Pediatric hepatic laboratory reporting with CFTR modulators: a FAERS pharmacovigilance study

Children receiving CFTR modulators undergo liver testing because labels warn about liver injury and liver failure. In FAERS, aminotransferase or bilirubin reports may reflect monitoring rather than confirmed injury. This study examined whether pediatric hepatic reporting was driven mainly by laboratory terms or by narrower injury/failure terms. FAERS/openFDA reports were analyzed using the 2026-01-27 update, retrieved on 30 April 2026. Pediatric reports required age < 18 years with age unit coded as years. Broad hepatic terms combined injury/failure terms and liver test abnormalities; narrow terms retained explicit injury/failure terms and excluded laboratory-only reports. RORs with 95% CIs used all other openFDA reports as comparator. A descriptive CF care context check summarized co-reported pancreatic enzyme replacement therapy and ursodeoxycholic acid/ursodiol terms. FAERS contained 34,731 CFTR modulator reports. The broad hepatic definition identified 935 CFTR hepatic reports, including 237 pediatric reports. Pediatric broad hepatic reporting was increased (ROR 1.67, 95% CI 1.46-1.90), whereas pediatric serious broad hepatic reporting was not (ROR 1.08, 95% CI 0.92-1.28). Pediatric narrow hepatic reporting was below background (ROR 0.65, 95% CI 0.50-0.84). Frequent terms were alanine aminotransferase increased, aspartate aminotransferase increased, and blood bilirubin increased. Pediatric FAERS data show a hepatic laboratory reporting pattern rather than a parallel increase in coded clinical liver injury. The findings support label-based monitoring and better case documentation. Incidence and treatment comparisons require multicenter pediatric cohort studies with exposed patient denominators.