Safety Profile

Safety data from 971 patients with CF in 2 randomized, double-blind,
active-controlled, Phase 3 trials of 52 weeks treatment duration1,2

Safety data from 971 patients with CF in 2 randomized, double-blind, active-controlled, Phase 3 trials of 52 weeks treatment duration1,2

  • A total of 480 patients with CF aged 12 years and older received at least one dose of ALYFTREK
  • Except where otherwise noted, the safety data provided below are from Trials 1 and 2, the active-controlled 52-week trials in patients aged 12 years and older. The adverse reactions in Trial 3 were generally similar to those observed in Trials 1 and 2

Trials 1 and 2 were not designed to evaluate meaningful comparisons of the incidence of adverse reactions between the ALYFTREK and ETI treatment groups.

Discontinuations due to adverse reactions1,2

3.7% OF PATIENTS TREATED WITH ETI (n=18)

3.8% OF PATIENTS TREATED WITH ALYFTREK (n=18)

Serious adverse reactions1,3

  • In Trials 1 and 2, serious adverse reactions that occurred more frequently in patients treated with ALYFTREK compared to ETI were influenza (1.5% vs. 0.6%), AST increased (0.4% vs. 0.2%), depression (0.4% vs. 0.0%), GGT increased (0.4% vs. 0.2%), and syncope (0.4% vs. 0.0%)

Most common adverse events and reactions in Trial 1 and 21,4

Adverse events and adverse reactions in ≥5% of patients

ETI

N=491
n (%)

ALYFTREK

N=480
n (%)

Infective pulmonary exacerbation of CF

158 (32)

133 (28)

Cougha

116 (24)

120 (25)

COVID- 19

127 (26)

107 (22)

Nasopharyngitisa

95 (19)

102 (21)

Upper respiratory tract infectiona

97 (20)

101 (21)

Headachea

63 (13)

76 (16)

Oropharyngeal paina

60 (12)

69 (14)

Diarrhea

59 (12)

58 (12)

Influenzaa

26 (5)

52 (11)

Pyrexia

50 (10)

52 (11)

Fatiguea

46 (9)

51 (11)

Nasal congestion

47 (10)

48 (10)

Sputum increased

50 (10)

45 (9)

Blood creatine phosphokinase increased

41 (8)

43 (9)

ALT increaseda

29 (6)

38 (8)

Rasha

22 (4)

37 (8)

Rhinorrhea

36 (7)

35 (7)

AST increaseda

27 (5)

33 (7)

Sinus congestiona

15 (3)

32 (7)

Hemoptysis

33 (7)

30 (6)

Nausea

30 (6)

29 (6)

Abdominal pain

37 (8)

25 (5)

Back pain

31 (6)

25 (5)

Arthralgia

36 (7)

24 (5)

Constipation

30 (6)

22 (5)

Sinusitis

36 (7)

19 (4)

Dyspnea

28 (6)

18 (4)

Vomiting

27 (6)

15 (3)

Adverse events and adverse reactions in ≥5% of patients

ETI

N=491
n (%)

ALYFTREK

N=480
n (%)

Infective pulmonary exacerbation of CF

158 (32)

133 (28)

Cougha

116 (24)

120 (25)

COVID- 19

127 (26)

107 (22)

Nasopharyngitisa

95 (19)

102 (21)

Upper respiratory tract infectiona

97 (20)

101 (21)

Headachea

63 (13)

76 (16)

Oropharyngeal paina

60 (12)

69 (14)

Diarrhea

59 (12)

58 (12)

Influenzaa

26 (5)

52 (11)

Pyrexia

50 (10)

52 (11)

Fatiguea

46 (9)

51 (11)

Nasal congestion

47 (10)

48 (10)

Sputum increased

50 (10)

45 (9)

Blood creatine phosphokinase increased

41 (8)

43 (9)

ALT increaseda

29 (6)

38 (8)

Rasha

22 (4)

37 (8)

Rhinorrhea

36 (7)

35 (7)

AST increaseda

27 (5)

33 (7)

Sinus congestiona

15 (3)

32 (7)

Hemoptysis

33 (7)

30 (6)

Nausea

30 (6)

29 (6)

Abdominal pain

37 (8)

25 (5)

Back pain

31 (6)

25 (5)

Arthralgia

36 (7)

24 (5)

Constipation

30 (6)

22 (5)

Sinusitis

36 (7)

19 (4)

Dyspnea

28 (6)

18 (4)

Vomiting

27 (6)

15 (3)

/a with: Adverse reactions occurring in ≥5 and ≥1% higher rate in ALYFTREK arm compared to ETI. FDA defines adverse reaction as reasonably associated with use of study drug.1,5

/a with: Adverse reactions occurring in ≥5 and ≥1% higher rate in ALYFTREK arm compared to ETI. FDA defines adverse reaction as reasonably associated with use of study drug.1,5

bCough is composed of several similar terms including productive cough.
cUpper respiratory tract infection is composed of several similar terms including viral upper respiratory tract infection.

bCough is composed of several similar terms including productive cough.
cUpper respiratory tract infection is composed of several similar terms including viral upper respiratory tract infection.

Liver function test elevations1,3

Incidence of maximum transaminases and maximum total bilirubin elevations in Trials 1 and 2

ETI

(N=491)

ALYFTREK

(N=480)

Elevated ALT or AST, n(%)

>3x ULN

15 (3.1)

29 (6.0)

>5x ULN

6 (1.2)

12 (2.5)

>8x ULN

1 (0.2)

6 (1.3)

ALT/AST >3x ULN and total bilirubin elevation >2X ULN,d %

   0.4

   0.2

Incidence of maximum transaminases and maximum total bilirubin elevations in Trials 1 and 2

ETI

(N=491)

ALYFTREK

(N=480)

Elevated ALT or AST, n(%)

>3x ULN

15 (3.1)

29 (6.0)

>5x ULN

6 (1.2)

12 (2.5)

>8x ULN

1 (0.2)

6 (1.3)

ALT/AST >3x ULN and total bilirubin elevation >2X ULN,d %

   0.4

   0.2

dThese ALT/AST elevations were not concurrent with bilirubin elevations.

dThese ALT/AST elevations were not concurrent with bilirubin elevations.

  • Adverse reactions of transaminase elevations (AST and/or ALT) occurred in 43 patients (9%) in patients treated with ALYFTREK and 35 patients (7.1%) in treated with ETI
  • 7 patients (1.5%) treated with ALYFTREK discontinued due to transaminase elevations, compared to 3 (0.6%) ETI-treated patients

Rash events1

  • The overall incidence of rash events was 11.0% in patients treated with ALYFTREK and 7.7% in ETI-treated patients
  • In the ALYFTREK arm, the incidence of rash events was 9.4% in males and 13.0% in females
  • A role for hormonal contraceptives in the occurrence of rash cannot be excluded. For patients taking hormonal contraceptives who develop rash, consider interrupting ALYFTREK and hormonal contraceptives. Following the resolution of rash, consider resuming ALYFTREK without the hormonal contraceptives. If rash does not recur, resumption of hormonal contraceptives can be considered

Increased creatine phosphokinase5

In Trial 1, the incidence of maximum CPK >5x ULN was 9.2% (18/196) in patients treated with ALYFTREK and 8.5% (17/202) in patients treated with ETI. In Trial 2, the incidence of maximum CPK >5x ULN was 7.0% (20/284) in patients treated with ALYFTREK and 5.2% (15/289) in patients treated with ETI

Increased blood pressure1

  • 3.5% of patients treated with ALYFTREK had systolic blood pressure >140 mmHg and a >10 mmHg increase from baseline on at least 2 occasions vs. 3.3% of patients treated with ETI
  • 1.7% of patients treated with ALYFTREK had diastolic blood pressure >90 mmHg and a >5 mmHg increase from baseline on at least 2 occasions vs. 1.8% of patients treated with ETI
  • The mean systolic and diastolic blood pressures remained in the normal range from both ALYFTREK and ETI treatment arms

ALT, alanine aminotransferase; AST, aspartate aminotransferase; CPK, creatine phosphokinase; ETI, elexacaftor/tezacaftor/ivacaftor and ivacaftor; ULN, upper limit of normal.

ALT, alanine aminotransferase; AST, aspartate aminotransferase; CPK, creatine phosphokinase; ETI, elexacaftor/tezacaftor/ivacaftor and ivacaftor; ULN, upper limit of normal.

Indications and Usage

Indications and Usage

ALYFTREK is indicated for the treatment of cystic fibrosis (CF) in patients 6 years of age and older who have at least one F508del mutation or another responsive mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.

ALYFTREK is indicated for the treatment of cystic fibrosis (CF) in patients 6 years of age and older who have at least one F508del mutation or another responsive mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.

If the patient’s genotype is unknown, an FDA-cleared CF mutation test should be used to confirm the presence of at least one indicated mutation.

If the patient’s genotype is unknown, an FDA-cleared CF mutation test should be used to confirm the presence of at least one indicated mutation.

Important Safety Information

WARNING: DRUG-INDUCED LIVER INJURY AND LIVER FAILURE 

Elevated transaminases have been observed in patients treated with ALYFTREK. Cases of serious and potentially fatal drug-induced liver injury and liver failure were reported in patients taking a fixed-dose combination drug containing elexacaftor, tezacaftor, and ivacaftor, which contains the same or similar active ingredients as ALYFTREK. Liver injury has been reported within the first month of therapy and up to 15 months following initiation of elexacaftor/tezacaftor/ivacaftor.

Assess liver function tests (ALT, AST, alkaline phosphatase, and bilirubin) in all patients prior to initiating ALYFTREK, every month during the first 6 months of treatment, every 3 months for the next 12 months, and at least annually thereafter. Consider more frequent monitoring for patients with a history of liver disease or elevated liver function tests (LFTs) at baseline.

Interrupt ALYFTREK for significant elevations in LFTs or in the event of signs or symptoms of liver injury. Consider referral to a hepatologist. Follow patients closely with clinical and laboratory monitoring until abnormalities resolve. If resolved, resume treatment only if benefit is expected to outweigh risk. Closer monitoring is advised after resuming ALYFTREK.

ALYFTREK should not be used in patients with severe hepatic impairment (Child-Pugh Class C). ALYFTREK is not recommended in patients with moderate hepatic impairment (Child-Pugh Class B) and should only be considered when there is a clear medical need and benefit outweighs risk. If used, monitor patients closely.

Warnings and Precautions

Drug-Induced Liver Injury and Liver Failure

  • Elevated transaminases have been observed in patients treated with ALYFTREK. Cases of serious and potentially fatal drug-induced liver injury and liver failure have been reported in patients with and without a history of liver disease taking a fixed-dose combination drug containing elexacaftor, tezacaftor, and ivacaftor (ELX/TEZ/IVA), which contains the same or similar active ingredients as ALYFTREK. Liver injury has been reported within the first month of therapy and up to 15 months following initiation of ELX/TEZ/IVA
  • Elevated transaminases have been observed in patients treated with ALYFTREK. Cases of serious and potentially fatal drug-induced liver injury and liver failure have been reported in patients with and without a history of liver disease taking a fixed-dose combination drug containing elexacaftor, tezacaftor, and ivacaftor (ELX/TEZ/IVA), which contains the same or similar active ingredients as ALYFTREK. Liver injury has been reported within the first month of therapy and up to 15 months following initiation of ELX/TEZ/IVA
  • Assess LFTs (ALT, AST, alkaline phosphatase, and bilirubin) in all patients prior to initiating ALYFTREK, every month during the first 6 months of treatment, every 3 months for the next 12 months, and at least annually thereafter. Consider more frequent monitoring in patients with a history of liver disease, elevated LFTs at baseline, or a history of elevated LFTs with drugs containing ELX, TEZ, and/or IVA
  • Interrupt ALYFTREK in the event of signs or symptoms of liver injury, which may include:
    • Significant elevations in LFTs (e.g., ALT or AST >5x the upper limit of normal (ULN) or ALT or AST >3x ULN with bilirubin >2x ULN)
    • Clinical signs or symptoms suggestive of liver injury (e.g., jaundice, right upper quadrant pain, nausea, vomiting, altered mental status, ascites)
  • Consider referral to a hepatologist and follow patients closely with clinical and laboratory monitoring until abnormalities resolve. If resolved and if benefit is expected to outweigh risk, resume ALYFTREK with close monitoring
  • ALYFTREK should not be used in patients with severe hepatic impairment. ALYFTREK is not recommended in patients with moderate hepatic impairment and should only be considered when there is a clear medical need and benefit outweighs risk. If used, monitor patients closely

Hypersensitivity Reactions, Including Anaphylaxis

  • Hypersensitivity reactions, including cases of anaphylaxis, have been reported in the postmarketing setting of drugs containing ELX, TEZ, and/or IVA (same or similar active ingredients in ALYFTREK). If signs or symptoms of serious hypersensitivity reactions develop during ALYFTREK treatment, discontinue ALYFTREK and institute appropriate therapy. Consider benefits and risks for the individual patient to determine whether to resume ALYFTREK

Patients Who Discontinued or Interrupted Elexacaftor-, Tezacaftor-, or Ivacaftor-Containing Drugs Due to Adverse Reactions

  • There are no available safety data for ALYFTREK in patients who previously discontinued or interrupted treatment with drugs containing ELX/TEZ/IVA due to adverse reactions. Consider the benefits and risks before using ALYFTREK in these patients. If ALYFTREK is used in these patients, closely monitor for adverse reactions as clinically appropriate

Reduced Effectiveness with Concomitant Use With CYP3A Inducers

  • Following concomitant use of strong or moderate CYP3A inducers with ALYFTREK, exposures of vanzacaftor, tezacaftor, and deutivacaftor were decreased, which may reduce ALYFTREK effectiveness. Concomitant use with strong or moderate CYP3A inducers is not recommended

Adverse Reactions with Concomitant Use With CYP3A Inhibitors

  • Following concomitant use of strong or moderate CYP3A inhibitors with ALYFTREK, exposures of vanzacaftor, tezacaftor, and deutivacaftor were increased, which may increase the risk of adverse reactions associated with ALYFTREK. Reduce the ALYFTREK dosage with concomitant use of strong or moderate CYP3A inhibitors

Cataracts

  • Non-congenital lens opacities have been reported in pediatric patients treated with drugs containing ivacaftor (similar to an active ingredient in ALYFTREK). Baseline and follow-up ophthalmological examinations are recommended in pediatric patients treated with ALYFTREK

Adverse Reactions

Serious Adverse Reactions

  • Serious adverse reactions that occurred more frequently with ALYFTREK than with ELX/TEZ/IVA in 2 or more patients (≥0.4%) were influenza (1.5%), increased AST (0.4%), increased GGT (0.4%), depression (0.4%), and syncope (0.4%)

Most Common Adverse Reactions

  • The most common adverse reactions to ALYFTREK (≥5% of patients and at a frequency higher than ELX/TEZ/IVA by ≥1%) were cough, nasopharyngitis, upper respiratory tract infection, headache, oropharyngeal pain, influenza, fatigue, increased ALT, rash, increased AST, and sinus congestion

Use in Specific Populations

Pediatric Use

  • The safety and effectiveness of ALYFTREK in patients <6 years of age have not been established

Please see full Prescribing Information, including Boxed WARNING, for ALYFTREK.

 

References:
1. ALYFTREK [prescribing information]. Boston, MA: Vertex Pharmaceuticals Incorporated; December 2024. 2. Keating C, Yonker LM, Vermeulen F, et al. Vanzacaftor–tezacaftor–deutivacaftor versus elexacaftor–tezacaftor–ivacaftor in individuals with cystic fibrosis aged 12 years and older (SKYLINE Trials VX20-121-102 and VX20-121-103): Results from two randomised, active-controlled, Phase 3 trials. Lancet Respir Med. 2025. doi:10.1016/2213-2600(24)00411-9. 3. Supplement to: Keating C, Yonker LM, Vermeulen F, et al. Vanzacaftor–tezacaftor–deutivacaftor versus elexacaftor–tezacaftor–ivacaftor in individuals with cystic fibrosis aged 12 years and older (SKYLINE Trials VX20-121-102 and VX20-121-103): Results from two randomised, active-controlled, Phase 3 trials. Lancet Respir Med. 2025. doi:10.1016/2213-2600(24)00411-9. 4. Data on file. Vertex Pharmaceuticals Incorporated. Boston, MA. REF-28934 (v1.0); 2024. 5. Data on file. Vertex Pharmaceuticals Incorporated. Boston, MA. REF-28378 (v1.0); 2024.