The Paravit® Q&A with Expert Healthcare Professionals in CF: Dr Anirban Maitra
Welcome to the Paravit® Expert Q&A where we’ll be chatting to leaders in the field of cystic fibrosis (CF) to hear about what they’re working on, discuss clinical best practices, and share emerging research shaping CF care. We hope this series helps enhance your knowledge with valuable insights! Next to be interviewed is Dr Anirban Maitra. If you’d like to be interviewed next, please do get in touch with us at hcp@paravit-cf.com.
Hello Dr Maitra! Thank you for joining us. Can you please tell us a bit about you and your role?
Thank you for including me in your newsletter. I am a consultant paediatrician specialising in respiratory medicine at the Royal Manchester Children’s Hospital, the largest single-site children’s hospital in the UK. I am also the director of the cystic fibrosis (CF) centre, the largest in the UK and one of the largest globally. We care for nearly 200 children with cystic fibrosis exclusively at our centre, supported by seven shared care centres (Lancaster, Blackpool, Preston, Blackburn, Burnley, Wythenshawe, and Stockport). With the assistance of our dedicated paediatric colleagues, we oversee the care of an additional 160 children. Our team includes specialists in cystic fibrosis, nurses, dietitians, respiratory physiotherapists, psychologists, and pharmacists, all working together to provide exceptional care.
What inspired you to follow a career in Cystic Fibrosis?
I have always been passionate about paediatric respiratory medicine, and cystic fibrosis is one of the major conditions we care for. I was fascinated by the multisystemic effects of this single-gene disorder. During my training, I found that cystic fibrosis was one area often met with sadness and despair from patients, their carers, and the medical professionals involved.
Early in my training, I had the opportunity to work as a research registrar at Bristol Children’s Hospital, where I gained a comprehensive understanding of the full spectrum of CF services. Later, during my specialised GRID training, I worked at Sheffield Children’s Hospital, which provided excellent and comprehensive services to people with CF.
However, with the advent of the first modulator, ivacaftor, the outlook and care for many individuals with cystic fibrosis changed dramatically. The development of newer, highly effective modulators has transformed cystic fibrosis care into a journey of hope and optimism for most patients, their parents, and medical teams was inspirational. I have been privileged to be involved in the tertiary care of many children with cystic fibrosis, and I am considered part of their extended family by their parents and carers.
Has any interesting research or guidance been published recently that you would like to share/signpost CF healthcare professionals to?
Most recently, the NHS England conditioning body has approved funding for Alyftrek, the newest highly effective modulator. This drug combines deutivacaftor, tezacaftor, and vanzacaftor, and is authorised to treat individuals with cystic fibrosis aged 6 years and above (https://www.england.nhs.uk/publication/commissioning-statement-nhs-england-commissioning-statement-arrangements-for-access-to-cystic-fibrosis-transmembrane-conductance-regulator-cftr-modulators-for-licensed-and-off-label-use-in-patient/).
It represents an advancement over Kaftrio, which is the current highly effective modulator. Alyftrek is a new once-a-day triple combination drug. It offers a treatment option for some people who are ineligible or unable to take Kaftrio, as well as an alternative for those already on Kaftrio. I am proud to state that my tertiary paediatric CF centre with a focus on research, my team at RMCH participated in the trials involving both Kaftrio and Alyftrek.
Looking 5–10 years ahead, where do you see the biggest shifts coming in CF care? What role do you think nutrition will play in that change?
Over the past decade, CF care has been transformed by the introduction of highly effective CFTR modulators. However, supportive therapies such as optimised nutrition, close monitoring, microbiology-led segregation, and advances in antimicrobials and mucolytics remain essential. As survival improves, there will be increasing emphasis on long-term health, including bone and nutritional status.
Importantly, the fundamental genetic issue remains unresolved; not all patients are eligible for modulator therapy, and some may discontinue treatment due to side effects. Ongoing research is exploring modulators for currently ineligible patients and novel genetic correction approaches using viral vectors or mRNA therapies. While many of these studies are still in early stages, some results are promising.
Nutrition, as always, will play a pivotal role in this process, whether in managing overnutrition and obesity or addressing the consequences of undernutrition and attrition.
From your perspective, are we moving more towards personalised approaches in CF nutrition, or do standardised guidelines still play the lead role?
In the pre-modulator days, CF nutrition focused on addressing deficits caused by a lack of pancreatic enzymes and the resulting malabsorption, particularly of fats and fat-soluble vitamins. Typically, the nutritionist would advise a high-calorie, nutritious diet with added salt. However, with the advent of highly effective modulator therapy, we have observed improvement in pancreatic function in a subgroup of our patients. This has led to a reduction in pancreatic enzyme replacement therapy for many, and notably, some patients have ceased enzymatic supplementation altogether.
Additionally, we have seen better absorption of fat-soluble vitamins. Consequently, more advanced formulations, such as Paravit-Mod, which contain lower amounts of supplemental vitamins, are now used. Nonetheless, this response, even among individuals with similar genetic profiles, remains inconsistent and unpredictable.
As a result, we have moved towards a more personalised approach to nutritional care, with our specialist dietitians closely monitoring anthropometric measures, signs of constipation and malabsorption, and conducting objective assessments of pancreatic function using faecal elastase tests, alongside systemic evaluations of fat-soluble vitamin absorption. Although still based on standardised guidelines, this approach is tailored to meet the specific needs of each child with cystic fibrosis. I believe this practice is now standard across all major centres caring for children with cystic fibrosis.
And finally… what’s something outside of work that brings you joy or helps you recharge?
Although I thoroughly enjoy my work, I must admit that it can be quite tiring at times! My hobbies outside of work mainly focus on relaxation techniques, such as reading, listening to music, and watching movies.
I also enjoy travelling and driving around in search of new places to explore with my wife, daughter and dog. More recently, I have been on a spiritual journey and have established the Manchester Vedanta Study Circle, a group dedicated to the study, discussion, and practice of the ancient Hindu philosophy of Vedanta. Vedanta emphasises self-enquiry, spiritual development, and understanding the unity of all existence.
I am also the founder and chair of the UK-registered charity Centre for Social Change and Development, which aims to develop marginalised and disadvantaged communities using social technologies.
Dr. Anirban Maitra is currently employed as a Consultant in Paediatric Respiratory Medicine (Paediatric Pulmonology) at the Royal Manchester Children’s Hospital (Central Manchester University Hospitals), the largest single-site tertiary children’s hospital in the UK. He serves as the Director of the Cystic Fibrosis (CF) Unit, which is the largest paediatric tertiary centre in the UK for children with CF. He has previously led clinical initiatives in the treatment of bronchiectasis and primary ciliary dyskinesia. Dr. Maitra also provides private consultations at Alexandra Hospital and Spire Manchester Hospital.
In addition to his clinical work, Dr. Maitra plays an active role in research in cystic fibrosis. He is also a board member of the CF Research Oversight Board (CF RSOB), the CF Specialist Advisory Group (CF–SAG), the CF Trust Quality Improvement Board, and the CF Trust Diversity in Trials Group.
