Cystic fibrosis respiratory microbiota remodelling over three years of elexacaftor–tezacaftor–ivacaftor therapy in a multi-centre cohort (microbiomejournal.biomedcentral.com)

• ETI therapy remodelled CF respiratory microbiota toward a healthy-like state over 3 years.
• Azithromycin co-administration impeded microbiota remodelling and promoted pathogen persistence.
• Canonical CF pathogens decreased in distribution and abundance with ETI duration.
• The study included 276 adults from six centres in the UK, USA, and Canada.

"This study examined the long-term effects of elexacaftor–tezacaftor–ivacaftor (ETI) therapy on the respiratory microbiota of 276 adults with cystic fibrosis from six centres in the UK, USA, and Canada over three years. Using 16S rRNA sequencing, they found that ETI therapy remodelled the microbiota toward a healthier state, with canonical CF pathogens decreasing in importance. However, concurrent azithromycin use impeded this remodelling and promoted dysbiosis and pathogen persistence. The findings suggest azithromycin should be evaluated for discontinuation in the CFTR modulator era."