Impact of elexacaftor/tezacaftor/ivacaftor on vitamin D absorption in cystic fibrosis patients

Pediatr Pulmonol. 2022 Mar;57(3):655-657. doi: 10.1002/ppul.25781. Epub 2021 Dec 12.

Abstract

Background: Cystic fibrosis (CF) is a multisystem disorder that results in the buildup of mucus in various organs. Ninety percent of CF patients are classified as pancreatic insufficient, leading to malabsorption of nutrients and fat-soluble vitamins without the assistance of exogenous pancreatic enzymes. This study was designed to determine if serum 25-hydroxyvitamin D concentrations were impacted by initiation of elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA).

Methods: Serum 25-hydroxyvitamin D concentrations were measured before and 1 year post-ELX/TEZ/IVA initiation. A Wilcoxon signed-rank test was used to compare values.

Results: Seventy-six patients were included in the final analysis. The average age of our population was 25.8 years (SD = 13.2 years) with a majority being male, homozygous F508del, pancreatic insufficient, and not modulator-naive. The median increase of serum vitamin D concentration after initiating ELX/TEZ/IVA was 5 ng/ml (interquartile range = -4, 13; p = .0035).

Conclusions: We suggest that ELX/TEZ/IVA may improve fat-soluble vitamin absorption, specifically serum 25-hydroxyvitamin D. These results may lead to adjustments in vitamin supplementation in patients receiving cystic fibrosis transmembrane conductance regulator modulator therapy.

Keywords: CFTR modulators; cystic fibrosis; vitamins and nutrition.

MeSH terms

  • Adolescent
  • Adult
  • Aminophenols / therapeutic use
  • Benzodioxoles / therapeutic use
  • Child
  • Chloride Channel Agonists / therapeutic use
  • Cystic Fibrosis Transmembrane Conductance Regulator / genetics
  • Cystic Fibrosis* / complications
  • Cystic Fibrosis* / drug therapy
  • Female
  • Humans
  • Indoles
  • Male
  • Mutation
  • Pyrazoles
  • Pyridines
  • Pyrrolidines
  • Quinolones
  • Vitamin D / therapeutic use
  • Vitamins / therapeutic use
  • Young Adult

Substances

  • Aminophenols
  • Benzodioxoles
  • Chloride Channel Agonists
  • Indoles
  • Pyrazoles
  • Pyridines
  • Pyrrolidines
  • Quinolones
  • Vitamins
  • tezacaftor
  • Cystic Fibrosis Transmembrane Conductance Regulator
  • Vitamin D
  • ivacaftor
  • elexacaftor