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

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 .
Competing Interests: 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.
(Copyright ©ERS 2019.)