean: 30 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 59% |
26 |
Recruitment Period Questionnaire sent in 2018–2019 Follow-Up Duration NS |
n | % | Discontinuation: | n | % | |
| - Pulmonary exacerbation - Post-partum acute myelocytic leukemia |
1 1 |
4 4 |
- Chest tightness | 2 | 8 | |||||
a When adult and pediatric patients both included, age range reported when possible; b Rates not reported for all AE, as indicated by ‘NS’; c To avoid redundancy, if AE only reported in context of dose modification, interruption, and/or discontinuation of therapy, it was not listed in overall AE; d Study population part of a compassionate, ‘expanded access’, ‘managed access’, or ‘named patient’ program; e Mean calculated from n = 3 (75%) of study subjects, as baseline not reported for n = 1 (25%); f Frequency of 17% based on n = 12 screened; 8% frequency for overall cohort of n = 26; g Study was case-control, but only LUM/IVA-treated participants included in systematic review; therefore, assessed as cohort study; h Reason for discontinuation was not consistently assessed, and may include reasons unrelated to AE; i Mean baseline age and ppFEV1 based on n = 52 in final analysis of outcomes assessing effectiveness; n = 10 excluded from this analysis; j This case series is included in Table 1 due to results being presented in aggregate. AST, aspartate aminotransferase; CFTR, cystic fibrosis transmembrane conductance regulator; CK, creatine kinase; h, hour(s); LFT, liver function test; mo, month(s); NR, not reported; NS, not specified; ppFEV1, percent predicted Forced Expiratory Volume in 1 sec; RLS, restless leg syndrome; SAE, serious adverse events; ULN, upper limit of normal; URTI, upper respiratory tract infection; wk, week(s); yr, year(s).
In the original article [1], there was a mistake in Table 2 as published. Subtitle “Lumacaftor/Ivacaftor” was wrong. The corrected Table 2 appears below. The authors state that the scientific conclusions are unaffected. The original article has been updated.
Table 2.
Summary of characteristics and results of cohort or survey studies in abstract form.
| Ref | Study Design | Population | n | Overall Adverse Events (AE) a,b | Dose Modification, Interruption, or Discontinuation Due to AE a,b | ||||
|---|---|---|---|---|---|---|---|---|---|
| Ivacaftor | |||||||||
| [62] | Prospective Cohort |
Baseline Age Pediatric - Mean: 5 yr CFTR Genotype ≥1 gating mutation Baseline ppFEV1 Mean NR |
4 | AE in n = 2 (50%): | n | % | None reported | ||
| - URTI - Nasal congestion - Headache |
NS NS NS |
- - - |
|||||||
| [63] | Retrospective Cohort |
Baseline Age Pediatric - Mean: 6 yr CFTR Genotype ≥1 gating mutation Baseline ppFEV1 Median: 87% |
10 |
- Transient rash - Increased obesity |
n 2 1 |
% 20 10 |
None reported |
|
|
| [64] | Prospective Cohort |
Baseline Age Pediatric and Adult - Mean NR CFTR Genotype ≥1 copy S549R Baseline ppFEV1 Mean: 54% |
15 |
- Liver enzyme derangement |
n | % | None reported | ||
| 2 | 13 | ||||||||
| [65] | Cross-sectional Survey |
Baseline Age Adult - Mean: 26 yr CFTR Genotype ≥1G551D Baseline ppFEV1 Mean: 62% |
11 d
|
AE in n = 8 (73%) d: - Transient rash - Dizziness - Unspecified AE |
n NS NS NS |
% - - - |
None reported | ||
| Lumacaftor/Ivacaftor | |||||||||
| [66] | Prospective Cohort |
Baseline Age Pediatric - Mean: 13 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 91% |
14 | n | % | Reduced dose *: | n | % | |
| - Acute drop in ppFEV1
(asymptomatic) - Chest tightness, tachypnea (requiring oxygen) |
1 1 |
7 7 |
- Chest tightness, tachypnea * Eventual titration to full dose |
1 | 7 | ||||
| [67] | Prospective Cohort |
Baseline Age Pediatric - Mean: 14 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 87% |
13 | n | % | None reported | |||
| - Drop in ppFEV1 requiring salbutamol |
7 |
54 |
|||||||
| [68] | Prospective Cohort |
Baseline Age Pediatric and Adult - Mean: 23 yr e CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean 61% e |
369 | n | % | Discontinuation: | n | % | |
| - Bronchospasm - Dyspnea - Abnormal respiration - Unspecified respiratory AE - Unspecified AE |
15 12 7 4 120 |
4 3 2 1 33 |
- Unspecified AE |
16 |
4 |
||||
| [69] | Prospective Cohort |
Baseline Age Pediatric and Adult - Mean: 25 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
311 |
379 AE in n = 213 (68%): - Dyspnea - Cough - GI discomfort (e.g., diarrhea, nausea, abdominal pain) - Headache - Fatigue - Unspecified |
n f NS NS NS NS NS NS |
% 31 6 31 6 5 NR |
Interruption (stop/restart): - Unspecified AE and other reasons g Discontinuation: - Unspecified AE and other reasons g |
n 12 42 |
% 4 14 |
| [35] | Prospective Cohort c |
Baseline Age Adult - Median: 31 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Median: 28% |
14 | n | % | Discontinuation: | n | % | |
| - Chest tightness, breathless - Rash |
7 1 |
50 7 |
- Respiratory AE and/or rash | 4 | 29 | ||||
| [70] | Prospective Cohort |
Baseline Age Adult - Mean NR CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
29 | n | % | Reduced dose: | n | % | |
| - Chest tightness * * n = 4 cases severe, requiring hospitalization for IV steroids and antibiotics |
13 |
45 |
- Chest tightness Discontinuation: - Chest tightness |
2 5 |
7 17 |
||||
| [36] | Prospective Cohort c |
Baseline Age Mean NR h CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
32 | AE in 88%: | n f | % | Interruption (stop/restart): | n | % |
| - Respiratory AE - Drop in ppFEV1 |
NS NS |
87 - |
- Unspecified AEA Discontinuation: - Unspecified AE |
1 8 |
3 25 |
||||
| [71] | Retrospective Cohort |
Baseline Age Pediatric and Adult - Mean NR CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
34 |
AE in n = 29 (85%): - Pulmonary exacerbation - Chest tightness - Dyspnea - Diarrhea - Abdominal pain |
n 16 9 3 3 3 |
% 47 26 9 9 9 |
Discontinuation: - Unspecified AE |
n 10 |
% 29 |
| Serious AE in n = 8 (24%): | |||||||||
| - Respiratory failure i - Unspecified AE |
1 7 |
3 21 |
|||||||
| [72] | Retrospective Cohort |
Baseline Age Pediatric and Adult - Mean: 26 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 68% |
103 | See Discontinuation | Interruption/discontinuation j: | n | % | ||
| - Chest tightness and/or pain - Elevated LFTs |
17 NS |
17 - |
|||||||
| [73] | Retrospective Cohort |
Baseline Age Adult - Mean: 31 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 50% |
71 | AE in n = 41 (58%): | n | % | Discontinuation: | n | % |
| - Chest tightness - Dyspnea - Increased cough - GI (pain, constipation, or diarrhea) - Rash - Pruritus - Irregular menses or metrorrhagia - Breast tension - Headache - Myalgia |
22 8 4 6 4 1 3 2 1 1 |
31 11 6 9 6 1 4 3 1 1 |
- Dyspnea - Chest tightness - Increased cough - Fatigue |
7 6 3 1 |
10 9 4 1 |
||||
| [74] | Retrospective Cohort |
Baseline Age Mean NR h CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
54 | See Discontinuation | Discontinuation: | n | % | ||
|
|
|
- Chest tightness, dyspnea, and/or drop in ppFEV1 |
8 |
15 |
|||||
| [75] | Retrospective Cohort |
Baseline Age Adult - Mean: 31 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
28 |
- Increased work of breathing or chest tightness - Drop in ppFEV1 |
n 12 5 |
% 43 18 |
Discontinuation - Respiratory intolerance vs. pulmonary exacerbation - Persistent respiratory intolerance/chest tightness - Rash and swelling of face - Increased anxiety |
n 1 3 1 1 |
% 4 11 4 4 |
| [76] | Retrospective Cohort |
Baseline Age Adult - Mean NR CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
46 | n | % | Discontinuation: | n | % | |
| - Drop in ppFEV1
- Transaminitis |
21 2 |
46 4 |
- Dyspnea, cough, CFPEx, and/or chest tightness - Transaminitis - Headache - Muscle ache - Fatigue - Rash |
4 1 NS NS NS NS |
9 2 - - - - |
||||
| [77] | Retrospective Cohort |
Baseline Age Adult - Mean NR CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
28 | See Discontinuation | Discontinuation: | n | % | ||
| - SOB and/or drop in ppFEV1 | 15 | 54 | |||||||
| [78] | Retrospective Cohort |
Baseline Age Mean: 32 yr h CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 62% |
20 | Overall AE: | n | % | Interruption (stop/restart): | n | % |
| - Chest tightness - Elevated LFTs - Upset stomach - Increased stool output - Rash - Elevated thyroid function test - RA exacerbation |
NS NS NS NS NS NS NS |
- - - - - - - |
- Unspecified AE - full-dose restart - half-dose restart Discontinuation: - Unspecified AE |
2 4 2 |
10 20 10 |
||||
| [79] | Retrospective Cohort |
Baseline Age Mean NR h CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
60 |
- Heartburn/reflux - Abdominal pain - Loose/oily stools |
n 20 19 17 |
% 33 32 28 |
None reported | ||
| [80] | Retrospective Cohort |
Baseline Age Mean: 29 yr h,k CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 80% k |
34 | See Discontinuation | Discontinuation: | n | % | ||
| Overall total: - Respiratory AE (70%) f - Unspecified reasons g |
11 NS NS |
32 - - |
|||||||
| [81] | Cohort l |
Baseline Age Pediatric - Mean NR CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
39 | n | % | None reported | |||
| - AST >3x ULN | 2 | 5 | |||||||
| [82] | Cohort l |
Baseline Age Pediatric and Adult - Range: 13–48 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
47 | See Discontinuation | Discontinuation: | n | % | ||
| - Thoracic oppression and unspecified AE | 4 | 9 | |||||||
| [83] | Cohort l |
Baseline Age Adult - Mean: 28 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 61% |
46 | See Discontinuation | Discontinuation: | n | % | ||
| - Dyspnea, increased sputum, and unspecified AE | 6 | 13 | |||||||
| [37] | Cohort c,l |
Baseline Age Adult - Mean: 31 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 28% |
30 |
- Drop in ppFEV1 - Dyspnea, chest tightness, or chest pain - Increased sputum *Based on 31 trials of LUM/IVA in 30 patients |
n 30 * 25 * NS |
% 97 81 - |
Discontinuation: - Respiratory AE, unspecified - Hypertension |
n 3 1 |
% 10 3 |
| [84] | Cohort l |
Baseline Age Adult - Mean: 31yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 40% |
8 | See Interruption | Interruption in n = 1 (13%): | n | % | ||
| - Drop in ppFEV1
- Eczema |
1 1 |
13 13 |
|||||||
| [38] | Cohort c,l |
Baseline Age Mean NR h CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
19 | See Discontinuation | Discontinuation: | n | % | ||
| - Chest tightness and dyspnea | 4 |
21 |
|||||||
| [85] | Cross-sectional questionnaire |
Baseline Age Mean NR h CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
11 |
AE in n = 5 (46%): - Increased cough - Chest pain - Trouble breathing - Chest tightness - Stomach pain |
n | % | Discontinuation: | n | % |
| 4 2 2 1 1 |
36 18 18 9 9 |
- Increased cough | 1 | 9 | |||||
| Tezacaftor/Ivacaftor | |||||||||
| [86] | Prospective Cohort |
Baseline Age Pediatric - Mean: 16 yr CFTR Genotype ∆F508 homozygous or heterozygous Baseline ppFEV1 Mean: 82% |
72 | See Discontinuation |
|
|
Discontinuation: Overall total: - New-onset hemoptysis - Persistent nausea/vomiting - Elevated LFTs - Mental health changes - Alterations in blood glucose - Acholic stools |
n 8 NS NS NS NS NS NS |
% 11 - - - - - - |
| [87] | Prospective Cohort |
Baseline Age Mean NR h CFTR Genotype NR Baseline ppFEV1 Mean NR |
50 | n | % | Discontinuation: | n | % | |
| - AE not specified |
5 | 10 | - Liver function abnormalities | 1 | 2 | ||||
| [88] | Prospective Cohort |
Baseline Age Adult - Mean: 34 yr CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean: 51% |
5 m | AE in n = 5 (11%) m: | n | % m | Discontinuation: | n | % m |
| - Sleep pattern disturbance - Out of body experience - Visual hallucination - Depersonalization - “Brain fog” - Severe migraine |
2 1 1 1 1 1 |
5 2 2 2 2 2 |
- Out of body experience, visual hallucination - Depersonalization, “brain fog” - Severe migraine |
1 1 1 |
2 2 2 |
||||
| [89] | Retrospective Cohort |
Baseline Age Adult - Mean NR CFTR Genotype ∆F508/∆F508 Baseline ppFEV1 Mean NR |
18 | See Discontinuation | Discontinuation: | n | % | ||
| - Hair loss and fatigue | 1 | 6 | |||||||
| [39] | Cohort c,l |
Baseline Age Adult - Mean NR CFTR Genotype NR Baseline ppFEV1 Mean: 34% |
22 |
AE in n = 3 (14%): - Rash - Blurred vision - Viral symptoms |
n | % | Discontinued: | n | % |
| 2 1 1 |
9 5 5 |
- Blurred vision | 1 | 5 | |||||
| Elexacaftor/Tezacaftor/Ivacaftor | |||||||||
| [40] | Retrospective Cohort |
Baseline Age Adult - Mean: 36 yr CFTR Genotype ≥1 copy ∆F508 Baseline ppFEV1 Mean: 31% |
11 | n | % | None reported | |||
| - Transaminitis | 4 | 36 | |||||||
a Rates not reported for all AE, as indicated by ‘NS’; b To avoid redundancy, if AE only reported in context of dose modification, interruption, and/or discontinuation of therapy, it was not listed in overall AE; c Study population part of a compassionate, ‘early access’, ‘expanded access’, ‘managed access’, or ‘named patient’ program; d Total study cohort of n = 11, but only n = 9 patients completed symptom questionnaire; AE frequency calculated based on total n = 11, e Mean baseline age and ppFEV1 based on n = 135 in final analysis of outcomes assessing effectiveness; n = 234 excluded from this analysis; f As reported, unable to accurately determine the absolute number of patients who experienced AE; g Frequency of specific reasons for interruption or discontinuation not clear and include reasons unrelated to AE; h Included age groups (i.e., pediatric and/or adult) not specified; i Respiratory failure occurred in 1 individual on two occasions, both within 24 h of initiating and reinitiating LUM/IVA; j Of the n = 25 who stopped, 9 restarted and 6 of experienced the same AE; unclear which AE the 3 who restarted experienced and whether the 6 who experienced the same AE then discontinued permanently; k Mean baseline age and ppFEV1 based on n = 23 in final analysis of outcomes assessing effectiveness; n = 11 excluded from this analysis; l Unable to discern if prospective versus retrospective based on reported information; m Total study cohort of n = 44, but focused on neurocognitive AE in n = 5; AE frequencies calculated based on total n = 44. AST, aspartate aminotransferase; CFTR, cystic fibrosis transmembrane conductance regulator; CFPEx, cystic fibrosis pulmonary exacerbation; GI, gastrointestinal; LFT, liver function test; LUM/IVA, lumacaftor/ivacaftor; NR, not reported; NS, not specified; ppFEV1, percent predicted forced expiratory volume in 1 sec; RA, rheumatoid arthritis; SOB, shortness of breath; ULN, upper limit of normal; URTI, upper respiratory tract infection; yr, year(s).
In the original article [1], there was a mistake in Table A2 as published. Reference citation [48,49,53,54] were wrong. “Talkwalker” was misspelled. The corrected Table A2 appears below. The authors state that the scientific conclusions are unaffected. The original article has been updated.
Table A2.
Summary of methodological ratings of included case series a,b.
| Criteria | McKinzie et al., 2017 [47] | Nash et al., 2020 [27] | Rotolo et al., 2020 [52] | Safirstein et al., 2020 [53] | Talwalkar et al., 2017 [48] |
|---|---|---|---|---|---|
| 1. Study objective clearly stated | Y | Y | N | Y | Y |
| 2. Study population clearly defined, using case definition | N | N | N | N | N |
| 3. Cases consecutive | NR | NR | NR | NR | NR |
| 4. Subjects comparable | CD | CD | CD | N | N |
| 5. Intervention clearly described | Y | Y | Y | Y | Y |
| 6. Outcome measures clearly defined, valid, reliable, implemented consistently | N | N | N | Y | N |
| 7. Adequate length of follow-up | Y | Y | Y | Y | CD |
| 8. Statistical methods well-described | N/A | N/A | N/A | N/A | N |
| 9. Results well-described | Y | N | Y | Y | Y |
| Final rating | Poor | Poor | Fair | Good | Poor |
a Studies were rated against the 9 criteria of the Quality Assessment for Case Series Studies from the National Institutes of Health, National Heart, Lung, and Blood Institute [24] from the standpoint of AE assessment; b Only case series with a full manuscript were assessed for quality. AE, adverse event; CD, cannot determine; N, no; N/A, not applicable; NR, not reported; Y, yes.
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Reference
- 1.Dagenais R.V.E., Su V.C., Quon B.S. Real-World Safety of CFTR Modulators in the Treatment of Cystic Fibrosis: A Systematic Review. J. Clin. Med. 2021;10:23. doi: 10.3390/jcm10010023. [DOI] [PMC free article] [PubMed] [Google Scholar]
