(373) Is there a Disparity in Access for Elexacaftor/Tezacaftor/Ivacaftor in Hispanic Versus Non-Hispanic Patients with Cystic Fibrosis?

Background: Hispanic people with cystic fibrosis (CF) are known to have worse outcomes than non-Hispanics. CF transmembrane conductance regulator (CFTR) modulators are known to improve outcomes, but ineligibility and/or access among ethnic minority groups contributes to a worsening health care disparity for treatment. Uniquely, at the Children’s Hospital Los Angeles CF Care Center, Hispanic people with CF comprise 60% of the demographic, which presents an opportunity to assess this disparity in our center. The purpose of our study is to determine if Hispanics with CF receive elexacaftor/tezacaftor/ivacaftor (elex/tez/iva) as much as non-Hispanics, and how this affects their clinical outcomes.

Methods: A retrospective chart review was completed from October 1, 2019 to January 31, 2022. Inclusion criteria were patients with a diagnosis of CF seen at our Center within the time frame. Ethnicity, genetic mutation, percent predicted FEV1 and BMI Z-scores (BMIz) were collected from patients’ electronic medical records. Comparative analysis of eligibility and Hispanic origin were performed using a Chi-square test, with a p value statistically significant if < 0.05. Lung function and nutrition were compared through percent predicted FEV1 and BMIz, respectively, using an unpaired t-test.

Results: Of the 145 CF patients in our center, 60% were Hispanic and 40% were non-Hispanic. Of the Hispanic patients, 68% were eligible to receive elex/tez/iva versus 76% of non-Hispanic patients (p=0.295). Of the eligible Hispanic patients, 76% actually received elex/tez/iva compared to 98% eligible non-Hispanic patients (p=0.0022). Therefore, eligible Hispanic patients are less likely than non-Hispanic patients to receive elex/tez/iva.

The mean FEV1 for Hispanics was 95.0±25.9% predicted compared to non-Hispanics, which was 92.3±24.4% predicted (p=0.57). There was a trend for Hispanic patients receiving elex/tez/iva to have a higher FEV1 (99.7+23.5% predicted) than those who did not receive elex/tez/iva (88.0+28.0% predicted: p=0.06). In non-Hispanics, FEV1 was not different in those receiving elex/tez/iva (93.2+25.2% predicted) than those not receiving elex/tez/iva (88.6+21.3% predicted: p=0.61).

Hispanic patients had a significantly higher mean BMIz (0.71+0.98) compared to non-Hispanics (0.12+1.05: p=0.0018). Hispanic patients receiving elex/tez/iva had the same mean BMIz (0.79+1.09) as those not receiving elex/tez/iva (0.62+0.85: p=0.46). Similarly, non-Hispanics receiving elex/tez/iva had the same mean BMIz (0.08+1.05) as those not receiving elex/tez/iva (0.21+1.09: p=0.69).

Conclusions: We conclude that there is no difference in eligibility for elex/tez/iva between Hispanic and non-Hispanic patients with CF at our Center. However, fewer Hispanic patients received elex/tez/iva than non-Hispanic patients. There is no difference in lung function between Hispanics and non-Hispanics, but there is a trend towards a higher FEV1 in Hispanics receiving elex/tez/iva. Hispanics also have a higher BMIz than non-Hispanics, but this is not influenced by whether or not they are receiving elex/tez/iva.

Acknowledgements: This work was supported by the Cystic Fibrosis Foundation Award for a Pharmacist and/or Pharmacy Technician [CFF Award#: CCRX014-19].

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