(316) Depression and anxiety scores post HEMT in pandemic times in adult CF clinic

Background: Elexacaftor/Tezacaftor/Ivacaftor (Trikafta®) has made a tremendous impact on the lives of people with Cystic Fibrosis (PWCF). Previous work by our team showed UC CF patients had lower PHQ9 and GAD7 scores approximately 10 months after initiating Trikafta® therapy (approximately December 2019 - September 2020). The UC Adult CF Clinic has continued to track GAD7 and PHQ9 scores of PWCF at every visit, more than the national CF guideline of once a year. The objective of this study is to determine the impact of Trikafta® treatment on depression and anxiety in adult PWCF both one and two years after initiating Trikafta®. Additionally, this study compares GAD7 and PHQ9 data with PWCF who have never undergone Trikafta® treatment.


Methods: A retrospective chart review of 172 PWCF seen at the UC adult clinic. GAD7 and PHQ9 scores were obtained from ambulatory flowsheets in electronic medical records (EMR). Three scores for each questionnaire were identified in every patient chart: the most recent scores immediately prior to initiating Trikafta® or before October 2019, scores approximately one year later, and the most recent scores immediately prior to the end of the year in 2021. 100 of the 172 patients have initiated Trikafta® treatment and have both GAD7 and PHQ9 scores before and after Trikafta®. 19 patients have not started Trikafta® but had both GAD7 and PHQ9 scores. The remaining 53 patients do not have GAD7 and PHQ9 scores within the same time period and so were excluded from the study. Patients were then separated further into three groups based on their initial GAD7 and PHQ9 score in 2019: “low” with scores of 0 - 4, “mild” with scores of 5 - 9, and “moderate” with scores of 10 or more.

Results: Totals: From 2019 to 2021 PWCF taking Trikafta® had an average decrease in GAD7 scores of 0.54 whereas PWCF who have not initiated Trikafta® therapy had an increase in GAD7 scores of 0.74. Similar to the GAD7 results, patients taking Trikafta® had an average decrease in PHQ9 scores of 0.80, however, in contrast to the GAD7 scores, patients not taking Trikafta® also had an average decrease in PHQ9 scores of 0.58 from 2019 to 2021.
GAD7: Patients taking Trikafta® in the Low-GAD7 group had an average increase in score of 0.46. Patients in the Mild-GAD7 group had an average decrease of 1.79. Patients in the Moderate-GAD7 group had an average decrease of 5.27. The effect was greatest from 2019 to 2020 and the scores remained relatively constant from 2020 to 2021.
PHQ9: Patients taking Trikafta® in the Low-PHQ9 group had an average increase in score of 0.53 from 2019 to 2021. Patients in the Mild-PHQ9 group had an average decrease of 4.23. Patients in the Moderate-PHQ9 group had an average decrease of 5.11. The effect identified here was again greatest from 2019 to 2020, but scores continued to decrease for the mild and moderate PHQ9 groups from 2020 to 2021.

Conclusions: Trikafta® has the potential to alter the GAD7 and PHQ9 scores in adult PWCF. We identified a decreasing trend in both GAD7 and PHQ9 scores in the entire patient population studied from 2019 to 2020 and followed that trend through to 2021. It appears that the GAD7 scores dropped initially from 2019 to 2020 but remained relatively stagnant from 2020 to 2021, whereas the PHQ9 scores also decreased from 2019 to 2020 and decreased further from 2020 to 2021.

Acknowledgements: This work was supported by the Cystic Fibrosis Foundation.

References: