Advertisement

Drug-induced acne with elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis

Published:September 07, 2022DOI:https://doi.org/10.1016/j.jcf.2022.09.002

      Highlights

      • Some patients report new or worsening acne after starting elexacaftor/tezacaftor/ivacaftor.
      • The immunologic basis of this adverse effect is unclear.
      • Treatment may require trial and error with combination topical therapies or systemic therapies.

      Abstract

      Elexacaftor/tezacaftor/ivacaftor (ELX-TEZ-IVA) is a Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator shown to improve lung function and reduce sweat chloride in people with Cystic Fibrosis (CF). The only commonly reported dermatologic adverse effect with CFTR modulators including ELX-TEZ-IVA is rash. In this case series, we describe 19 patients who reported new onset or worsening of acne after initiation of this drug to their CF pharmacist or another member of their CF care team. The mechanism and frequency of this adverse effect is unknown.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cystic Fibrosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sanders D.B.
        • Fink A.K.
        Background and epidemiology.
        Pediatr Clin N Am. 2016; 63 (Aug): 567-584https://doi.org/10.1016/j.pcl.2016.04.001
        • Bernstein M.L.
        • McCusker M.M.
        • Grant-Kels J.M.
        Cutaneous manifestations of cystic fibrosis.
        Pediatr Dermatol. 2008; 25: 150-157
        • Daye M.
        • Pekcan S.
        • Mevlitoğlu İ.
        Skin findings in cystic fibrosis cases.
        Cyprus J Med Sci. 2018; 3: 149-153
        • Kazandjieva J.
        • Tsankov N
        Drug-induced acne.
        Clin Dermatol. 2017; 35: 156-162
        • Accurso F.J.
        • Rowe S.M.
        • Clancy J.P.
        • et al.
        Effect of VX-770 in persons with cystic fibrosis and the G551D-CFTR mutation.
        N Engl J Med. 2010; 363: 1991-2003
        • Heijerman H.G.M.
        • McKone E.F.
        • Downey D.G.
        • et al.
        Efficacy and safety of the elexacaftor plus tezacaftor plus ivacaftor combination regimen in people with cystic fibrosis homozygous for the F508del mutation: a double-blind, randomised, phase 3 trial.
        Lancet N Am Ed. 2019; 394: 1940-1948
        • Middleton P.G.
        • Mall M.A.
        • Dřevínek P.
        • et al.
        Elexacaftor–Tezacaftor–Ivacaftor for cystic fibrosis with a single Phe508del allele.
        N Engl J Med. 2019; 381: 1809-1819
        • Stashower J.
        • Carr P.
        • Miller V.
        • Zlotoff B.
        Novel reaction to new cystic fibrosis medication Trikafta.
        Clin Case Rep. 2021; 9 (May 4): e04116
        • Hu M.K.
        • Wood G.
        • Dempsey O.
        ‘Triple therapy’ (elexacaftor, tezacaftor, ivacaftor) skin rash in patients with cystic fibrosis.
        Postgrad Med J. 2022; 98 (doi: 0.1136/postgradmedj-2020-139264): 86
        • Leonhardt K.
        • Autry E.B.
        • Kuhn R.J.
        • Wurth M.A.
        CFTR modulator drug desensitization: preserving the hope of long term improvement.
        Pediatr Pulmonol. 2021; 56 (Aug): 2546-2552
        • Diseroad E.R.
        • Mogayzel Jr, P.J.
        • Pan A.
        Rechallenge of elexacaftor/tezacaftor/ivacaftor after skin rash in two pediatric patients.
        J Pediatr Pharmacol Ther. 2022; 27: 463-466https://doi.org/10.5863/1551-6776-27.5.463
        • Bhaskaran D.
        • Kathryn B.
        A case of Elexacaftor-Tezacaftor-Ivacaftor induced rash resolving without interruption of treatment.
        J Cyst Fibros. 2022; S1569-1993 (Jul 1200598-7)https://doi.org/10.1016/j.jcf.2022.06.011
      1. Witworth, J. “Dealing with Trikafta acne”. Cystic-Fibrosis.Com. 4 March 2021, cystic-fibrosis.com/living/trikafta-acne. Accessed 2 August 2022.

      2. r/CysticFibrosis “Acne /trikafta” redditt. reddit.com/r/CysticFibrosis/comments/elz95o/acne_trikafta/. Accessed 2 August 2022.

      3. Livingston, Jenny. “Real talk tuesday: trikafta acne”. Instagram. 23 June 2020, .instagram.com/p/CBylHiQjoUj/?hl=en. Accessed 2 August 2022.

        • Bari O.
        • Paravar T.
        Isotretinoin therapy for the treatment of acne in patients with cystic fibrosis: a case series and review of the literature.
        Dermatol Online J. 2016; 22 (1613030/qt0793n5z2)
        • Perera E.
        • Massie J.
        • Phillips R.J.
        Treatment of acne with oral isotretinoin in patients with cystic fibrosis.
        Arch Dis Child. 2009; 94 (Aug): 583-586https://doi.org/10.1136/adc.2008.156406
        • Strauss J.S.
        • Krowchuk D.P.
        • Leyden J.J.
        • Lucky A.W.
        • Shalita A.R.
        • Siegfried E.C.
        • Thiboutot D.M.
        • Van Voorhees A.S.
        • Beutner K.A.
        • Sieck C.K.
        • Bhushan R.
        American Academy of Dermatology/American Academy of Dermatology Association. Guidelines of care for acne vulgaris management.
        J Am Acad Dermatol. 2007; 56 (Apr): 651-663https://doi.org/10.1016/j.jaad.2006.08.048
        • Sosinski L.M.
        • CM H.
        • Neugebauer K.A.
        • Ghuneim L.J.
        • Guzior D.V.
        • Castillo-Bahena A.
        • et al.
        A restructuring of microbiome niche space is associated with Elexacaftor–Tezacaftor–Ivacaftor therapy in the cystic fibrosis lung.
        J Cyst Fibros. 2021; S1569-1993: 02131-02137https://doi.org/10.1016/j.jcf.2021.11.003
      4. Master in Philosophy thesis. https://livrepository.liverpool.ac.uk/3004710/1/200646917_May2016.pdf. Accessed 2 September 2022.