Trikafta in Cystic Fibrosis Patients

• Status: Recruiting
• Trial end date: 2023-05-01
• Target enrollment: 0
• Participant gender: All

Summary

Cystic Fibrosis (CF) is a life threatening genetic disorder resulting from mutations found in the gene known as the cystic fibrosis transmembrane conductance regulator (CFTR). This clinical study will enroll 22 participants without the F508del mutation, carrying partial function mutations not approved for Trikafta, and who are not expected to be approved for CFTR modulator treatment in the immediate future. Each participant will be given Trikafta for approximately four weeks. The study researchers will monitor clinical endpoints that include forced expiratory volume (FEV1), sweat chloride, and nasal potential difference. Additionally, the researchers will obtain skin biopsy material from each subject so that induced pluripotent stem (iPS) cells can be modified into airway cell monolayers and tested for response to Trikafta. In this way, the study will evaluate an emerging and readily accessible in vitro endpoint as a predictor of clinical response. This study will serve as a pilot/test case for other clinical protocols relevant to patients with rare CFTR variants who do not currently receive modulator therapies. It is hypothesized that a robust correlation will be established between in vitro Trikafta responsiveness of iPS cells and in vivo benefit (FEV1) to patients, and will provide a new tool for utilizing iPS to identify patient populations most suitable for cystic fibrosis modulator therapy.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Emory University
• Collaborator: National Heart, Lung, and Blood Institute (NHLBI)
• Treatments: Elexacaftor; Ivacaftor

Criteria

Inclusion Criteria:

• Provision of signed and dated informed consent form or assent form

• Stated willingness to comply with all study procedures and availability for the duration of the study

• Male or female age ≥12

• A clinical diagnosis of CF or CFTR-related disease and evidence for a partial function mutation not currently covered or likely to be covered for FDA treatment with a CFTR modulator

• A diagnosis of CF as defined by current guidelines: one or more clinical features consistent with the CF phenotype or positive CF newborn screen AND one or more of the following criteria: sweat chloride ≥ 60 mmol/L by quantitative pilocarpine iontophoresis or 2 well characterized disease-causing CFTR gene mutations

• Or, with the consensus of two study co-investigator physicians, a clinical diagnosis of CF or CFTR-related disorder with documented evidence of chronic pulmonary disease (chronic cough with sputum production, persistent pulmonary radiographic abnormalities (e.g bronchiectasis), chronic abnormality in percent predicted FEV1 (ppFEV1), and/or persistent colonization with a typical CF pathogen)

• Sweat Chloride < 80 mmol/L and/or pancreatic sufficiency as indicated by no exogenous pancreatic enzyme supplement therapy

• FEV1% predicted ≤ 90 using equations of the Global Lung Function Initiative (GLI) and meeting American Thoracic Society (ATS) criteria for acceptability and repeatability

• Clinically stable in the past 4 weeks with no evidence of CF exacerbation (prior to screening and study Day 1)

• Willingness to use at least one form of acceptable birth control including abstinence or condom with spermicide. This will include birth control for at least one month prior to screening and agreement to use such a method during study participation for an additional four weeks after the last administration of study drug

• Ability to take Trikafta

• Agreement to adhere to all current medical therapies as designated by the CF care center physician

Exclusion Criteria:

• Documented history of drug or alcohol abuse within the last year

• Subjects should not have a pulmonary exacerbation or changes in therapy for pulmonary disease in the 4 weeks prior to screening

• Listed for lung or liver transplant at the time of screening

• Cirrhosis or elevated liver transaminases > 3 times the upper limit of normal

• Pregnant or breastfeeding

• Inhibitors or inducers of CYP3A4, including certain herbal medications and grapefruit/grapefruit juice, or other medicines known to negatively influence Trikafta administration

• History of solid organ transplant

• Active therapy for non-tuberculosis mycobacterial infection or any plan to intiate non-tuberculosis mycobacterial therapies during the study period

• Known allergy to Trikafta

• Treatment in the last 6 months with either Kalydeko, Orkambi or Symdeko

• Any other condition that in the opinion of the lead investigators might confound results of the study or pose an additional risk from administering study drug

• Treatment with another investigational drug or other intervention within one month prior to enrollment, throughout the duration of study participation, and for an additional four weeks following final drug administration

• Evidence of cataract/lens opacity determined to be clinically significant by an ophthalmologist at or within 3 months prior to the Screening Visit