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Cystic FibrosisPhase 4RECOVERNCT04602468

Real World Clinical Outcomes With Novel Modulator Therapy Combinations in People With CF (RECOVER)

A Phase 4 study testing Elexacaftor/Tezacaftor/Ivacaftor in people with Cystic Fibrosis and Cystic Fibrosis Liver Disease, run by Royal College of Surgeons, Ireland at 7 sites in 2 countries.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

RECOVER is a prospective, multicenter observational study designed to measure the real world clinical effectiveness of elexacaftor/tezacaftor/ivacaftor (ETI) triple combination therapy in people with cystic fibrosis initially over a two year period, followed by a five year extension period. Read more about this study

Who is it for?
Ages 6 years and older
What is being tested?
Elexacaftor/Tezacaftor/Ivacaftor
Could I receive a placebo?
No, everyone receives an active treatment
How many people
206 participants
Where
7 sitesin 2 countries
Study dates
3 Sep 2020to 1 Jul 2029
Phase
Phase 4
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Participants may only be selected for inclusion in RECOVER if they have been independently determined by their treating physician to be suitable for treatment with ETI in compliance with the official marketing authorization and summary of product characteristics (SPC).
  • The decision to include participants in the study is independent of decision to prescribe ETI.
  • Participants will receive treatment only through prescription by their physician through usual clinical treatment pathways.
  • Subjects on ETI In exceptional circumstances where baseline clinical data has been collected prior to the start of treatment either through clinical care or ethically approved research projects (including a cohort of subjects initially recruited to this study on the understanding that it was a non-regulated observational study) subjects already receiving ETI may be recruited to this study and undergo on-treatment visits. Any additional patient data can only be added with written informed consent from the patients/parents concerned.
  • All subjects must have a signed informed consent form and/or signed assent form when appropriate, as determined by the subjects age and individual site and country standards.
  • Male and female participants of childbearing potential must agree to adhere to contraception requirements as detailed in the local ETI SmPC and in line with the standard of care.

Who cannot join

  • Patients not willing to comply with study procedures or assessments.
  • Individuals on clinical trials of investigational CFTR modulators.
  • Clinical instability at baseline assessments. Subjects undergoing an active exacerbation and at the beginning of their treatment should be excluded from the study as this is likely to skew the data.

Trial locations and contacts

7 sites in 2 countries.

7 sites in 2 countries

Ireland5 sites
  • Children's Health Ireland at Crumlin

    Dublin, Leinster

  • Children's Health Ireland at Temple Street

    Dublin

  • St. Vincent's University Hospital

    Dublin

  • University Hospital Limerick

    Limerick, Limerick, V94 F858

  • Children's Health Ireland at Tallaght

    Tallaght

Other trials in Ireland

United Kingdom2 sites
  • Royal Belfast Hospital for Sick Children

    Belfast

  • Royal Brompton Hospital

    London

Other trials in United Kingdom

About this study

RECOVER is a prospective, multicenter observational study designed to measure the real world clinical effectiveness of elexacaftor/tezacaftor/ivacaftor (ETI) triple combination therapy in people with cystic fibrosis initially over a two year period, followed by a five year extension period. Measured outcomes include measures of lung function, lung inflammation, lung imaging, abdominal symptoms, gut inflammation, liver function, pancreatic exocrine function, nasal inflammation, quality of life and adherence to therapy. The study will examine outcomes in two cohorts, children aged six to eleven years and children and adults aged twelve and above.

Read the detailed description

Our aim with RECOVER is to examine the clinical impact of ETI on key clinical outcomes in people with CF in a real-world setting. For this study, in addition to some of the more traditional ways of monitoring clinical outcomes in people with CF such a standard lung function, nutrition, exacerbations and liver disease, the investigators are proposing to include some novel outcome measures not typically used in clinical trials such as lung clearance index (LCI) and spirometry controlled chest CT.

By implementing an extensive study protocol that will include important outcomes in a number of areas of health in people with CF, and matching this to a comprehensive biosample collection plan, the investigators will have the power to gain important insight into how ETI works, and what impact it has on rescue of CFTR function in this group of people.

Data on the following outcomes will be collected during the study:

Lung Clearance Index Ultra-low dose, spirometry-controlled CT scanning Sweat Chloride Nasal Lavage (inflammatory markers and microbiome) Fraction of Exhaled Nitric Oxide (FeNO) Liver Ultrasound Liver examination (signs of liver disease) Sputum Collection (inflammatory markers and microbiome) Stool Collection (inflammation, microbiome, fecal elastase) Abdominal symptom questionnaire CFQ-R (quality of life) Adherence to treatment Height, weight, BMI Forced Expiratory volume in 1 second (FEV1) Microbiological culture of airway specimens (clinical laboratories at sites) Mental Health outcomes

The Lead Investigator is Paul McNally, with Prof. Jane Davies as Co-Lead Investigator. The study will operate in collaboration with our academic and clinical partners and the CF registries in Ireland and the UK. The study is supported by the European CF Society Clinical Trials Network (ECFS-CTN). The study is being run as a CTIMP in the UK clinical sites, as determined by the MHRA. In the Irish sites, the HPRA has determined this study to be an observational research study.

Being tested
Elexacaftor/Tezacaftor/Ivacaftor
Medical subject headings
Cystic Fibrosis, Medication Adherence

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Elexacaftor/Tezacaftor/IvacaftorDrug

    The intervention is the same for both study groups. In addition to all the assessments in the standard arm, the advanced arm subjects will undergo spirometry controlled CT, nasal lavage and sputum sample collection.

Study groups in NCT04602468
Study groupRoleWhat they receive
Standard groupOtherThe standard testing group will be available for both age cohorts with sites having a predefined recruitment cap for each testing group. The standard testing will involve the following assessments; sweat chloride, LCI, height/weight/BMI, FEV1, airway sampling (micro), FeNO, liver function testing, liver ultrasound, liver examination, stool collection, blood collection, abdominal symptom score, CFQ-R, pharmacy records medication pick up rate, adherence questionnaires, MEMs caps and antibiotic use.
Receives: Drug: Elexacaftor/Tezacaftor/Ivacaftor
Advanced groupOtherIn addition to all elements of the standard testing group, the advanced testing group will undergo: Ultra-low dose spirometry-controlled CT scanning, sputum collection and nasal lavage collection. This will be available for both age cohorts with sites having a predefined recruitment cap for each testing group.
Receives: Drug: Elexacaftor/Tezacaftor/Ivacaftor

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in LCI on treatment with ETI in children and adults with CF.

    Measured using multiple breath washout (MBW)

    Measured: 84 month period

Secondary outcomes (24)
  1. The change in spirometry-controlled CT scores on treatment with ETI in children and adults with CF.

    Spirometry controlled CT

    Measured: 84 month period

  2. Change in airway inflammation markers in children and adults with CF

    Change in NE, SLPI and IL-8 (pg/ml) concentration sputum and nasal lavage

    Measured: 84 month period

  3. The change on gastrointestinal symptoms on treatment with ETI in children and adults with CF

    Abdominal symptom questionnaire scores

    Measured: 84 month period

  4. To determine the effect of treatment with ETI on antibiotic treatment of pulmonary disease in children and adults with CF over a two-year period

    Medication possession ratio (MPR)

    Measured: 24 month period

  5. To assess the impact of the introduction of ETI on adherence with overall medical treatments for CF

    Medication Event Monitoring (MEM) caps

    Measured: 24 month period

  6. To determine the effect of treatment with TCM on CF liver disease in children and adults with CF

    Ultrasound and liver function test

    Measured: 84 month period

  7. To assess the understanding of disease and experiences with ETI among children and adolescents with CF.

    Qualitative Interviews and Drawings

    Measured: Up to year 1

  8. To determine the longitudinal changes in mental health outcomes associated with the use of TCM in children and adults with CF.

    Patient Health Questionnaire - 9 (PHQ-9)

    Measured: 60 month period

  9. Rate of Forced Expiratory Volume in 1 second (FEV1) (L) change on ETI treatment

    Measured: 86 months

  10. Change in microbiology on treatment with ETI in children and adults

    Microbiology from clinical swabs and samples

    Measured: 86 months

  11. Change in iron oxide (FeNO) in children and adults with CF

    Measured with the Niox VERO device

    Measured: 84 month period

  12. The change in gut inflammation on treatment with ETI in children and adults with CF

    Fecal sample - M2PK

    Measured: 84 month period

  13. The change of pancreatic function on treatment with ETI in children and adults with CF

    Measured by use of pancreatic enzymes

    Measured: 84 month period

  14. To assess the understanding of disease and experiences with ETI among children and adolescents with CF.

    Patient Health Questionnaire 9 (PHQ-9)-Modified for Adolescents

    Measured: Up to year 1

  15. To assess the understanding of disease and experiences with ETI among children and adolescents with CF.

    Generalised Anxiety Disorder 7 (GAD-7)

    Measured: Up to year 1

  16. To determine the longitudinal changes in mental health outcomes associated with the use of TCM in children and adults with CF.

    Generalized Anxiety Disorder -7 (GAD-7)

    Measured: 60 month period

  17. To determine the longitudinal changes in mental health outcomes associated with the use of TCM in children and adults with CF.

    PROMIS Pediatric Anxiety Scale (Short Form - 8a)

    Measured: 60 month period

  18. To determine the longitudinal changes in mental health outcomes associated with the use of TCM in children and adults with CF.

    Depressed Mood Scale (Short Form - 8a)

    Measured: 60 month period

  19. To determine the longitudinal changes in mental health outcomes associated with the use of TCM in children and adults with CF.

    PROMIS Pediatric Cognitive Function Scale (Short Form 7a)

    Measured: 60 month period

  20. To determine the longitudinal changes in mental health outcomes associated with the use of TCM in children and adults with CF.

    RECOVER Body image questionnaire

    Measured: 60 month period

  21. To assess the impact of the introduction of ETI on adherence with overall medical treatments for CF

    Adherence questionnaires

    Measured: 24 month period

  22. To assess the impact of the introduction of ETI on adherence with overall medical treatments for CF

    Medication possession ratio (MPR)

    Measured: 24 month period

  23. The change in gut inflammation on treatment with ETI in children and adults with CF

    Fecal sample - fecal elastase

    Measured: 84 month period

  24. The change in gut inflammation on treatment with ETI in children and adults with CF

    Fecal sample - calprotectin

    Measured: 84 month period

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Oct 2020
  2. Study start3 Sep 2020
  3. Primary completion1 Jul 2029 (estimated)
  4. Study completion1 Jul 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Other
Allocation
Non-randomised
Intervention model
Single group
Model description
The decision to implement ETI treatment is made completely independently of the decision to enter the study. The investigators will follow the requirements of the local approved ETI SmPC for the patient management as detailed in the 'special warnings and precautions for use' (e.g. management of hepatic impairment, rash, ophthalmological monitoring, between others), and for the management of interaction with other medicinal products and other forms of interactions. The 12+ cohort will be enrolled first on the basis the drug will be approved for children aged 12 and over first. The 6-11 year cohort will only be enrolled when the license is extended to this age group, and treatment with ETI will only occur in the context of prescription by a physician in compliance with marketing authorization and the SPC.
Masking
Single blind
Who is masked
Participant
Enrolment
206 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04602468
Sponsor's protocol ID
RECOVER
Acronym
RECOVER
Status last verified
Aug 2026
First submitted
20 Oct 2020
Last updated
9 Sep 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • McNally P, Lester K, Stone G, Elnazir B, Williamson M, Cox D, Linnane B, Kirwan L, Rea D, O'Regan P, Semple T, Saunders C, Tiddens HAWM, McKone E, Davies JC; RECOVER Study Group. Improvement in Lung Clearance Index and Chest Computed Tomography Scores with Elexacaftor/Tezacaftor/Ivacaftor Treatment in People with Cystic Fibrosis Aged 12 Years and Older - The RECOVER Trial. Am J Respir Crit Care Med. 2023 Nov 1;208(9):917-929. doi: 10.1164/rccm.202308-1317OC.

    PubMed 37703083

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Elexacaftor/Tezacaftor/Ivacaftor in people with Cystic Fibrosis and Cystic Fibrosis Liver Disease, run by Royal College of Surgeons, Ireland at 7 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 9 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in Ireland, United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in LCI on treatment with ETI in children and adults with CF. (time frame: 84 month period). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04602468, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Sep 2026.

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