(212) BMI changes over time and post CFTR modulator in a population with cystic fibrosis

Background: Rates of overweight and obesity in cystic fibrosis (CF) show a rising prevalence over time but are thought to vary by country. CFTR modulators target the defective CFTR protein and have the potential to improve anthropometric measurements. A systematic review has shown that elexacaftor/tezacaftor/ivacaftor increased body mass index (BMI) in those aged >12 who were hetero- or homozygous for the F508del mutation. BMI changes in the Northern Ireland (NI) population with CF are unknown.

Changes in BMI (including a subgroup on elexacaftor/tezacaftor/ivacaftor), rates of overweight and obesity, in our adult CF population were assessed between 2018 and 2022.

Methods: Electronic Care Records (2011-2022) of 306 adults with CF were examined for BMI. Those on elexacaftor/tezacaftor/ivacaftor were identified and examined for BMI immediately pre-starting drug and at the most recent review after its commencement.

Results: For 2018, 265 records were examined. 206 patients were included, 63 excluded as no BMI data available. Of these 49% are male, age range 19-74 years, median age 32 years, 35% PS and 17% had CFD. In 2022. 306 records were examined, 52% male, age range 18-78 years and median age 33 years. Of these 36% were PS, 24% had CFD. 303 patients were included.

159 patients (56% male) on elexacaftor/tezacaftor/ivacaftor were included, 21 excluded as BMI data was unavailable pre and post. The age range was 18-78 years, median age 32 years.

Median BMI pre-elexacaftor/tezacaftor/ivacaftor was 22.8 (range 14.1–37.7) kg/m², median BMI post-elexacaftor/tezacaftor/ivacaftor was 24 (range 16.3-38.2) kg/m². Time on elexacaftor/tezacaftor/ivacaftor ranged from 3-12 months.

In a 4 year period the median has increased by 1.4kg/m². Combined overweight and obesity levels have increased from 33% to 41% (Table 1). CFTR modulators have contributed to this trend. The underweight rate decreased from 15% to 6%, whilst rates of overweight and obesity increased from 29% to 33%, for adults with CF on elexacaftor/tezacaftor/ivacaftor.

Conclusions: Rates of overweight and obesity are increasing in patients with CF in NI and is exacerbated by the addition of new CFTR modulators.

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