Treatments for MAC, M. abscessus pulmonary infection often not guideline based
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Of patients being treated for Mycobacterium avium complex and Mycobacterium abscessus pulmonary infection, fewer than half received guideline-based treatment, according to a recent study.
“Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause pulmonary infections leading to chronic, debilitating disease,” Jennifer Ku, PhD, MPH, infectious disease epidemiologist at the Kaiser Permanente Southern California department of research and evaluation, told Healio. “Treatment for NTM pulmonary infection often requires long-term multidrug antibiotic therapy, which often causes adverse events that lead to treatment interruptions, modifications, and/or early termination.”
According to Ku, the current treatment guidelines published by the American Thoracic Society/Infectious Disease Society of America (ATS) recommend a macrolide-based three-drug antibiotic therapy. Ku added that although guideline-based-therapy (GBT) is currently recognized as the most effective regimen, guidelines are not consistently followed.
“Even with the published guidelines, there is a critical unmet need for data on treatment patterns and drug-related adverse outcomes,” she said.
Ku and colleagues used the Bronchiectasis and NTM Research Registry (BRR), a prospective cohort of patients with an established diagnosis of bronchiectasis and/or NTM enrolled across 13 sites in the U.S. staring in 2008. The researchers used data from people enrolled starting January 2020 who were diagnosed with Mycobacterium avium complex (MAC) or M. abscessus pulmonary infection. They then assessed patient characteristics, antibiotic therapy used and associated adverse events during the baseline period, which were later assessed for relation to each drug.
Among 2,504 BRR subjects, 1,216 (49%) met case definitions for pulmonary MAC or M. abscessus infection. After excluding 58 people with infection by more than one species, 1,038 (90%) had MAC infection and 120 (10%) had M. abscessus infection.
The data showed that of those with MAC pulmonary infection, 40% received antibiotic treatment — the most common being macrolide (68%) and rifamycin (60%) — with GBT used in only about half (48%) and some receiving regimens associated with macrolide resistance. Additionally, drug-related adverse events occurred in 21% of those treated for MAC, with some of note being linezolid-attributed peripheral neuropathy and amikacin-attributed hearing loss.
Among patients with M. abscessus infection, 28% received antibiotic treatment, with a high proportion receiving macrolide monotherapy (33%) and many not following the guidelines. The study also revealed drug-related adverse events, including rifampin-attributed hepatitis, rifampin-attributed transaminitis and linezolid-attributed peripheral neuropathy.
Ku said these results highlight poor adherence to ATS/IDSA treatment guidelines for MAC and M. abscessus pulmonary infection, with less than half of treated subjects receiving GBT.
“Factors leading to therapy interruptions and discontinuation, such as adverse events and tolerability, have an important role in how NTM pulmonary infection is treated in the U.S.,” Ku said. “Further research is needed to evaluate reasons for poor adherence to guideline recommendations.”
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