Original Research: Genetic and Developmental Disorders |

Effects of Ivacaftor in Patients With Cystic Fibrosis Who Carry the G551D Mutation and Have Severe Lung DiseaseIvacaftor in Severe Cystic Fibrosis

Peter J. Barry, MBBCh; Barry J. Plant, MD; Arjun Nair, MBChB; Stephen Bicknell, MBChB; Nicholas J. Simmonds, MD; Nicholas J. Bell, MBChB; Nadia T. Shafi, MD; Thomas Daniels, MD; Susan Shelmerdine, MBBS; Imogen Felton, MBBS; Cedric Gunaratnam, MBBCh; Andrew M. Jones, MD; Alex R. Horsley, PhD
Author and Funding Information

From the University Hospital of South Manchester NHS Foundation Trust (Drs Barry, Jones, and Horsley), Manchester, England; Royal College of Physicians of Ireland (Dr Barry), Dublin, Ireland; Cork University Hospital (Dr Plant), University College Cork, Cork, Ireland; Royal Brompton Hospital and Imperial College (Drs Nair, Simmonds, Shelmerdine, and Felton), London, England; Gartnavel General Hospital (Dr Bicknell), Glasgow, Scotland; Bristol Adult Cystic Fibrosis Centre (Dr Bell), Bristol, England; Papworth Hospital (Dr Shafi), Cambridge, England; University Hospital Southampton (Dr Daniels), Southampton, England; Beaumont Hospital (Dr Gunaratnam), Dublin, Ireland; and the University of Manchester, Manchester Academic Health Science Centre (Dr Horsley), University Hospital of South Manchester NHS Foundation Trust, Manchester, England.

CORRESPONDENCE TO: Alex R. Horsley, PhD, Manchester Adult Cystic Fibrosis Center, University Hospital of South Manchester, Wythenshawe, Manchester, M23 9LT, England; e-mail: alexander.horsley@manchester.ac.uk

FUNDING/SUPPORT: This study was supported by the Manchester Adult Cystic Fibrosis Centre. Dr Horsley is funded by a National Institute for Health Research Clinician Scientist award [NIHR CS012-013].

Some of the data included in this manuscript have been published in abstract form (Barry P, Plant B, Nair A, et al. J Cyst Fibros. 2013;12[1]:S15 and Barry P, Plant B, Simmonds NJ, et al. J Cyst Fibros. 2013;12[1]:S62) and presented at the European Cystic Fibrosis Conference, June 12-15, 2013, Lisbon, Portugal, and at the North American Cystic Fibrosis Conference, October 17-19, 2013, Salt Lake City, UT.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2014;146(1):152-158. doi:10.1378/chest.13-2397
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BACKGROUND:  The development of ivacaftor represents a significant advance in therapeutics for patients with cystic fibrosis (CF) who carry the G551D mutation. Patients with an FEV1 < 40% predicted represent a considerable proportion of eligible patients but were excluded from phase 3 clinical trials, and the effectiveness of the drug in this population is, therefore, unknown.

METHODS:  Data were collected from adult CF centers in the United Kingdom and Ireland with patients enrolled in an ivacaftor compassionate use program (FEV1 < 40% or on lung transplant waiting list). Clinically recorded data were collated from patient records for 1 year prior and for a period of 90 to 270 days following ivacaftor commencement. Each patient was matched to two control subjects who would have met the requirements for the compassionate use program with the exception of genotype.

RESULTS:  Twenty-one patients received ivacaftor for a median of 237 days. Mean FEV1 improved from 26.5% to 30.7% predicted (P = .01), representing a 16.7% relative improvement. Median weight improved from 49.8 to 51.6 kg (P = .006). Median inpatient IV antibiotic days declined from 23 to 0 d/y (P = .001) and median total IV treatment days decreased from 74 to 38 d/y (P = .002) following ivacaftor. Changes in pulmonary function and IV antibiotic requirements were significant compared with control subjects.

CONCLUSIONS:  Ivacaftor was clinically effective in patients with CF who carry the G551D mutation and have severe pulmonary disease. The reductions in treatment requirements were clinically and statistically significant and have not been described in less severe populations.

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