As highly effective CFTR modulators like Trikafta have transformed life for people with cystic fibrosis (CF), many patients have quietly started dropping some of their longstanding daily therapies — and a new study suggests that may be okay. Published in the Annals of the American Thoracic Society, the HERO-2 study followed 709 CF patients (aged 12+) on elexacaftor/tezacaftor/ivacaftor (ETI) for 12 months, tracking whether stopping chronic add-on therapies affected lung function or pulmonary exacerbations.

The findings were reassuring: patients who discontinued at least one chronic therapy showed no significant difference in lung function decline or risk of IV-antibiotic-treated exacerbations compared to those who kept all their treatments. Notably, 41.5% of participants had already self-reported stopping at least one therapy — with airway clearance, dornase alfa, and inhaled antibiotics topping the list.

Key Takeaways:

• No significant difference in pulmonary exacerbation probability between discontinuers and non-discontinuers (12.8% vs. 14.8%)
• Annual FEV1 change did not significantly differ between the two groups (mean difference: 0.41%/year)
• 7% of participants had stopped five or more different chronic treatments

Why it matters: These findings give clinicians and patients a real-world evidence base to begin conversations about "treatment simplification" — reducing the daily burden of CF care without compromising outcomes. However, researchers caution this isn't a one-size-fits-all green light; individualized, shared decision-making remains essential.