A survey of clarithromycin monotherapy and long‐term administration of ethambutol for patients with MAC lung disease in Japan: A retrospective cohort study using the database of health insurance claims

Iwao, Tomohide; Kato, Genta; Ito, Isao; Aramaki, Eiji; Kuroda, Tomohiro

doi:10.1002/pds.4951

Cited by 3 publications

(2 citation statements)

References 16 publications

(14 reference statements)

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“…Importantly, patients treated by Dermatologists with dual-or triple-drug regimens were excluded from the study to screen out possible cases of NTM skin and soft tissue infections. These results (and the results regarding the length of treatment) indicate adherence to the guidelines may not be optimal, a nding that was also observed in previously published studies from the US, Europe and Japan [8, 9,13,14,[21][22][23][24]. One potential explanation is that these regimens were not used for NTM-LD, but rather for M. marinum skin infection or staphylococcal prosthetic joint infections.…”

Section: Discussionsupporting

confidence: 60%

Real-world treatment patterns in patients with nontuberculous mycobacterial lung disease in the Netherlands based on medication dispensing data

Hoefsloot

Dacheva

Laan³

et al. 2023

Preprint

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Purpose: Real-world data on antibiotic management of nontuberculous mycobacterial lung disease (NTM-LD) is limited for many countries. This study aimed to evaluate real-world treatment practices of NTM-LD in the Netherlands using medication dispensing data. Methods: A retrospective longitudinal real-world study was conducted using IQVIA’s Dutch pharmaceutical dispensing database. The data are collected monthly and include approximately 70% of all outpatient prescriptions in the Netherlands. Patients initiated on specific NTM-LD treatment regimens between October 2015 and September 2020 were included. The main areas of investigation were initial treatment regimens, persistence on treatment, treatment switching, treatment compliance in terms of medication possession rate (MPR) and restarts of treatment. Results: The database included 465 unique patients initiated on triple- or dual-drug regimens for the treatment of NTM-LD. Treatment switches were common and occurred approximately 1.6 per quarter throughout the treatment period. The average MPR of patients initiated on triple-drug therapy was 90%. The median time on therapy for these patients was 119 days; after six months and one year, 47% and 20% of the patients, respectively, were still on antibiotic therapy. Of 187 patients initiated on triple-drug therapy, 33 (18%) patients restarted antibiotic therapy after the initial treatment had been stopped. Conclusion: When on therapy, patients were compliant with the NTM-LD treatment; however, many patients stopped their therapy prematurely, treatment switches often occurred, and part of patients had to restart their therapy after a longer treatment gap. NTM-LD management should be improved through greater guideline adherence and appropriate involvement of expert centers.

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Section: Discussionsupporting

confidence: 60%

Real-world treatment patterns in patients with nontuberculous mycobacterial lung disease in the Netherlands based on medication dispensing data

Hoefsloot

Dacheva

Laan³

et al. 2023

Preprint

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“…In addition, Kadota et al and Ito et al showed that CLR + EMB treatment regimens without RIF do not increase macrolide resistance [ 57 , 58 ]. In their analysis of Japanese national health insurance receipt data, Iwao et al reported that the percentage of patients who received CLR monotherapy for MAC-PD for more than 3 months was 9.2% [ 59 ]. Morimoto et al reported that among 77 patients with macrolide-resistant MAC-PD, approximately 20% (15 cases) exhibited AMK MIC >32 μg/mL [ 22 ].…”

Section: Drug Resistant Status Of Major Mycobacterial Pathogensmentioning

confidence: 99%

Anti-Mycobacterial Drug Resistance in Japan: How to Approach This Problem?

Kamada

Mitarai

2021

Antibiotics

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Mycobacteriosis is mainly caused by two groups of species: Mycobacterium tuberculosis and non-tuberculosis mycobacteria (NTM). The pathogens cause not only respiratory infections, but also general diseases. The common problem in these pathogens as of today is drug resistance. Tuberculosis (TB) is a major public health concern. A major challenge in the treatment of TB is anti-mycobacterial drug resistance (AMR), including multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis. Recently, the success rate of the treatment of drug-resistant tuberculosis (DR-TB) has improved significantly with the introduction of new and repurposed drugs, especially in industrialized countries such as Japan. However, long-term treatment and the adverse events associated with the treatment of DR-TB are still problematic. To solve these problems, optimal treatment regimens designed/tailor-made for each patient are necessary, regardless of the location in the world. In contrast to TB, NTM infections are environmentally oriented. Mycobacterium avium-intracellulare complex (MAC) and Mycobacterium abscessus species (MABS) are the major causes of NTM infections in Japan. These bacteria are naturally resistant to a wide variation of antimicrobial agents. Macrolides, represented by clarithromycin (CLR) and amikacin (AMK), show relatively good correlation with treatment success. However, the efficacies of potential drugs for the treatment of macrolide-resistant MAC and MABS are currently under evaluation. Thus, it is particularly difficult to construct an effective treatment regimen for macrolide-resistant MAC and MABS. AMR in NTM infections are rather serious in Japan, even when compared with challenges associated with DR-TB. Given the AMR problems in TB and NTM, the appropriate use of drugs based on accurate drug susceptibility testing and the development of new compounds/regimens that are strongly bactericidal in a short-time course will be highly expected.

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Real-world treatment patterns in patients with nontuberculous mycobacterial lung disease in the Netherlands based on medication dispensing data

Hoefsloot

Dacheva²,

Laan³

et al. 2023

BMC Pulm Med

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Purpose Real-world data on antibiotic management of nontuberculous mycobacterial lung disease (NTM-LD) is limited for many countries. This study aimed to evaluate real-world treatment practices of NTM-LD in the Netherlands using medication dispensing data. Methods A retrospective longitudinal real-world study was conducted using IQVIA’s Dutch pharmaceutical dispensing database. The data are collected monthly and include approximately 70% of all outpatient prescriptions in the Netherlands. Patients initiated on specific NTM-LD treatment regimens between October 2015 and September 2020 were included. The main areas of investigation were initial treatment regimens, persistence on treatment, treatment switching, treatment compliance in terms of medication possession rate (MPR) and restarts of treatment. Results The database included 465 unique patients initiated on triple- or dual-drug regimens for the treatment of NTM-LD. Treatment switches were common and occurred approximately 1.6 per quarter throughout the treatment period. The average MPR of patients initiated on triple-drug therapy was 90%. The median time on therapy for these patients was 119 days; after six months and one year, 47% and 20% of the patients, respectively, were still on antibiotic therapy. Of 187 patients initiated on triple-drug therapy, 33 (18%) patients restarted antibiotic therapy after the initial treatment had been stopped. Conclusion When on therapy, patients were compliant with the NTM-LD treatment; however, many patients stopped their therapy prematurely, treatment switches often occurred, and part of patients had to restart their therapy after a longer treatment gap. NTM-LD management should be improved through greater guideline adherence and appropriate involvement of expert centers.

show abstract

A survey of clarithromycin monotherapy and long‐term administration of ethambutol for patients with MAC lung disease in Japan: A retrospective cohort study using the database of health insurance claims

Cited by 3 publications

References 16 publications

Real-world treatment patterns in patients with nontuberculous mycobacterial lung disease in the Netherlands based on medication dispensing data

Real-world treatment patterns in patients with nontuberculous mycobacterial lung disease in the Netherlands based on medication dispensing data

Anti-Mycobacterial Drug Resistance in Japan: How to Approach This Problem?

Real-world treatment patterns in patients with nontuberculous mycobacterial lung disease in the Netherlands based on medication dispensing data

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