Chest
Volume 149, Issue 5, May 2016, Pages 1285-1293
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Original Research: Chest Infections
Long-term Follow-up of Mycobacterium avium Complex Lung Disease in Patients Treated With Regimens Including Clofazimine and/or Rifampin

Part of this article has been presented at the 2012 American Thoracic Society International Conference, May 18-23, 2012, San Francisco, CA.
https://doi.org/10.1378/chest.15-0543Get rights and content

Background

Mycobacterium avium complex (MAC) lung disease requires prolonged treatment with multiple antibiotics. Drug intolerances and interactions are common with the current recommended treatment. There is limited information on outcomes with alternative medications.

Methods

Retrospective review including adult patients with MAC lung disease who were treated and monitored for at least 6 months posttreatment. The aim was to evaluate the clinical and microbiologic outcomes in patients treated with regimens including clofazimine and/or rifampin.

Results

One hundred and seven patients were included (79% were female; mean age, 67 years). Sputum samples were smear positive in 54% of patients. The majority (84%) were treated with clofazimine in combination with a macrolide and ethambutol. Fourteen patients (13%) were treated with rifampin, macrolide, and ethambutol. Most patients (95%) converted from positive to negative sputum culture results in an average of 4.5 ± 4.2 months (range, 0-30 months). A significantly greater proportion of patients treated with clofazimine converted to negative culture results compared with those treated with rifampin (100% vs 71%; P = .0002). Microbiologic relapse occurred in 52 of 107 patients (49%). Thirty-six percent of patients required retreatment. There was no difference in microbiologic relapse or re-treatment rates between the two treatment groups.

Conclusions

The majority of patients with MAC lung disease achieve negative sputum culture results. Re-treatment is needed in approximately one-third of patients. In this cohort, both initial outcomes and re-treatment rates were at least as good in patients treated with clofazimine-containing regimens as in patients receiving rifampin-containing regimens. Clofazimine should be considered as an alternative drug for the treatment of MAC lung disease.

Section snippets

Patient Population

All patients treated at the Calgary Tuberculosis Clinic (Calgary, AB, Canada) from January 1, 1990 to December 31, 2009 for pulmonary nontuberculous mycobacterial infections were reviewed (Fig 1). Patients were included in the study if (1) they were 18 years of age or older; (2) they met ATS/IDSA diagnostic criteria for MAC lung disease including (a) pulmonary symptoms, (b) the presence of multifocal bronchiectasis and multiple small nodules on chest radiograph or high-resolution CT scan of the

Patient Population

One hundred and seven patients seen at the Calgary Tuberculosis Clinic between January 1990 and December 2009 met inclusion criteria. One hundred and fifty patients treated for MAC lung disease were assessed, and 43 patients were excluded (see Fig 1 for details). Follow-up data were collected until March 31, 2013. Patients were predominantly female (n = 84; 79%) with a mean age at treatment initiation of 67.0 ± 11.9 years (range, 38-88 years). A minority of patients (6%) were immunocompromised (

Discussion

Patients with MAC lung disease treated with macrolide-containing multidrug regimens had an excellent culture conversion rate (95%). Following completion of treatment, approximately one-half of patients (49%) experienced microbiologic relapse. In addition to microbiologic relapse, 38 of 107 (36%) also developed worsening clinical symptoms and/or radiologic progression that required re-treatment. There was a significantly higher culture conversion rate among patients treated with a

Conclusions

In summary, this is the first report of a large number of patients with MAC lung disease, most of whom were treated with clofazimine-containing regimens and were monitored for an extended period allowing for the determination of re-treatment rates. The vast majority of patients can achieve negative sputum culture results. Microbiologic relapses occur in half of patients and approximately one-third of patients require re-treatment. Microbiologic and treatment outcomes in patients treated with

Acknowledgments

Author contributions: J. J. is guarantor of the manuscript. J. J. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. J. P. D., R. L. C., D. A. F., and S. K. F. contributed substantially to the study design, data analysis and interpretation, and writing of the manuscript.

References (36)

  • R.M. Thomson

    Changing epidemiology of pulmonary nontuberculous mycobacteria infections

    Emerg Infect Dis

    (2010)
  • A. Amorim et al.

    Non-tuberculous mycobacteria in HIV-negative patients with pulmonary disease in Lisbon, Portugal

    Scand J Infect Dis

    (2010)
  • S.K. Lee et al.

    Changing epidemiology of nontuberculous mycobacterial lung disease in South Korea

    Scand J Infect Dis

    (2012)
  • T.K. Marras et al.

    Isolation prevalence of pulmonary non-tuberculous mycobacteria in Ontario, 1997-2003

    Thorax

    (2007)
  • K.L. Winthrop et al.

    Pulmonary nontuberculous mycobacterial disease prevalence and clinical features: an emerging public health disease

    Am J Respir Crit Care Med

    (2010)
  • D.E. Griffith et al.

    An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases

    Am J Respir Crit Care Med

    (2007)
  • R.D. Kim et al.

    Pulmonary nontuberculous mycobacterial disease: prospective study of a distinct preexisting syndrome

    Am J Respir Crit Care Med

    (2008)
  • K. Maekawa et al.

    High-resolution computed tomography and health-related quality of life in Mycobacterium avium complex disease

    Int J Tuberc Lung Dis

    (2013)
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    FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

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