Mycobacterium abscessus pulmonary disease: Individual patient data meta-analysis

Nakwon Kwak, Margareth Pretti Dalcolmo, Charles L. Daley, Geoffrey Eather, Regina Gayoso, Naoki Hasegawa, Byung Woo Jhun, Won Jung Koh, Ho Namkoong, Jimyung Park, Rachel Thomson, Jakko Van Ingen, Sanne M.H. Zweijpfenning, Jae Joon Yim

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Abstract

Treatment of Mycobacterium abscessus pulmonary disease (MAB-PD), caused by M. abscessus subsp. abscessus, M. abscessus subsp. massiliense or M. abscessus subsp. bolletii, is challenging. We conducted an individual patient data meta-analysis based on studies reporting treatment outcomes for MAB-PD to clarify treatment outcomes for MAB-PD and the impact of each drug on treatment outcomes. Treatment success was defined as culture conversion for 12 months while on treatment or sustained culture conversion without relapse until the end of treatment. Among 14 eligible studies, datasets from eight studies were provided and a total of 303 patients with MAB-PD were included in the analysis. The treatment success rate across all patients with MAB-PD was 45.6%. The specific treatment success rates were 33.0% for M. abscessus subsp. abscessus and 56.7% for M. abscessus subsp. massiliense. For MAB-PD overall, the use of imipenem was associated with treatment success (adjusted odds ratio (aOR) 2.65, 95% CI 1.36–5.10). For patients with M. abscessus subsp. abscessus, the use of azithromycin (aOR 3.29, 95% CI 1.26–8.62), parenteral amikacin (aOR 1.44, 95% CI 1.05–1.99) or imipenem (aOR 7.96, 95% CI 1.52–41.6) was related to treatment success. For patients with M. abscessus subsp. massiliense, the choice among these drugs was not associated with treatment outcomes. Treatment outcomes for MAB-PD are unsatisfactory. The use of azithromycin, amikacin or imipenem was associated with better outcomes for patients with M. abscessus subsp. abscessus.

Original languageEnglish
Article number1801991
JournalEuropean Respiratory Journal
Volume54
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1

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ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Kwak, N., Dalcolmo, M. P., Daley, C. L., Eather, G., Gayoso, R., Hasegawa, N., Jhun, B. W., Koh, W. J., Namkoong, H., Park, J., Thomson, R., Van Ingen, J., Zweijpfenning, S. M. H., & Yim, J. J. (2019). Mycobacterium abscessus pulmonary disease: Individual patient data meta-analysis. European Respiratory Journal, 54(1), [1801991]. https://doi.org/10.1183/13993003.01991-2018