ABSTRACT
Background: Cystic fibrosis transmembrane conductance regulator modulators are the only available treatment for cystic fibrosis. Although elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) is well-tolerated, rash has been reported as very frequent. In severe rashes, ELX/TEZ/IVA withdrawal is necessary, leading to clinical deterioration. The objective of the study is to increment the experience of ELX/TEZ/IVA desensitization. Methods: Adult patients who developed a delayed hypersensitivity rash to ELX/TEZ/IVA between December 2021 and February 2023 and required withdrawal due to ineffective rescue medication were included. Skins test for ELX/TEZ/IVA and IVA were conducted to establish hypersensitivity mechanism. Balijepally ELX/TEZ/IVA desensitization protocol was selected. In cases where desensitization had to be discontinued due to rash, an extended desensitization was proposed. Clinical and health-related quality of life parameters were collected before ELX/TEZ/IVA and after desensitization. Results: 162 patients (81 women, 31.2 [23.8-42.5] years) started ELX/TEZ/IVA, developing rash 12 of them (7.4%, six women). Six patients (five women) required stopping ELX/TEZ/IVA and were selected for desensitization. Skin tests indicated delayed type-IV hypersensitivity in one patient. Two patients presented adequate tolerance to desensitization; while, four patients developed rash. Three of these patients, successfully concluded extended desensitization (one patient declined participation). No significant clinical deterioration or quality of life worsening was observed during desensitization; in fact, there was an improvement in practically all mesured parameters. All five patients who resumed ELX/TEZ/IVA are currently receiving therapy with good tolerance. Conclusion: Desensitization to ELX/TEZ/IVA could be a successful and safe strategy for reintroducing this essential treatment in cases of a delayed hypersensitivity rash.
ABSTRACT
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Subject(s)
Humans , Adult , Cystic Fibrosis/diagnosis , Life Expectancy/trends , Diagnosis, Differential , Bronchiectasis/complications , Bronchiectasis/diagnosis , Cystic Fibrosis/complications , Cystic Fibrosis/therapy , Neonatal Screening/methodsABSTRACT
The exceptional efficiency of the iron chelate of ethylenediaminedi(o-hydroxyphenyl)acetic acid (o,o-EDDHA) in correcting iron chlorosis in plants and the medical applications of various metallic chelates of this compound have long been recognized. As commercial preparations of o,o-EDDHA usually contain impurities, a method for their detection is proposed. By using one- and two-dimensional nuclear magnetic resonance two impurities were identified. The structure of one of these compounds was assigned to an isomer of EDDHA containing at least one p-hydroxyphenyl moiety. The structure of the other impurity was tentatively assigned to a byproduct of the EDDHA synthesis: 2,6-di[CH(COOH)NHCH(2)CH(2)NHCH(COOH)Ar]phenol (Ar = hydroxyphenyl). Both compounds were also detected in the EDDHA extracted from a commercial iron fertilizer.
