Diagnosis and treatment of ADHD in pediatric patients during the first year of elexacaftor/tezacaftor/ivacaftor.

Background: With elexacaftor/tezacaftor/ivacaftor (ETI), children with cystic fibrosis (CwCF) are living healthier lives with a focus on typical developmental issues such as attention deficit/hyperactivity disorder (ADHD). This paper characterizes CwCF with ADHD within the first year of ETI treatment.

Methods: This retrospective, observational analysis examines a subgroup of CwCF participating in a longitudinal study obtaining prospective data regarding the impact of ETI on mental health. All participants started on ETI were offered enrollment, with rolling enrollment as younger children became eligible. Clinical data regarding CF symptoms, mental health diagnoses, medications, changes in mental health symptoms and BMI were collected via chart review.

Results: Before ETI, ADHD diagnoses were identified in 21 children; an additional 3 were diagnosed within the first year. Eleven children were treated with ADHD medication at ETI initiation; nine children did not use ADHD medication during the study period. In the 1-year follow-up, four children started ADHD medication. Of the 11 who started ETI on ADHD medication, five increased doses, three changed medications and/or decreased dose, and one discontinued medication. Two children experienced no changes to their treatment.

Conclusion: Most CwCF on ADHD medication underwent changes in dosing and/or medication after ETI initiation. Several children were diagnosed with ADHD after starting ETI. The role of ETI in these recent diagnoses and treatment plans is unclear. Given the prevalence of pediatric ADHD diagnoses and the medication changes that were needed by this population, additional research is warranted to clarify the relationship between ETI and ADHD in CwCF.