Unsuccessful Treatment Outcomes in Nontuberculous Mycobacteria Lung Disease

Approximately one-third of adults who undergo treatment for nontuberculous mycobacteria lung disease (NTM-LD) experience an unsuccessful outcome, with adverse events and treatment discontinuation being major challenges in the disease management.

An observational, retrospective study was conducted in consecutive adults who received treatment for NTM-LD in Milan, Italy, between 2007 and 2017. Results of the study were published in Respiratory Medicine.

Investigators sought to explore NTM-LD clinical outcomes in a real-life setting. A total of 170 patients were enrolled in the current study. Of the participants, the median age was 68 years (range, 59-76 years) and 68.2% were women. All of the patients underwent computed tomography (CT) scanning; 21.8% had fibrocavitary disease and 78.2% had nodular bronchiectatic disease. NTM-LD was related primarily to Mycobacterium avium complex (MAC) in 71.2%, M kansasii in 9.4%, and M xenopi in 7.1% of patients.

With a median follow-up of 31 months, adverse events were reported in 37.6% of the participants. Considering the study population as a whole, treatment outcomes included an unsuccessful outcome in 35.3% of the participants.  Treatment was discontinued in 13.5%of patients and treatment failure occurred in 4.1% of patients. Recurrence was reported in 11.2% of patients, reinfection was reported in 5.3%, treatment failure occurred in 4.1% of individuals, and relapse was observed in 1.2% of patients. The most common reason for treatment discontinuation was drug intolerance.

There were no differences observed between patients with MAC lung disease (MAC-LD) and those with other NTM-LDs with respect to unsuccessful treatment outcomes overall (35.5% vs 34.7%, respectively). Of note, treatment discontinuation was reported in a significantly higher percentage of patients with NTM-LD other than MAC, compared with patients with MAC-LD (22.4% vs 9.9%, respectively; P =.030).

A major limitation of the current study was its observational, retrospective design, which might be associated with the interference of both unknown and recorded confounding factors. Another limitation was that since this was a real-life study, no culture data were available in >40% of the patients.

The investigators concluded that prospective, longitudinal, observational studies are warranted to provide more detailed data on clinical follow-up and the related variables (eg, treatment adherence and relapse).

Reference

Aliberti S, Sotgiu G, Castellotti P, et al. Real-life evaluation of clinical outcomes in patients undergoing treatment for nontuberculous mycobacteria lung disease: a 10-year cohort study. Respir Med. 2020;164:105899. doi:10.1016/j.rmed.2020.105899