Journal Article

Factors Related to Response to Intermittent Treatment of Mycobacterium avium Complex Lung Disease

Lam, Phung K, Catanzaro, Antonino, Ruoss, Stephen J, Garay, Stuart M, Griffith, David E, Daley, Charles L, Aksamit, Timothy R

2006

Overview

Abstract Rationale: Mycobacterium avium complex pulmonary disease (MAC-PD) is associated with substantial morbidity, and standard daily multidrug therapy is difficult to tolerate. Objectives To characterize response to a three-times-weekly (TIW) regimen of clarithromycin, ethambutol, and rifampin. Methods A 1-yr prospective noncomparative trial of TIW treatment was conducted during 2000–2003 in 17 U.S. cities. Participants were 91 HIV-negative adults, diagnosed with moderate to severe MAC-PD, who originally participated in a trial of an inhaled IFN-γ treatment. Improvement in sputum culture, high-resolution computed tomography (HRCT), and symptoms were assessed. Results Treatment response rates (and median response times) were 44% (2 mo or longer) for culture, 60% (5.5–11.5 mo) for HRCT, and 53% (8.5 mo) for symptoms. Having noncavitary, compared with cavitary, disease increased culture response by 4.0 times (95% confidence interval [CI], 1.7–9.2) and HRCT response by 4.9 times (95% CI, 1.9–13.0). Culture response was 1.5 times (95% CI, 1.1–2.2) higher for older subjects and 2.2 times (95% CI, 1.0–4.7) higher for previously untreated subjects. Being smear-negative increased culture response by 2.3 times (95% CI, 1.1–5.2) but decreased HRCT response by 4.4 times (95% CI, 1.7–11.5). Increasing ethambutol use by 5 mo increased culture response by 1.5 times (95% CI, 1.0–2.1) but decreased symptom response. Not having chronic obstructive pulmonary disease, bronchiectasis, or poor lung function increased symptom response by 1.9 to 3.9 times. Conclusions TIW therapy was less effective for MAC-PD patients with cavitary disease and a history of chronic obstructive pulmonary disease, bronchiectasis, or previous treatment for MAC-PD. Further research is needed to study the long-term outcomes of TIW treatment.

• Publisher: Am Thoracic Soc,Oxford University Press,American Lung Association
• Subject: Aged / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Antitubercular Agents - administration & dosage / Antitubercular Agents - adverse effects / Biological and medical sciences / Blood and lymphatic vessels / Bronchiectasis - drug therapy / Bronchiectasis - etiology / Cardiology. Vascular system / Chronic obstructive pulmonary disease / Chronic obstructive pulmonary disease, asthma / Clarithromycin - administration & dosage / Clarithromycin - adverse effects / Clinical trials / Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous / Double-Blind Method / Drug Therapy, Combination / Ethambutol - administration & dosage / Ethambutol - adverse effects / Female / Forced Expiratory Flow Rates / Forced Expiratory Volume / HIV / Human immunodeficiency virus / Humans / Intensive care medicine / Male / Medical sciences / Middle Aged / Mycobacterium avium / Mycobacterium avium Complex / Mycobacterium avium-intracellulare Infection - diagnostic imaging / Mycobacterium avium-intracellulare Infection - drug therapy / Patients / Physicians / Pneumology / Prospective Studies / Radiography / Response rates / Rifampin - administration & dosage / Rifampin - adverse effects / Sputum - microbiology / Tomography / Treatment Outcome / Tuberculosis, Pulmonary - drug therapy / Tuberculosis, Pulmonary - microbiology