: TRANSITION: An Observational Study of Transition From Lumacaftor/Ivacaftor to Tezacaftor/Ivacaftor (Tez/Iva)

: TRANSITION: An Observational Study of the Effects on Sweat Chloride and Clinical Outcomes of Transition From Lumacaftor/Ivacaftor to Tezacaftor/Ivacaftor (Tez/Iva)

Status

Completed

Phases

Unknown

Study type

Observational

Source

ClinicalTrials.gov

Registry ID

NCT03445793

Enrollment

Registered

2018-02-26

Start date

2018-03-01

Completion date

2019-11-01

Last updated

2024-01-23

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Cystic Fibrosis (CF)

Keywords

DeltaF508deletion (F508del) mutation in 2 copies

Brief summary

This study is a single center study of clinical and laboratory outcomes in patients ≥ 12 who transition from use of Orkambi to tez/iva. Clinical and laboratory measurements will be measured at baseline, 1 month, 3 months, and 6 months after initiation of tez/iva. Change from baseline at 6 months pre-specified will be reported. The length of study participation will be approximately 6 months.

Detailed description

While cystic fibrosis (CF) therapeutic development previously targeted the signs and symptoms of the disease, in the last 5 years, two drugs that treat the basic defect in CF have been approved, ivacaftor (iva) and lumacaftor/ivacaftor (lum/iva). This class of drugs, deemed cystic fibrosis transmembrane conductance regulator (CFTR) modulators, variably improve CFTR function as measured by pilocarpine iontophoresis and sweat collection, and clinical outcomes including lung function, body mass index (BMI), rate of exacerbations and patient reported quality of life. In patients with the G551D mutation who received iva, there was a marked decrease in sweat chloride and marked improvement in lung function as measured by absolute change from baseline of percent predicted expiratory volume in 1 second (ppFEV1). The clinical outcomes assessed in the phase III studies of lum/iva and tez/iva were similar, and included lung function, rate of pulmonary exacerbations, BMI, and CFQ-R scores. While the correlation between improvement in sweat chloride and lung function is poor, and a minimum threshold for change in sweat chloride that correlates with clinical outcomes has yet to be defined, it has also not been determined if an increase in sweat chloride caused by a transition from one drug to another would adversely impact clinical outcomes. Outcomes between the phase III studies of lum/iva and tez/iva were similar, tez/iva has three advantages that are likely to make it more appealing to patients and providers than lum/iva including positive clinical efficacy data, fewer drug-drug interactions, and an improved tolerance profile. Following tez/iva approval, a rapid uptake of tez/iva for patients homozygous for F508del CFTR is expected; as a result of the transition from lum/iva to tez/iva, sweat chloride will increase possibly resulting in an adverse impact on clinical outcomes. This study aims to determine the rationale for patient transition from lum/iva to tez/iva, in addition to evaluate the impact of transition on CFTR function, pulmonary health, gastrointestinal health, and general health. While it is possible that there will be no change in sweat chloride or small changes that are without clinical significance, systematic collection of data as patients transition from lum/iva to tez/iva would permit rapid identification of any safety issues. Because the U.S. always leads the way with approval and reimbursement of new therapeutics, our experience with this transition will help guide its conduct for physicians and patients in the rest of the world.

Interventions

None listed

Study design

Observational model

COHORT

Time perspective

PROSPECTIVE

Eligibility

Sex/Gender

ALL

Age

12 Years to No maximum

Healthy volunteers

Inclusion criteria

* Confirmed diagnosis of CF * Male or female subjects greater than or equal to 12 years of age * Ability to reproducibly perform spirometry testing * Physician decision to treat with tezacaftor/ivacaftor (Smydeko) * Ability to understand and sign a written informed consent or assent and comply with the requirements of the study * Continuous use of orkambi for at least 1 month prior to visit 1

Exclusion criteria

* History of hypersensitivity to tezacaftor and/or ivacaftor * Presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the patient or the quality of the data * Any acute lower respiratory symptoms treated with oral, inhaled or intravenous antibiotics (IV) or systemic corticosteroids within the 2 weeks prior to Visit 1 * Major or traumatic surgery within 12 weeks prior to Visit 1 * For women of child-bearing potential: a positive pregnancy test at Visit 1 * Unable or unwilling to fast (including no enteric tube feedings) for at least 6 hours prior each visit * Initiation of any new chronic therapy within 4 weeks prior to Visit 1 * Use of an investigational agent within 28 days prior to Visit 1 * Use of chronic oral corticosteroids within 28 days prior to Visit 1 * Treatment for nontuberculous mycobacterial (NTM) infection, consisting of greater than or equal to two antibiotics (oral, IV, and/or inhaled) within 28 days prior to Visit 1 * History of lung or liver transplantation, or listing for organ transplantation

Design outcomes

Primary

Measure	Time frame	Description
Change in Sweat Chloride Concentration in Millimoles/Liter From Baseline at 6 Months Pre-specified to be Reported	Baseline to 6 months	Sweat chloride is a measure of cystic fibrosis transmembrane conductance regulator function. The calculations represent the average change from baseline to the average change at 6 months.

Secondary

Measure	Time frame	Description
Rationale for Transition Per Subject Questionnaire	1 day (the questionnaire is done once at visit 1)	Questionnaire to determine the subject's reason for transition to tezacaftor/ivacaftor from lumacaftor/ivacaftor
Pulmonary Exacerbations	One year prior to study entry (time of consent) and during study participation	Number of pulmonary exacerbations requiring oral or IV antibiotics
Change in Percent Predicted (ppFEV1) Value From Baseline at 6 Months Pre-specified to be Reported	Baseline to 6 months	Pulmonary function by spirometry, percent predicted forced expiratory volume in 1 second. The calculations represent the average change from baseline to the average change at 6 months.
Change in Cystic Fibrosis Questionnaire-Revised (CFQ-R) Respiratory Domain Score From Baseline at 6 Months	Baseline to 6 months	CF-related quality of life measure is a validated, CF specific, patient reported outcome (PRO). This portion of the PRO is specific to respiratory symptoms. The scaled score for each domain ranges from 0 (worst condition) to 100 (best condition), with higher scores indicating better health in respiratory domain.
Rationale for Transition Per Physician Questionnaire	1 day (the questionnaire is done once at visit 1)	Questionnaire to determine the treating physician's reason for transition to tezacaftor/ivacaftor from lumacaftor/ivacaftor
Change in BMI in kg/m^2 From Baseline at 6 Months Pre-specified to be Reported	Baseline to 6 months	BMI is a reflection of nutrition status in CF and is expected to improve with CFTR modulation. The calculations represent the average change from baseline to the average change at 6 months.
Number of People With Undetectable or Normal Fecal Elastase Measurements at 6 Months Pre-specified to be Reported	6 months	Fecal elastase in micrograms/gram. Fecal elastase is a measure of pancreatic function: Less than 100 mcg/g indicates severe exocrine pancreatic insufficiency, 100-200 mcg/g indicates moderate to mild insufficiency, greater than 200 indicates normal pancreatic function. The count represents the number of participants with either an undetectable fecal elastase level or normal level at 6 months, indicating change in pancreatic function at 6 months.
Change in Gastrointestinal Symptom Tracker Score From Baseline to 6 Months	Baseline to 6 months	The Exocrine Pancreatic Insufficiency (EPI) GI Symptom Tracker is meant to measure the impact treatment is having on GI symptoms, perceived by person completing the tracker. Participants answer 24 symptom questions on a scale from almost always to never (scale 4 to 1). Higher scores reflect more challenges/problems related to GI symptoms. For purposes of this outcome measure, subscales were combined to compute a total score (minimum score 24, maximum score 96). The difference of total scores from baseline at 6 months were calculated to measure average overall change in GI symptoms.
Change in Weight in Kilograms From Baseline at 6 Months Pre-specified to be Reported	Baseline to 6 months	Weight is a reflection of nutrition status in CF and is expected to improve with CFTR modulation. The calculations represent the average change from baseline to the average change at 6 months.

Countries

United States

Participant flow

Recruitment details

Single center recruitment from March 2018 until November 2019.

Pre-assignment details

Participant must complete baseline visit while on lumacaftor/ivacaftor prior to transition to tezacaftor/ivacaftor.

Participants by arm

Arm	Count
Observational Participants who have cystic fibrosis and are clinically stable at time of transition from Lumacaftor/Ivacaftor to tezacaftor/ivacaftor as a continuous treatment as determined by their clinical physician.	5
Total	5

Baseline characteristics

Characteristic	Observational
Age, Continuous	28.4 years STANDARD_DEVIATION 1.14
BMI	22.3 kg/m^2 STANDARD_DEVIATION 1.5
Cystic Fibrosis Mutation Type Heterozygous for F508del	0 Participants
Cystic Fibrosis Mutation Type Homozygous for F508del	5 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants
Race (NIH/OMB) Asian	0 Participants
Race (NIH/OMB) Black or African American	0 Participants
Race (NIH/OMB) More than one race	0 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants
Race (NIH/OMB) White	5 Participants
Sex: Female, Male Female	2 Participants
Sex: Female, Male Male	3 Participants

Adverse events

Event type	EG000 affected / at risk
deaths Total, all-cause mortality	0 / 5
other Total, other adverse events	2 / 5
serious Total, serious adverse events	3 / 5

Outcome results

Primary

Change in Sweat Chloride Concentration in Millimoles/Liter From Baseline at 6 Months Pre-specified to be Reported

Sweat chloride is a measure of cystic fibrosis transmembrane conductance regulator function. The calculations represent the average change from baseline to the average change at 6 months.