Mateja Janković Makek, Goran Glodic, Ivan Sabol, Ljiljana Zmak, Ana-Marija Sola, Ante Marusic, Ivana Marekovic, Ana Hecimovic, Andrea Vukic Dugac, Fedja Dzubur, Marko Jakopovic, Brigita Ticac, Ljiljana Kardum Bulat, Sanja Popovic Grle, Blazenka Barisic, Vesna Carevic Vladic, Drazen Strelec, Gordana Pavlisa, Miroslav Samarzija
European Respiratory Journal 2019 54: PA4645; DOI: 10.1183/13993003.congress-2019.PA4645
Abstract
Introduction: guidelines for nontuberculous mycobacterial pulmonary disease (NTMPD) treatment are mainly based on cohort studies and data on M. avium complex (MAC).
Methods: retrospective analysis of all Croatian residents with respiratory NTM isolate from 2006 to 2016. ATS/IDSA guidelines were used for NTMPD definition. Cure was defined as multiple negative cultures at the end of treatment or at 12 months follow-up in case of shorter regimens. Regimens were grouped as: tuberculosis (TB), adequate NTM (NTM), <12 months adequate NTM (short NTM).
Results: 137 cases of NTMPD (mean age 66.5; 52.6% males) were mostly caused by M.xenopi (n=54), and MAC (n=53). Median follow up was 60.47 months. 5-year all-cause mortality amounted to 36.5%. 38/137 had cavitary form; 47/114 were smear positive. Therapy was started in 98 (71.5%) cases - TB in 43.9%, NTM in 31.6%, and short NTM in 15.3% and cases. Cure was achieved in 64.7%, 82.8%, and 64.3% of patients finishing TB, NTM, and short NTM regimen, respectively. Patients receiving adequate therapy had 4x higher chance (p=0.012) of cure compared to ones receiving other regimen or no therapy. Therapy was started in 34 (89.5%) cases of cavitary NTMPD. Cure was achieved in 63.6% on TB and 83.3% on NTM therapy. 43 (91.5%) smear positive cases received treatment. Cure was achieved in 46.7% on TB and 75% on NTM therapy. In smear negative patients, regardless of NTMPD form, all regimens resulted with similar cure rates (over 80%).
Conclusions: smear status and cavitary disease were major factors influencing therapy initiation. Adequate NTM regimens significantly improved overall cure rate but seem to be of highest importance in „heavier“disease forms (i.e. smear positive and/or cavitary).
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA4645.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019
Back to top
As a seasoned expert in the field of respiratory medicine and pulmonary diseases, I bring forth a wealth of knowledge and experience to dissect and elucidate the content of the provided article. With a robust background in respiratory research, I am well-equipped to navigate through the intricacies of the study conducted by Mateja Janković Makek and colleagues, as published in the European Respiratory Journal in 2019.
The study delves into the treatment guidelines for nontuberculous mycobacterial pulmonary disease (NTMPD), primarily relying on cohort studies and data concerning Mycobacterium avium complex (MAC). The methods involved a retrospective analysis of Croatian residents with respiratory NTM isolates from 2006 to 2016, utilizing the ATS/IDSA guidelines for NTMPD definition.
Key Concepts in the Article:
-
NTMPD Definition and Guidelines:
- The study employs the ATS/IDSA guidelines for defining nontuberculous mycobacterial pulmonary disease (NTMPD). These guidelines are crucial for standardizing the diagnosis and treatment of NTMPD.
-
Study Methodology:
- The research involves a retrospective analysis of cases spanning from 2006 to 2016, focusing on Croatian residents with respiratory NTM isolates. This approach helps in understanding the trends and outcomes over a specific period.
-
NTMPD Epidemiology:
- The article reports 137 cases of NTMPD, with a mean age of 66.5, and a male predominance of 52.6%. The causative agents include M.xenopi and MAC, highlighting the epidemiological profile of NTMPD in the Croatian population during the study period.
-
Treatment Regimens:
- Therapy regimens are categorized into tuberculosis (TB), adequate NTM (NTM), and <12 months adequate NTM (short NTM). The study explores the outcomes associated with each regimen, emphasizing the importance of appropriate treatment in achieving a cure.
-
Cure Rates and Mortality:
- The study evaluates cure rates based on different regimens, with 5-year all-cause mortality reaching 36.5%. Understanding the effectiveness of treatment options is crucial for improving patient outcomes.
-
Influence of Smear Status and Disease Severity:
- The research highlights the significant impact of smear status and the presence of cavitary disease on therapy initiation. Adequate NTM regimens are shown to significantly improve the overall cure rate, particularly in "heavier" disease forms, such as smear-positive and/or cavitary cases.
-
Implications for Therapy Initiation:
- The findings suggest that patients receiving adequate therapy have a higher chance of cure compared to those receiving other regimens or no therapy. This underscores the importance of timely and appropriate intervention in the management of NTMPD.
In conclusion, this study contributes valuable insights into the management of NTMPD, shedding light on the significance of treatment regimens, disease severity, and smear status in influencing patient outcomes. These findings have implications for clinical practice and the development of tailored therapeutic approaches for individuals with NTMPD.
