DEPRESSION AND ANXIETY SYMPTOMS FOLLOWING
ELEXACAFTOR/TEZACAFTOR/IVACAFTOR IN ADULTS WITH CYSTIC FIBROSIS
Abstract
Background: Elexacaftor/tezacaftor/ivacaftor (E/T/I), has
broadened access to life-changing pharmacotherapy for people living with
cystic fibrosis (plwCF). However, case reports suggest CFTR modulators
may induce psychiatric adverse symptoms. To systematically examine this,
we studied depression and anxiety symptoms before and after initiation
of E/T/I. Methods: Patient Health Questionnaire-9 (PHQ-9,
depression symptoms) and Generalized Anxiety Disorder-7 (GAD-7, anxiety
symptoms) scores recorded in a clinic database were studied. Patients
who had scores collected pre- and post-E/T/I initiation were included.
Mean total score changes were calculated for each questionnaire, and
regression analyses described associations between score changes and
age, race, ethnicity, sex, CFTR mutation, and prior depression and/or
anxiety diagnoses. Secondary analyses examined the possible confounding
effects of the SARS-CoV-2 (COVID-19) pandemic. Results:
Eighty-six patients were included. Mean GAD-7 and PHQ-9 total scores did
not change from pre-initiation (4.90 ± 5.31 and 4.98 ± 5.77,
respectively) to post-initiation (5.27 ± 5.59 and 4.82 ± 5.55,
respectively). Although patients (N = 40) evaluated prior to the
COVID-19 pandemic showed a significant worsening of GAD-7 scores
post-E/T/I initiation, this difference was not observed in the overall
cohort (N=92). Pre-existent anxiety, depression, or other clinical
factors did not predict an increased risk of mental health symptoms
post-E/T/I initiation. Conclusions: Treatment with E/T/I does
not lead to changes in depression or anxiety symptoms at the population
level. No clinical predictors were identified to stratify potential
risk. Overall, these findings are reassuring for clinicians and pwCF
when deciding about initiating E/T/I treatment.