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Investigation of Risk Factors for Relapse of Mycobacterium Avium Complex Lung Disease After Treatment in Accordance with the Guidelines
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A2597 - Investigation of Risk Factors for Relapse of Mycobacterium Avium Complex Lung Disease After Treatment in Accordance with the Guidelines
Author Block: K. Shinfuku1, H. Matsui2, K. Takeda3, S. Akashi3, O. Narumoto4, H. Tashimo5, K. Ohta3; 1Tokyo National Hospital, Kiyose-shi, Japan, 2Center for Pulmonary Diseases, Tokyo National Hospital, Kiyose, Japan, 3Tokyo National Hospital, Tokyo, Japan, 4Tokyo National Hospital, Kiyose, Japan, 5Center for Asthma and Allergy, NHO Tokyo National Hospital, Kiyose, Japan.
Introduction: Against Mycobacterium avium complex (MAC) pulmonary disease, 2007 ATS/IDSA and 2017 BTS guidelines both recommend combination chemotherapy with macrolide (azithromycin or clarithromycin (CAM)), ethambutol (EB), and rifampicin (RFP), plus aminoglycosides for severe patients, with treatment endpoint of 12 months after culture conversion although the old BTS guidelines in 2000 recommended 2-year treatment irrespective of sputum culture. In clinical practice, the confirmation of sputum culture conversion is often difficult, mainly because of lack of sputum collection. Besides, this recommendation is not based on robust evidence. Therefore, considering the rate of relapse, reinfection or retreatment of MAC, MAC lung disease might be treated for a longer duration in selected patients for a better outcome.Aim: To determine the risk factors for relapse of MAC lung disease and figure out the patient characteristics of the candidate for longer or additional treatments. Methods: We analyzed medical records of patients with MAC lung disease, who were successfully treated with CAM, EB and RFP at some time during 2013 Oct - 2014 Sep. We excluded patients whose follow-up was discontinued in less than 6 months after treatment cessation. We analyzed data of age, sex, treatment endpoint, dose of CAM, use of erythromycin, radiologic pattern and affected area, retreatment, and microbiological examination. In this study, relapse was defined as reversion of sputum culture plus retreatment of MAC. Results: Sixty-six patients who met the above criteria were assessed in this study. The mean age was 69.1 years with 6 males and 60 females. The number of relapse cases was 26 with the relapse rate of 39%. In the relapse cases, the radiographically affected area was greater (larger than one lung field affected in 30.8% of the relapse group vs 12.5% of the non-relapse group) and Pseudomonas isolation rate was higher (23.1% vs 5.0%). Conclusions: The relapse rate after standard therapy in accordance with the guidelines was 39%. In patients with MAC affecting larger than one lung field and co-infected with Pseudomonas, we should consider treatment for a longer period or with additional drugs.
Author Block: K. Shinfuku1, H. Matsui2, K. Takeda3, S. Akashi3, O. Narumoto4, H. Tashimo5, K. Ohta3; 1Tokyo National Hospital, Kiyose-shi, Japan, 2Center for Pulmonary Diseases, Tokyo National Hospital, Kiyose, Japan, 3Tokyo National Hospital, Tokyo, Japan, 4Tokyo National Hospital, Kiyose, Japan, 5Center for Asthma and Allergy, NHO Tokyo National Hospital, Kiyose, Japan.
Introduction: Against Mycobacterium avium complex (MAC) pulmonary disease, 2007 ATS/IDSA and 2017 BTS guidelines both recommend combination chemotherapy with macrolide (azithromycin or clarithromycin (CAM)), ethambutol (EB), and rifampicin (RFP), plus aminoglycosides for severe patients, with treatment endpoint of 12 months after culture conversion although the old BTS guidelines in 2000 recommended 2-year treatment irrespective of sputum culture. In clinical practice, the confirmation of sputum culture conversion is often difficult, mainly because of lack of sputum collection. Besides, this recommendation is not based on robust evidence. Therefore, considering the rate of relapse, reinfection or retreatment of MAC, MAC lung disease might be treated for a longer duration in selected patients for a better outcome.Aim: To determine the risk factors for relapse of MAC lung disease and figure out the patient characteristics of the candidate for longer or additional treatments. Methods: We analyzed medical records of patients with MAC lung disease, who were successfully treated with CAM, EB and RFP at some time during 2013 Oct - 2014 Sep. We excluded patients whose follow-up was discontinued in less than 6 months after treatment cessation. We analyzed data of age, sex, treatment endpoint, dose of CAM, use of erythromycin, radiologic pattern and affected area, retreatment, and microbiological examination. In this study, relapse was defined as reversion of sputum culture plus retreatment of MAC. Results: Sixty-six patients who met the above criteria were assessed in this study. The mean age was 69.1 years with 6 males and 60 females. The number of relapse cases was 26 with the relapse rate of 39%. In the relapse cases, the radiographically affected area was greater (larger than one lung field affected in 30.8% of the relapse group vs 12.5% of the non-relapse group) and Pseudomonas isolation rate was higher (23.1% vs 5.0%). Conclusions: The relapse rate after standard therapy in accordance with the guidelines was 39%. In patients with MAC affecting larger than one lung field and co-infected with Pseudomonas, we should consider treatment for a longer period or with additional drugs.
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