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We Must Pay Closer Attention to the Global CF Population

Based on the stringent qualifications the Cystic Fibrosis Foundation uses to determine who has cystic fibrosis, approximately 70,000 people currently have CF worldwide. That includes 30,000-35,000 in the United States. In this broad population, many subpopulations fit neatly into the CFF’s qualifications. Others do not.

As much as we all wish it were different, CF is not the simple disease it was once believed to be. I wrote about this spectrum of the disease a few months ago. Essentially, the thesis of that piece was that CF is not a monolithic disease that affects everyone the same.

The most common subpopulation of CFers consists of those with two copies of the ∆F508 allele. This mutation has historically seen the most research. It’s a tough allele to understand and requires at least one corrector and one potentiator to even slightly “fix” it, such as Orkambi (lumacaftor/ivacaftor) and Symdeko (tezacaftor/ivacaftor).

A rarer mutation like G551D is easier to understand and only requires a potentiator to significantly improve it, such as Kalydeco (ivacaftor).

Meanwhile, the results from important triple combo studies, which Cystic Fibrosis News Today reported on, are extremely promising and show a significant benefit for a wide subpopulation of CFers with one or two copies of ∆F508. It’s estimated that up to 90 percent of people with CF may benefit from the inevitable triple combo therapy in the next few years.

I want to bring attention to some important details. Much like we can’t allow ourselves to forget the people with no copies of ∆F508 or those with hard-to-fix mutations (and other types), we also can’t forget about the global population of people with CF. Since it is believed that the ∆F508 mutation originated in Western Europe about 5,000 years ago, it is true that CF mostly affects white populations. However, it also affects every ethnicity in the U.S., which means there is a worldwide population that does not have the same access to medications that we have.

I don’t want to spend too much time on the U.S. healthcare system and how broken it is. This strange, hard-to-navigate system makes it difficult for affected patients to obtain the medications and the care they need. Despite all of that, CF care still is exceptional in the U.S. As we witness a standoff between the U.K.’s National Health Service and the pharmaceutical company Vertex, which manufactures Orkambi, Symdeko, and Kalydeco, over the pricing for CF medications, we should acknowledge how fortunate our population is here. But we also must realize how far we still have to go for our companions around the world.

In the U.S. in 2019, CF is a bad diagnosis, but we have state-of-the-art care, which means infants with CF tend to do quite well here. It’s reasonable to think that there are babies across the world — and even in the U.S. — with some gradient of CF, CF-related diabetes, or CF metabolic disorder that do not get proper care and die of dehydration or malnourishment. If they survive past infancy, they may fail to thrive, struggle with chronic lung infections, or have debilitating intestinal pain that they might never recover from. Sadly, I think this is the reality. It makes me concerned for how many people across the world are affected by CF but never see the light of even basic medical intervention. This includes chest physiotherapy, enzymes, hypertonic saline, or albuterol.

As we move toward the future of better CF care, we must remember that access to all medication and a better understanding of what cystic fibrosis really is and how to treat it by everyone with CF on Earth is the only acceptable path forward.

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