Multisystem Effects
As is well known, CF effect more than the lungs, thus there were several notable reports related to ETI use and multisystem alterations. Presence of Mycobacterium abscessus infection for over 12 years, was no longer seen in culture in one PwCF after starting ETI49. Vitamin levels were altered, with vitamin E levels increasing 12 months after ETI in a review of 76 patients50 and 2 reported cases of papilledema with elevated Vitamin A levels51. Mental status changes (mainly mental fogginess) were seen in a case series of 6 patients, all stopping the medication withing 3 months of initiation, despite attempts at altered dosing regimens52. Glycemic effects were examined in 24 patients with and without CF related diabetes demonstrating a reduction in glucose parameters from continuous glucose monitoring and no one showed evidence of hypoglycemia53. Biliary disease was seen in 7 patients at two adults centers, with 6 patients requiring cholecystectomy54. Although the additional effects of ETI are still being determined, some of benefit, but some of concern, thus additional care/concern should be undertaken when monitoring our patients on modulators.