Skip to main content
Journal of Clinical Medicine logoLink to Journal of Clinical Medicine
. 2022 Jan 10;11(2):318. doi: 10.3390/jcm11020318

Correction: Dagenais et al. Real-World Safety of CFTR Modulators in the Treatment of Cystic Fibrosis: A Systematic Review. J. Clin. Med. 2021, 10, 23

Renée V E Dagenais 1,2,*, Victoria C Su 1,2, Bradley S Quon 1,3,4
PMCID: PMC8779097  PMID: 35054167

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.

Footnotes

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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]

Articles from Journal of Clinical Medicine are provided here courtesy of Multidisciplinary Digital Publishing Institute (MDPI)

RESOURCES