Mycobacterium abscessus pulmonary disease: individual patient data meta-analysis

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.

Clinical Efficacy and Adverse Effects of Antibiotics Used to Treat Mycobacterium abscessus Pulmonary Disease

“…Two recent meta-analyses reported disappointing treatment outcomes for M. abscessus pulmonary disease; the therapeutic efficiency rates were 54% and 45.6% for all patients, and 35% and 33.0% for patients diagnosed with pulmonary, M. abscessus subsp. abscessus infections (9, 14). Similar rates of treatment success are reported here, i.e., 45.1% for all cases of M. abscessus pulmonary disease and 33.5% for cases involving M. abscessus subsp.…”

“…Recently, the NTM International Network released a consensus statement defining the treatment outcomes of NTM pulmonary disease, allowing for a better evaluation of the efficacy of each antibiotic used in clinical studies (8). Using this criteria, Kwak and colleagues conducted an excellent meta-analysis of 14 studies with detailed individual patient data (9). Patients treated with azithromycin, amikacin or imipenem exhibited better outcomes, emphasizing the import of different therapeutic approaches.…”

Same meat, different gravy: ignore the new names of mycobacteria

“…Significant progress has been gained in recent years by promoting evidence-based clinical care, treatment outcomes and clinical trials in nontuberculous mycobacterial infections as a group, sharing a simple term familiar to clinicians and patients (mycobacteria) and an appropriate acronym (NTM) [11][12][13][14]. The proposed new nomenclature does not help this cause.…”

Rifabutin: A Repurposing Candidate for Mycobacterium abscessus Lung Disease

“…Ubiquitously present in soil and water, Mab typically causes disease in vulnerable populations, including immune-compromised patients and people suffering from lung disorders such as cystic fibrosis and chronic obstructive pulmonary disease. Whereas, a drug regime that cures tuberculosis within 6 months is available, cure rates for Mab with the currently recommended combinations are 50% at best (Kwak et al, 2019). The prevalence of Mab pulmonary disease is increasing and more efficacious drugs are urgently needed (Wu et al, 2018;Daniel-Wayman et al, 2019).…”