Short-term effects of Lumacaftor/Ivacaftor (Orkambi™) on exertional symptoms, exercise performance, and ventilatory responses in adults with cystic fibrosis

Bradley S Quon, Andrew H Ramsook, Satvir S Dhillon, Reid A Mitchell, Kyle G Boyle, Pearce G Wilcox, Jordan A Guenette, Bradley S Quon, Andrew H Ramsook, Satvir S Dhillon, Reid A Mitchell, Kyle G Boyle, Pearce G Wilcox, Jordan A Guenette

Abstract

Rationale: Lumacaftor/ivacaftor (LUM/IVA) modestly improves lung function following 1 month of treatment but it is unknown if this translates into improvements in exercise endurance and exertional symptoms.

Methods: Adult CF participants completed a symptom-limited constant load cycling test with simultaneous assessments of dyspnea and leg discomfort ratings pre- and 1 month post-initiation of LUM/IVA.

Results: Endurance time, exertional dyspnea and leg discomfort ratings at submaximal exercise did not change significantly. There was a significant inverse correlation between changes in leg discomfort and endurance time (r = - 0.88; p = 0.009) following 1-month of LUM/IVA.

Conclusions: Overall, 1-month of LUM/IVA did not increase endurance time or modify exertional dyspnea or leg discomfort ratings. However, individuals who experienced a reduction in leg discomfort following LUM/IVA had an improvement in endurance time. Future studies with a larger sample size are needed to verify these findings and to assess the long-term effects of LUM/IVA on exercise outcomes.

Trial registration: ClinicalTrials.gov Identifier: NCT02821130. Registered July 1, 2016.

Conflict of interest statement

B.S.Q has received consulting fees from Vertex Pharmaceuticals and advisory board fees from Proteostasis Therapeutics.

References

    1. Nixon PA, Orenstein DM, Kelsey SF, Doershuk CF. The prognostic value of exercise testing in patients with cystic fibrosis. N Engl J Med. 1992;327:1785–1788. doi: 10.1056/NEJM199212173272504.
    1. Hebestreit H, Hulzebos EHJ, Schneiderman JE, Karila C, Boas SR, Kriemler S, Dwyer T, Sahlberg M, Urquhart DS, Lands LC, Ratjen F, Takken T, Varanistkaya L, Rucker V, Hebestreit A, Usemann J, Radtke T, Prognostic Value of CiCFSG Cardiopulmonary exercise testing provides additional prognostic information in cystic fibrosis. Am J Respir Crit Care Med. 2019;199:987–995. doi: 10.1164/rccm.201806-1110OC.
    1. Wainwright CE, Elborn JS, Ramsey BW, Marigowda G, Huang X, Cipolli M, Colombo C, Davies JC, De Boeck K, Flume PA, Konstan MW, McColley SA, McCoy K, McKone EF, Munck A, Ratjen F, Rowe SM, Waltz D, Boyle MP, Group TS. Group TS Lumacaftor/Ivacaftor in patients with cystic fibrosis homozygous for Phe508del CFTR. N Engl J Med. 2015;373:220–231. doi: 10.1056/NEJMoa1409547.
    1. Taylor-Cousar JL, Munck A, McKone EF, van der Ent CK, Moeller A, Simard C, Wang LT, Ingenito EP, McKee C, Lu Y, Lekstrom-Himes J, Elborn JS. Tezacaftor-Ivacaftor in patients with cystic fibrosis homozygous for Phe508del. N Engl J Med. 2017;377:2013–2023. doi: 10.1056/NEJMoa1709846.
    1. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–381.
    1. Gruet M, Troosters T, Verges S. Peripheral muscle abnormalities in cystic fibrosis: etiology, clinical implications and response to therapeutic interventions. J Cyst Fibros. 2017;16:538–552. doi: 10.1016/j.jcf.2017.02.007.
    1. Lands LC, Heigenhauser GJ, Jones NL. Analysis of factors limiting maximal exercise performance in cystic fibrosis. Clin Sci (Lond) 1992;83:391–397. doi: 10.1042/cs0830391.
    1. Quon BS, Wilkie SS, Molgat-Seon Y, Schaeffer MR, Ramsook AH, Wilcox PG, Guenette JA. Cardiorespiratory and sensory responses to exercise in adults with mild cystic fibrosis. J Appl Physiol (1985) 2015; 119: 1289–1296.
    1. Edgeworth D, Keating D, Ellis M, Button B, Williams E, Clark D, Tierney A, Heritier S, Kotsimbos T, Wilson J. Improvement in exercise duration, lung function and well-being in G551D-cystic fibrosis patients: a double-blind, placebo-controlled, randomized, cross-over study with ivacaftor treatment. Clin Sci (Lond) 2017;131:2037–2045. doi: 10.1042/CS20170995.
    1. Puente-Maestu L, Palange P, Casaburi R, Laveneziana P, Maltais F, Neder JA, O'Donnell DE, Onorati P, Porszasz J, Rabinovich R, Rossiter HB, Singh S, Troosters T, Ward S. Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement. Eur Respir J. 2016;47:429–460. doi: 10.1183/13993003.00745-2015.
    1. Savi D, Schiavetto S, Simmonds NJ, Righelli D, Palange P. Effects of Lumacaftor/Ivacaftor on physical activity and exercise tolerance in three adults with cystic fibrosis. J Cyst Fibros. 2019;18:420–424. doi: 10.1016/j.jcf.2019.03.001.
    1. McKone EF, Barry SC, FitzGerald MX, Gallagher CG. Reproducibility of maximal exercise ergometer testing in patients with cystic fibrosis. Chest. 1999;116:363–368. doi: 10.1378/chest.116.2.363.

Source: PubMed

3
Subskrybuj