ELX/TEZ/IVA for Cystic Fibrosis

Recruiting at 80 trial locations

Overseen By Medical Information

Age: Any Age

Sex: Any

Trial Phase: Phase 3

Sponsor: Vertex Pharmaceuticals Incorporated

Must be taking: ELX/TEZ/IVA

Disqualifiers: Study drug intolerance, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Pivotal Trial (Near Approval) This treatment is in the last trial phase before FDA approval

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: Unknown

297 Participants Needed

Trial Summary

What is the purpose of this trial?

This study will evaluate the long-term safety, efficacy and pharmacodynamics of ELX/TEZ/IVA in participants with cystic fibrosis (CF) with at least 1 non-F508del ELX/TEZ/IVA-responsive CF transmembrane conductance regulator (CFTR) gene mutation.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

How is the drug ELX/TEZ/IVA unique for treating cystic fibrosis?

ELX/TEZ/IVA is unique because it combines three CFTR modulators (elexacaftor, tezacaftor, and ivacaftor) to improve the function of the CFTR protein in people with cystic fibrosis, especially those with the F508del mutation. This combination has shown significant improvements in lung function and other health outcomes compared to previous treatments. ^{1 2 3 4 5}

Eligibility Criteria

This trial is for people with cystic fibrosis who have at least one non-F508del mutation responsive to the drug combo ELX/TEZ/IVA. Participants should have completed treatment in a previous study or, if interrupted, made it to the last scheduled visit of that study's treatment period.

Inclusion Criteria

Completed study drug treatment in parent study or had study drug interruption(s) in parent study but completed study visits up to the last scheduled visit of the treatment period in the parent study

Exclusion Criteria

You had trouble tolerating the study drug in a previous study.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment Part A

Participants receive ELX/TEZ/IVA in the morning and IVA in the evening

96 weeks

Treatment Part B

Participants continue to receive ELX/TEZ/IVA in the morning and IVA in the evening

96 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• ELX/TEZ/IVA
• IVA

Trial Overview The trial is testing the long-term safety and effectiveness of a drug combination called Elexacaftor/Tezacaftor/Ivacaftor (ELX/TEZ/IVA) for treating cystic fibrosis in patients without the F508del mutation.

Participant Groups

Group I: ELX/TEZ/IVA Experimental Treatment 2 Interventions

Part A: Participants will receive ELX/TEZ/IVA in the morning and IVA in the evening for 96 weeks. Part B: Participants will receive ELX/TEZ/IVA in the morning and IVA in the evening for an additional 96 weeks.

ELX/TEZ/IVA is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Trikafta for:

• Cystic fibrosis in patients aged 2 years and older with at least one copy of the F508del mutation in the CFTR gene or another mutation responsive to treatment

Approved in European Union as Kaftrio for:

• Cystic fibrosis in patients aged 2 years and older with at least one copy of the F508del mutation in the CFTR gene or another mutation responsive to treatment

Approved in Canada as Trikafta for:

• Cystic fibrosis in patients aged 2 years and older with at least one copy of the F508del mutation in the CFTR gene or another mutation responsive to treatment

Who Is Running the Clinical Trial?

Vertex Pharmaceuticals Incorporated

Lead Sponsor

Trials

267

Recruited

36,100+

Dr. David Altshuler

Vertex Pharmaceuticals Incorporated

Chief Medical Officer since 2020

MD, PhD

Dr. Reshma Kewalramani

Vertex Pharmaceuticals Incorporated

Chief Executive Officer since 2020

MD, trained in internal medicine and nephrology

Findings from Research

In a study of 16 cystic fibrosis patients treated with the combination therapy of elexacaftor, tezacaftor, and ivacaftor (ELX-TEZ-IVA), 37.5% developed new acneiform rashes, while 62.5% experienced a relapse or worsening of previous acne, indicating a notable skin-related side effect of this treatment.

Despite the occurrence of acneiform eruptions, most cases were mild and manageable with treatments like topical medications and isotretinoin, leading to partial or complete remission in 85.7% of patients reevaluated.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acneiform Eruption Following Elexacaftor-Tezacaftor-Ivacaftor Treatment in Patients With Cystic Fibrosis. Okroglic, L., Sohier, P., Martin, C., et al.[2023]

In a study of 13 lung transplant recipients (LTRs) using elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA), the therapy was found to be poorly tolerated, with 38.4% of patients discontinuing due to issues like declining pulmonary function and mood disturbances.

Despite the challenges, 46.2% of patients reported improvements in sinus symptoms and a significant reduction in tacrolimus dose requirements (by 50%), indicating some therapeutic benefit for extrapulmonary cystic fibrosis manifestations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Poor tolerability of cystic fibrosis transmembrane conductance regulator modulator therapy in lung transplant recipients. Doligalski, CT., McKinzie, CJ., Yang, A., et al.[2022]

In a study of 19 cystic fibrosis patients treated with elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) for 6 months, significant improvements were observed in lung structure, including reduced bronchial wall thickening and mucus plugging, as assessed by MRI.

Patients also showed marked clinical benefits, including improved respiratory function (FEV1% increased from 58.5% to 71.4%), better body mass index, and reduced pulmonary exacerbations, confirming the efficacy of ELX/TEZ/IVA in managing cystic fibrosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Structural changes in lung morphology detected by MRI after modulating therapy with elexacaftor/tezacaftor/ivacaftor in adolescent and adult patients with cystic fibrosis. Fainardi, V., Skenderaj, K., Ciuni, A., et al.[2023]

In a study of 16,116 cystic fibrosis patients treated with elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) for an average of 20.4 months, there was a significant 79% reduction in pulmonary exacerbations and a 74% reduction in hospitalizations compared to the 5-year pre-treatment period.

The treatment also led to sustained improvements in lung function (average increase of 8.9 percentage points in forced expiratory volume in 1 second by Year 2), increased body mass index, and a notable decrease in the rates of death (72% lower) and lung transplantation (85% lower) compared to the year before the treatment became available.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Real-world safety and effectiveness of elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis: Interim results of a long-term registry-based study. Bower, JK., Volkova, N., Ahluwalia, N., et al.[2023]

In a study involving eight cystic fibrosis patients with the N1303K mutation, treatment with elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) led to significant improvements in lung function, with an average increase of 18.4 percentage points in forced expiratory volume after 8 weeks.

The treatment also resulted in a notable increase in body mass index (BMI) and improvements in CFTR channel activity in intestinal organoids, indicating that ELX/TEZ/IVA can provide clinical benefits for patients with the N1303K mutation, despite it not being included in the original list of responsive mutations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical and functional efficacy of elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis carrying the N1303K mutation. Sadras, I., Kerem, E., Livnat, G., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

Acneiform Eruption Following Elexacaftor-Tezacaftor-Ivacaftor Treatment in Patients With Cystic Fibrosis. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Poor tolerability of cystic fibrosis transmembrane conductance regulator modulator therapy in lung transplant recipients. [2022]

3. England pubmed.ncbi.nlm.nih.gov

Structural changes in lung morphology detected by MRI after modulating therapy with elexacaftor/tezacaftor/ivacaftor in adolescent and adult patients with cystic fibrosis. [2023]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Real-world safety and effectiveness of elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis: Interim results of a long-term registry-based study. [2023]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Clinical and functional efficacy of elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis carrying the N1303K mutation. [2023]