Research and Reports in Pulmonology

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.
Reach Us +44-1518-081136

Mini Review - Research and Reports in Pulmonology (2022) Volume 3, Issue 3

Pharmacokinetic-Led Guidance for Patients with Cystic Fibrosis Taking Elexacaftor-Tezacaftor-Ivacaftor with Nirmatrelvir-Ritonavir

Duarte Afonso*

Department of Medicine, University of Coimbra, Coimbra, Portugal

*Corresponding Author:
Duarte Afonso
Department of Medicine
University of Coimbra, Coimbra, Portugal

Received: 11-May-2022, Manuscript No. AARRP-22-67438; Editor assigned: 13-May-2022, PreQC No. AARRP-22-67438(PQ); Reviewed: 27-May-2022, QC No. AARRP-22-67438; Revised: 03-Jun-2022, Manuscript No. AARRP-22-67438(R); Published: 10-Jun-2022, DOI:10.35841/aarrp-3.3.112

Citation: Afonso D. Pharmacokinetic-led guidance for patients with cystic fibrosis taking elexacaftor-tezacaftor-ivacaftor with nirmatrelvirritonavir. Res Rep Pulomonol. 2022;3(3):112

Visit for more related articles at Research and Reports in Pulmonology


Cystic fibrosis transmembrane conductance controller balancing treatments, including elexacaftor-tezacaftor-ivacaftor, are essentially wiped out through cytochrome P450 (CYP) 3A-intervened digestion. This makes a 56restorative test to the treatment of Covid illness 2019 (COVID-19) with nirmatrelvir-ritonavir in individuals with Cystic Fibrosis (CF) because of the potential for huge medication drug communications (DDIs). Be that as it may, the populace with CF is more in danger of difficult disease following COVID-19 contamination and subsequently it is vital to deal with the DDI risk and give treatment choices.


Cystic Fibrosis, Pharmacokinetic-led, Nirmatrelvir-ritonavir.


CYP3A-mediated DDI of elexacaftor-tezacaftor-ivacaftor was assessed utilizing a physiologically-based pharmacokinetic displaying approach. Demonstrating was performed integrating physiological data and drug-dependent boundaries of elexacaftor-tezacaftor-ivacaftor to foresee the impact of ritonavir (the CYP3A repressing part of the mix) on the pharmacokinetics of elexacaftor-tezacaftor-ivacaftor [1].

The elexacaftor-tezacaftor-ivacaftor models were confirmed utilizing free clinical pharmacokinetic and DDI information of elexacaftor-tezacaftor-ivacaftor with a scope of CYP3A modulators. At the point when ritonavir was directed on Days 1 through 5, the anticipated region under the bend (AUC) proportion of ivacaftor (the most touchy CYP3A substrate) on Day 6 was 9.31, demonstrating that its digestion was firmly hindered. In light of the anticipated DDI, the portion of elexacaftor-tezacaftor-ivacaftor ought to be decreased when coadministered with nirmatrelvir-ritonavir to elexacaftor 200 mg-tezacaftor 100 mg-ivacaftor 150 mg on Days 1 and 5, with deferred resumption of full-dose elexacaftor-tezacaftorivacaftor on Day 9, taking into account the leftover inhibitory impact of ritonavir as a mechanism-based inhibitor. The reenactment predicts a routine of elexacaftor-tezacaftorivacaftor managed correspondingly with nirmatrelvir-ritonavir in individuals with CF that will probably diminish the effect of the medication cooperation [2].

The presentation of the Cystic Fibrosis Transmembrane Conductance normal (CFTR) modulator, a triple blend of elexacaftor-tezacaftor-ivacaftor (Trikafta) has brought about huge enhancements in lung capability and healthful status in individuals with cystic fibrosis. While elexacaftor-tezacaftorivacaftor is shown in up to 90% of the CF populace, every one of the three parts are disposed of mostly through cytochrome P450 (CYP) 3A-mediated hepatic digestion, and consequently present a remedial test in individuals with CF because of the potential for critical medication drug cooperations (DDIs). The utilization of solid CYP3A inducers will expand the digestion of elexacaftor-tezacaftor-ivacaftor, bringing about decreased openness and a likely absence of viability, while corresponding treatment with specialists that restrain CYP3A will increment elexacaftor-tezacaftor-ivacaftor levels, putting the patient at expanded chance of unfavorable impacts (AEs), including respiratory-related AEs and strange liver capability tests. Consequently, the protected and compelling utilization of CFTR modulators requires fitting DDI the executives with accompanying CF meds [3].

One prominent remedial test is in the treatment of Covid illness 2019 (COVID-19) (serious intense respiratory condition Covid 2 (SARS-CoV-2)). In individuals with CF, popular respiratory plot diseases can prompt intense pneumonic intensifications with an adverse consequence on lung capability. COVID-19 disease sets off a cytokine storm which can prompt the lifethreatening respiratory trouble disorder, possibly putting the populace with CF tainted with COVID-19 at high gamble of difficult sickness.

The US Food and Drug Administration (FDA) have as of late given a crisis use approval for the utilization of the nirmatrelvir-ritonavir (Paxlovid) for the treatment of gentle to direct COVID-19. Nirmatrelvir-ritonavir treatment altogether lessens medical clinic affirmations and passings among individuals with COVID-19 who are at high gamble of extreme disease. Nirmatrelvir is coadministered with ritonavir, a CYP3A inhibitor, to help nirmatrelvir fixations to accomplish remedial levels. Notwithstanding, because of the intense hindrance impact of ritonavir, it might increment plasma convergences of medications that are fundamentally used by CYP3A. Along these lines, coadministration of nirmatrelvirritonavir is contraindicated with drugs exceptionally reliant upon CYP3A for freedom and for which raised focuses are related with serious as well as life-threatening responses. Since each of the three parts of elexacaftor-tezacaftor-ivacaftor are killed principally through CYP3A, nirmatrelvir-ritonavir is supposed to display a critical medication collaboration with elexacaftor-tezacaftor-ivacaftor. Accordingly, the utilization of nirmatrelvir-ritonavir in individuals with CF would require a changed dosing routine of elexacaftor-tezacaftor-ivacaftor to forestall expanded plasma fixations and potential unfriendly medication responses. In any case, there are as of now no clinical information accessible in regards to the cooperations of elexacaftor-tezacaftor-ivacaftor with nirmatrelvirritonavir, and no particular dosing rules have been laid out. Subsequently, there is a dire requirement for the legitimate direction in regards to the utilization of nirmatrelvir-ritonavir for individuals with CF to forestall movement of COVID-19 to extreme sickness [4].

This study intended to examine the extent of the medication cooperations of ritonavir-elexacaftor-tezacaftor-ivacaftor, to reenact conceivable treatment situations and give dosing suggestions to defeat the communication. The CYP3A inhibition-mediated drug connection of elexacaftor-tezacaftorivacaftor was assessed utilizing a Physiologically-Based Pharmacokinetic (PBPK) simulation-based approach [5].


PBPK recreation is a device to foresee the pharmacokinetic conduct of medications in people by coordinating the data from different in vitro and clinical examinations, investigating the impacts of medication (e.g., physicochemical properties) and framework (e.g., physiological) data on drug openness. The prescient presentation of PBPK reproductions for CYP enzyme-based DDIs has been deep rooted, and this system is progressively included during administrative audit by the FDA as an option for investigating DDI potential to give dosing suggestions in the item marking. The current review adds to further developed treatment for COVID-19 in individuals with CF by giving apparatuses to assess and possibly beat clinically significant medication cooperations including exceptionally dynamic CFTR modulator treatment.


  1. Rock BM, Hengel SM, Rock DA, et al. Characterization of ritonavir-mediated inactivation of cytochrome P450 3A4. Mol Pharmaco. 2014;86(6):665-74.
  2. Indexed at, Google Scholar, Cross Ref

  3. Katzenmaier S, Markert C, Riedel KD, et al. Determining the time course of CYP3A inhibition by potent reversible and irreversible CYP3A inhibitors using a limited sampling strategy. Clin Pharmacology Therap. 2011;90(5):666-73.
  4. Indexed at, Google Scholar, Cross Ref

  5. Cholon DM, Quinney NL, Fulcher ML, et al. Potentiator ivacaftor abrogates pharmacological correction of ΔF508 CFTR in cystic fibrosis. Sci Transl Med. 2014;6(246):246-96.
  6. Indexed at, Google Scholar, Cross Ref

  7. Avramescu RG, Kai Y, Xu H, et al. Mutation-specific downregulation of CFTR2 variants by gating potentiators. Human Mol Gen. 2017;26(24):4873-885.
  8. Indexed at, Google Scholar, Cross Ref

  9. Dagenais RV, Su VC, Quon BS. Real-world safety of CFTR modulators in the treatment of cystic fibrosis: a systematic review. J Clin Med. 2020;10(01):23.
  10. Indexed at, Google Scholar, Cross Ref

Get the App