The Rapid Reduction of Infection-Related Visits and Antibiotic Use Among People With Cystic Fibrosis After Starting Elexacaftor-Tezacaftor-Ivacaftor.

Abstract

BACKGROUND:

People with cystic fibrosis (CF) routinely suffer from recurrent sinopulmonary infections. Such infections require frequent courses of antimicrobials and often involve multidrug-resistant organisms. The goal of this study was to identify real-world evidence for the effectiveness of elexacaftor-tezacaftor-ivacaftor (ELX/TEZ/IVA) in decreasing infection-related visits and antimicrobial use in people with CF.

METHODS:

Using IBM MarketScan data, we identified 389 enrollees with CF who began taking ELX/TEZ/IVA before 1 December 2019 and were enrolled from 1 July 2019 to 14 March 2020. We also identified a comparison population who did not begin ELX/TEZ/IVA during the study period. We compared the following outcomes in the 15 weeks before and after medication initiation: total healthcare visits, inpatient visits, infection-related visits, and antimicrobial prescriptions. We analyzed outcomes using both a case-crossover analysis and a difference-in-differences analysis, to control for underlying trends.

RESULTS:

For the case-crossover analysis, ELX/TEZ/IVA initiation was associated with the following changes over a 15-week period: change in overall healthcare visit dates, -2.5 (95% confidence interval, -3.31 to -1.7); change in inpatient admissions, -0.16 (-.22 to -.10); change in infection-related visit dates, -0.62 (-.93 to -.31); and change in antibiotic prescriptions, -0.78 (-1.03 to -.54). Results from the difference-in-differences approach were similar.

CONCLUSIONS:

We show a rapid reduction in infection-related visits and antimicrobial use among people with CF after starting a therapy that was not explicitly designed to treat infections. Currently, there are >30 000 people living with CF in the United States alone. Given that this therapy is effective for approximately 90% of people with CF, the impact on respiratory infections and antimicrobial use may be substantial.

• Authors: Aaron C Miller, Logan M Harris, Joseph E Cavanaugh, Mahmoud Abou Alaiwa, David A Stoltz, Douglas B Hornick, Philip M Polgreen
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 75 Issue 7 Pg. 1115-1122 (09 30 2022) ISSN: 1537-6591 [Electronic] United States
• PMID: 35142340 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Chemical References

• Aminophenols
• Anti-Bacterial Agents
• Benzodioxoles
• Chloride Channel Agonists
• Indoles
• Pyrazoles
• Pyridines
• Pyrrolidines
• Quinolones
• tezacaftor
• Cystic Fibrosis Transmembrane Conductance Regulator
• ivacaftor
• elexacaftor

Topics

• Aminophenols (therapeutic use)
• Anti-Bacterial Agents (therapeutic use)
• Benzodioxoles
• Chloride Channel Agonists (therapeutic use)
• Cystic Fibrosis (complications, drug therapy)
• Cystic Fibrosis Transmembrane Conductance Regulator (genetics, therapeutic use)
• Humans
• Indoles
• Mutation
• Pyrazoles
• Pyridines
• Pyrrolidines
• Quinolones