Assessing the impact of elexacaftor/tezacaftor/ivacaftor on work productivity and activity impairment in people living with cystic fibrosis in Canada.

BACKGROUND: Elexacaftor/tezacaftor/ivacaftor (ETI) has been associated with substantial improvements in lung function and quality of life in people with cystic fibrosis (pwCF). Its longer-term impact on work productivity and daily activity remains less well characterized. METHODS: We analyzed data from the CAN-IMPACT-CF and REAL-ETI-CF observational studies. Work productivity and activity impairment (WPAI) outcomes were compared at baseline and after 1 year of ETI using paired t-tests. Absenteeism represents % of work missed and presenteeism represents % impairment at work. Associations between changes in WPAI outcomes and domains of the Cystic Fibrosis Questionnaire-Revised (CFQ-R) were assessed using Spearman's correlation. RESULTS: This analysis included 146 pwCF. Among working participants (n = 75), absenteeism decreased from 13.1% to 3.3% (p = 0.006), presenteeism from 24.9% to 8.8% (p = 0.0002), and overall work productivity loss from 30% to 10.8% (p = 0.0002) following 1 year of ETI. Reductions in productivity loss were most strongly correlated with relative improvements in CFQ-R Role Functioning (ρ=-0.66), Physical Functioning (ρ=-0.63), and Respiratory (ρ=-0.59) domains (all p = 0.0003). Overall activity impairment decreased from 30.1% to 15.1% (p = 0.0002) and similarly was most strongly correlated with improvements in CFQ-R Role Functioning (ρ=-0.53), Physical Functioning (ρ=-0.57), and Respiratory (ρ=-0.54) domains (all p = 0.0003). CONCLUSIONS: In this real-world study, ETI was associated with significant improvements in work productivity and activity impairment. These functional gains closely mirror improvements in physical, role, and respiratory domains, highlighting the broader socioeconomic and quality-of-life benefits of ETI beyond traditional clinical endpoints.