Open Access192. Tolerability Outcomes of Multi-drug Antibiotic Treatment for Pulmonary Nontuberculous Mycobacterial Disease due to Mycobacterium avium Complex in U.S. Medicare Beneficiaries with Bronchiectasis
Author(s) -
Jennifer H. Ku,
Emily Henkle,
Kathleen F. Carlson,
Miguel Marino,
Sarah K. Brode,
Theodore K. Marras,
Kevin Winthrop,
Kevin Winthrop
Publication year - 2021
Publication title -
open forum infectious diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.546
H-Index - 35
ISSN - 2328-8957
DOI - 10.1093/ofid/ofab466.192
Subject(s) - ethambutol , rifabutin , medicine , azithromycin , tolerability , clarithromycin , regimen , discontinuation , rifamycin , bronchiectasis , antibacterial agent , antibiotics , tuberculosis , adverse effect , rifampicin , microbiology and biotechnology , lung , pathology , biology , helicobacter pylori
Background Nontuberculous mycobacteria (NTM), most frequently Mycobacterium avium complex (MAC), cause increasingly common pulmonary infections. Treatment interruptions and early discontinuation are common in MAC therapy, but population-based data on treatment outcomes are severely lacking. We examined tolerability outcomes of guideline-based 3-drug therapies (GBT) targeted for pulmonary MAC infection.Methods Among beneficiaries with bronchiectasis (ICD-9-CM 494.0 or 494.1) in U.S. Medicare data (01/2006 – 12/2014), we identified first-time MAC GBT therapy users, excluding those with cystic fibrosis, HIV, or a history of organ transplant. MAC GBT was defined as an overlapping prescription of ≥ 28-day supply of a macrolide, ethambutol and rifamycin. Using Cox regression methods, we compared time-to-regimen change or discontinuation within 12 months of therapy start in the following groups: 1) azithromycin-ethambutol-rifamycin vs. clarithromycin-ethambutol-rifamycin; 2) macrolide-ethambutol-rifampin vs. macrolide-ethambutol-rifabutin; and 3) azithromycin-ethambutol-rifampin vs. clarithromycin-ethambutol-rifabutin. Results We identified 4,626 GBT therapy users (mean 77.9 years [s.d. 6.1], female [77.7%], and non-Hispanic white [87.2%]). Overall, the rate of regimen change or discontinuation was higher in the clarithromycin-based regimens compared to azithromycin-containing regimens, and in rifabutin-containing regimens compared to rifampin-containing regimens. The rate of drug regimen change or discontinuation was 65% greater in the clarithromycin-ethambutol-rifabutin group compared to the azithromycin-ethambutol-rifampin group (adjusted hazard ratio: 1.64, 95% CI: 1.43, 1.64) ( Table 1 , Figure 1 ).Conclusion Azithromycin-based regimens and rifampin-containing regimens were less likely to be changed or discontinued within 12 months of therapy compared to clarithromycin-based regimens and rifabutin-containing regimens, respectively. More research is needed to identify factors associated with early treatment change or discontinuation.Disclosures Emily Henkle, PhD, MPH , AN2 (Consultant, Advisor or Review Panel member) Zambon (Advisor or Review Panel member) Theodore K. Marras, MD , Astra Zeneca (Speaker’s Bureau) Insmed (Scientific Research Study Investigator) Novartis (Speaker’s Bureau) RedHill (Consultant) Spero (Consultant) Kevin L. Winthrop, MD, MPH , Insmed (Consultant, Grant/Research Support) Paratek (Consultant) RedHill (Consultant) Spero (Consultant) Kevin L. Winthrop, MD, MPH , Insmed (Consultant, Research Grant or Support) Paratek (Consultant) RedHill Biopharma (Consultant) Spero (Consultant)