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Eur Respir J. 2019;54(1):13993003.01991-2018.

M ycobacterium abscessus pulmonary disease: individual patient data meta-analysis.

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제1저자 곽낙원 · 교신저자 임재준

PMID 30880280 DOI 10.1183/13993003.01991-2018 IF 23.8 호흡기내과
소속 (11)
  1. Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
  2. Centro de Referencia Helio Fraga, Escola Nacional de Saúde Pública, FIOCRUZ, Rio de Janeiro, Brazil.
  3. Division of Mycobacterial and Respiratory Infections, Dept of Medicine, National Jewish Health, Denver, CO, USA.
  4. Metro South Clinical Tuberculosis Service and Dept of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia.
  5. Center for Infectious Diseases and Infection Control, Keio University School of Medicine, Tokyo, Japan.
  6. Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
  7. Division of Pulmonary Medicine, Dept of Medicine, Keio University School of Medicine, Tokyo, Japan.
  8. Gallipoli Medical Research Institute, University of Queensland, Brisbane, Australia.
  9. Dept of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.
  10. Dept of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
  11. Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea yimjj@snu.ac.kr.

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.

Copyright ©ERS 2019.

Comment · 정정

Conflict of interest statement

Conflict of interest: N. Kwak has nothing to disclose. Conflict of interest: M.P. Dalcolmo has nothing to disclose. Conflict of interest: C.L. Daley reports grants and personal fees from Insmed, and personal fees from Horizon, Spero and Johnson and Johnson, outside the submitted work. Conflict of interest: G. Eather has nothing to disclose. Conflict of interest: R. Gayoso has nothing to disclose. Conflict of interest: N. Hasegawa reports grants and personal fees from Insmed Inc., during the conduct of the study; grants from Nikon Corporation, Taisho-Toyama Pharmaceutical Co., Ltd, Eisai Co., Ltd, Daiichi Sankyo Co., Ltd, MSD KK a subsidiary of Merck & Co. Inc., Sumitomo Dainippon Pharma Co., Ltd, Pfizer Inc., Astellas Pharma Inc., Cepheid Inc., Precision System Science Co., Ltd, and Medical and Biological Laboratories Co., Ltd, outside the submitted work. Conflict of interest: B.W. Jhun has nothing to disclose. Conflict of interest: W-J. Koh has received a consultation fee from Insmed Inc. for the Insmed advisory board meeting, not associated with the submitted work. Conflict of interest: H. Namkoong has nothing to disclose. Conflict of interest: J. Park has nothing to disclose. Conflict of interest: R. Thomson reports personal fees for advisory board work from Insmed and Savara, and personal fees for CME talks from Menarini and AstraZeneca, outside the submitted work. Conflict of interest: J. van Ingen reports personal fees for advisory board membership from Insmed, Spero Therapeutics and Johnson & Johnson, during the conduct of the study. Conflict of interest: S.M.H. Zweijpfenning reports personal fees and nonfinancial support from Insmed and Novartis outside the submitted work. Conflict of interest: J-J. Yim has nothing to disclose.

그 밖의 정보
출판 형태
Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't
저널
The European respiratory journal · eISSN 1399-3003
전자 출판
2019-07-11
MeSH
Aged · Amikacin · Anti-Bacterial Agents / therapeutic use · Azithromycin · Clarithromycin · Databases, Factual · Female · Humans · Imipenem · Lung Diseases / drug therapy / microbiology · Male · Microbial Sensitivity Tests · Middle Aged · Mycobacterium Infections, Nontuberculous / drug therapy · Mycobacterium abscessus / drug effects
Substances
Anti-Bacterial Agents · Imipenem · Azithromycin · Amikacin · Clarithromycin