Elexacaftor-Tezacaftor-Ivacaftor Reduces Revision Sinus Surgery in People With Cystic Fibrosis

To assess whether elexacaftor-tezacaftor-ivacaftor (ETI) reduces the frequency of endoscopic sinus surgeries (ESS) in patients with cystic fibrosis (pwCF).

We conducted a retrospective chart review of pwCF aged 6 years and older who received ETI between January 1, 2018 and December 31, 2023. Inclusion criteria required a history of ESS and a follow-up time of at least 2 years before and after ETI initiation. Records were reviewed from up to 8 years prior to ETI through the most recent visit. The total number and frequency of ESS were evaluated using univariable linear models, estimating mean difference with 95% confidence intervals (CI) and p-values.

Fifty-six patients met inclusion criteria, with a median follow-up time of 8 years (IQR: 8, 8) before ETI initiation and 4.13 years (IQR: 3.47, 4.78) after initiation of ETI. Median age at ETI initiation was 13 years (IQR: 10, 23). Among these patients, 98% (n = 55) required ESS prior to ETI, compared to 21% (n = 12) after ETI. The average number of sinus surgeries decreased from 2.88 ± 1.68 before ETI to 0.30 ± 0.63 after ETI (mean difference: 2.6; 95% CI: [2.1, 3.1]; p < 0.001). The frequency of surgeries per year dropped from 0.37 ± 0.22 to 0.07 ± 0.15 after beginning ETI (mean difference: 0.30; 95% CI: [0.23, 0.37]; p < 0.001).

ETI was associated with a significant decrease in the frequency and rate of ESS in pwCF. These findings suggest an improvement in CF-related chronic rhinosinusitis outcomes following ETI and may influence future CF treatment decisions.