Factors Influencing Elexacaftor-Tezacaftor-Ivacaftor Use Post-Lung Transplant

In the United States, nearly one-third of lung transplant recipients eligible for cystic fibrosis (CF) treatment received prescriptions for elexacaftor-tezacaftor-ivacaftor (ETI) following their surgeries, according to a recent study led by Dr. Nora C. Burdis from the Department of Medicine at the University of Washington. The findings, published in the Journal of Cystic Fibrosis on July 1, 2025, indicate that the likelihood of receiving ETI prescriptions varied significantly based on patient characteristics and the types of medical centers involved.

The retrospective analysis, which included data from 1,666 lung transplant recipients with an ETI-eligible genotype, reveals that specific factors—namely the presence of sinus disease and a body mass index (BMI) below 18.5—are positively correlated with increased ETI prescription rates. These results underscore the complexity of post-transplant medication management and raise questions about the role of prescribing practices at different transplant centers.

According to the study, 29.3% of patients initiated ETI prescriptions after their transplants. The analysis classified centers into three categories based on their prescribing patterns: low-prescribing (0-1 patient), middle-prescribing (>1 but <50% of patients), and high-prescribing (≥50% of patients). Notably, patients at high-prescribing centers were significantly more likely to receive ETI prescriptions compared to those at low-prescribing centers, with an odds ratio of 0.19 (95% CI, 0.14-0.26) for middle-prescribing centers and 0.02 (95% CI, 0.01-0.04) for low-prescribing centers.

Dr. Burdis and her team hypothesized that low BMI might be particularly relevant to prescribing practices at smaller and lower-prescribing centers. They suggested that low BMI is often a concerning extrapulmonary manifestation of CF, which may influence clinicians' decisions to prescribe ETI in cases where they might otherwise hesitate.

The study's limitations include challenges in monitoring long-term medication adherence and variable follow-up practices across CF centers, which affected the completeness of the data. Additionally, the lack of information on symptom severity restricted the analysis of the relationship between ETI prescription and the severity of patients' conditions.

Financial disclosures reveal that while the study did not receive specific financial support, the authors acknowledged support from various organizations, including the National Institutes of Health and the Cystic Fibrosis Foundation, as well as financial relationships with multiple pharmaceutical companies.

The implications of these findings are significant for clinicians and patients alike. Understanding the factors that drive medication prescribing post-lung transplant can lead to improved treatment outcomes and more tailored therapeutic strategies for patients suffering from cystic fibrosis. As the landscape of CF treatment continues to evolve with the introduction of new drugs, ongoing research will be vital in ensuring that all eligible patients receive optimal care.

This study highlights the need for further exploration into the prescribing patterns and the potential barriers that exist in accessing state-of-the-art therapies for cystic fibrosis patients post-transplant. As new therapies become available, the medical community must work to ensure equitable access and utilization across all transplant centers in the United States.