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Mycobacterium abscessus pulmonary disease: individual patient data meta-analysis
Senin, 02 Des 2019 15:51:30

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 Yi

European Respiratory Journal 2019; DOI: 10.1183/13993003.01991-2018

Abstract

Treatment of Mycobacterium abscessus pulmonary disease (MAB-PD), caused by M. abscessus subspecies abscessusM. abscessus subspecies massiliense, or M. abscessus subspecies bolletii, is challenging.

We conducted an individual patient data meta-analysis based on studies reporting treatment outcomes for MAB-PD to clarify the 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 subspecies abscessus and 56.7% for M. abscessus subspecies massiliense. For MAB-PD overall, the use of imipenem was associated with treatment success (adjusted odds ratio [aOR], 2.65; 95% confidence interval [CI], 1.36–5.10). For patients with M. abscessus subspecies 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 subspecies massiliense, the choice among these drugs was not associated with the 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 subspecies abscessus.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Kwak has nothing to disclose.

Conflict of interest: Dr. DALCOLMO has nothing to disclose.

Conflict of interest: Dr. Daley reports grants and personal fees from Insmed, personal fees from Horizon, personal fees from Spero, personal fees from Johnson and Johnson, outside the submitted work; .

Conflict of interest: Dr. Eather has nothing to disclose.

Conflict of interest: Dr. Gayoso has nothing to disclose.

Conflict of interest: Dr. Hasegawa reports grants and personal fees from Insmed Incorporated, during the conduct of the study; grants from Nikon Corporation, grants from Taisho-Toyama Pharmaceutical Co., Ltd., grants from Eisai Co., Ltd., grants from Daiichi Sankyo Co., Ltd., grants from MSD K.K. a subsidiary of Merck & Co.Inc., grants from Sumitomo Dainippon Pharma Co., Ltd., grants from Pfizer Inc., grants from Astellas Pharma Inc., grants from Cepheid Inc.

Conflict of interest: Dr. Jhun has nothing to disclose.

Conflict of interest: Dr. Koh reports personal fees from Insmed Inc., outside the submitted work.

Conflict of interest: Ho Namkoong

Conflict of interest: Dr. Park has nothing to disclose.

Conflict of interest: Dr. THOMSON reports personal fees from INSMED, personal fees from SAVARA, personal fees from MENARINI, personal fees from ASTRA ZENECA, outside the submitted work.

Conflict of interest: Dr. van Ingen reports personal fees from Insmed, personal fees from Spero Therapeutics, personal fees from Johnson and Johnson, during the conduct of the study.

Conflict of interest: Dr. Zweijpfenning reports personal fees and non-financial support from insmed and novartis outside the submitted work.

Conflict of interest: Dr. Yim has nothing to disclose.

Conflict of interest: Dr. Namkong has nothing to disclose.

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