Abstract
Background: The optimal duration of antimicrobial therapy for Mycobacterium avium complex lung disease (MAC-LD) is unknown, and recurrence rates are high after treatment discontinuation. Intermittent therapy is recommended for the initial treatment of non-cavitary nodular/bronchiectatic MAC-LD. We hypothesized that intermittent maintenance therapy (IMT) could effectively prevent recurrence after successful treatment of MAC-LD. Methods: Adult patients diagnosed with MAC-LD who received IMT after successful daily therapy (DT) between January 1, 2006 and December 31, 2016 were identified from clinical databases at three institutions in Japan. Treatment outcomes were evaluated for all patients. Results: Of 38 patients (median age, 66 years; 29 women; nodular/bronchiectatic form, 29 patients) who received IMT after successful treatment, one was excluded due to death from an unknown cause, 1 month after IMT initiation. Finally, treatment outcomes were evaluated for 37 patients. Twenty-eight (76%) patients had sustained negative culture results over a median follow-up duration of 2.7 (interquartile range [IQR], 1.9–6.0) years, while six (16%) required switching to DT because of clinical deterioration over a median follow-up duration of 2.7 (IQR, 1.6–4.1) years. Favorable clinical outcomes were achieved for all patients who exhibited clinical deterioration. All patients tolerated the antimicrobials without discontinuation, and follow-up drug susceptibility testing showed negative results for clarithromycin-resistant MAC in the patients who experienced clinical deterioration. Conclusions: IMT after successful treatment may be a feasible option for patients with MAC-LD. Further studies should determine the population that would benefit from this strategy.
| Original language | English |
|---|---|
| Journal | Journal of Infection and Chemotherapy |
| DOIs | |
| Publication status | Accepted/In press - 2018 Jan 1 |
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Keywords
- Intermittent maintenance therapy (IMT)
- Mycobacterium avium complex (MAC)
- Nontuberculous mycobacteria (NTM)
- Pulmonary disease
ASJC Scopus subject areas
- Microbiology (medical)
- Pharmacology (medical)
- Infectious Diseases
Cite this
Efficacy and safety of intermittent maintenance therapy after successful treatment of Mycobacterium avium complex lung disease. / Nontuberculous Mycobacteriosis Japan Research Consortium (NTM-JRC).
In: Journal of Infection and Chemotherapy, 01.01.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Efficacy and safety of intermittent maintenance therapy after successful treatment of Mycobacterium avium complex lung disease
AU - Nontuberculous Mycobacteriosis Japan Research Consortium (NTM-JRC)
AU - Asakura, Takanori
AU - Nakagawa, Taku
AU - Suzuki, Shoji
AU - Namkoong, Ho
AU - Morimoto, Kozo
AU - Ishii, Makoto
AU - Kurashima, Atsuyuki
AU - Betsuyaku, Tomoko
AU - Ogawa, Kenji
AU - Hasegawa, Naoki
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background: The optimal duration of antimicrobial therapy for Mycobacterium avium complex lung disease (MAC-LD) is unknown, and recurrence rates are high after treatment discontinuation. Intermittent therapy is recommended for the initial treatment of non-cavitary nodular/bronchiectatic MAC-LD. We hypothesized that intermittent maintenance therapy (IMT) could effectively prevent recurrence after successful treatment of MAC-LD. Methods: Adult patients diagnosed with MAC-LD who received IMT after successful daily therapy (DT) between January 1, 2006 and December 31, 2016 were identified from clinical databases at three institutions in Japan. Treatment outcomes were evaluated for all patients. Results: Of 38 patients (median age, 66 years; 29 women; nodular/bronchiectatic form, 29 patients) who received IMT after successful treatment, one was excluded due to death from an unknown cause, 1 month after IMT initiation. Finally, treatment outcomes were evaluated for 37 patients. Twenty-eight (76%) patients had sustained negative culture results over a median follow-up duration of 2.7 (interquartile range [IQR], 1.9–6.0) years, while six (16%) required switching to DT because of clinical deterioration over a median follow-up duration of 2.7 (IQR, 1.6–4.1) years. Favorable clinical outcomes were achieved for all patients who exhibited clinical deterioration. All patients tolerated the antimicrobials without discontinuation, and follow-up drug susceptibility testing showed negative results for clarithromycin-resistant MAC in the patients who experienced clinical deterioration. Conclusions: IMT after successful treatment may be a feasible option for patients with MAC-LD. Further studies should determine the population that would benefit from this strategy.
AB - Background: The optimal duration of antimicrobial therapy for Mycobacterium avium complex lung disease (MAC-LD) is unknown, and recurrence rates are high after treatment discontinuation. Intermittent therapy is recommended for the initial treatment of non-cavitary nodular/bronchiectatic MAC-LD. We hypothesized that intermittent maintenance therapy (IMT) could effectively prevent recurrence after successful treatment of MAC-LD. Methods: Adult patients diagnosed with MAC-LD who received IMT after successful daily therapy (DT) between January 1, 2006 and December 31, 2016 were identified from clinical databases at three institutions in Japan. Treatment outcomes were evaluated for all patients. Results: Of 38 patients (median age, 66 years; 29 women; nodular/bronchiectatic form, 29 patients) who received IMT after successful treatment, one was excluded due to death from an unknown cause, 1 month after IMT initiation. Finally, treatment outcomes were evaluated for 37 patients. Twenty-eight (76%) patients had sustained negative culture results over a median follow-up duration of 2.7 (interquartile range [IQR], 1.9–6.0) years, while six (16%) required switching to DT because of clinical deterioration over a median follow-up duration of 2.7 (IQR, 1.6–4.1) years. Favorable clinical outcomes were achieved for all patients who exhibited clinical deterioration. All patients tolerated the antimicrobials without discontinuation, and follow-up drug susceptibility testing showed negative results for clarithromycin-resistant MAC in the patients who experienced clinical deterioration. Conclusions: IMT after successful treatment may be a feasible option for patients with MAC-LD. Further studies should determine the population that would benefit from this strategy.
KW - Intermittent maintenance therapy (IMT)
KW - Mycobacterium avium complex (MAC)
KW - Nontuberculous mycobacteria (NTM)
KW - Pulmonary disease
UR - http://www.scopus.com/inward/record.url?scp=85054133287&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85054133287&partnerID=8YFLogxK
U2 - 10.1016/j.jiac.2018.07.021
DO - 10.1016/j.jiac.2018.07.021
M3 - Article
JO - Journal of Infection and Chemotherapy
JF - Journal of Infection and Chemotherapy
SN - 1341-321X
ER -