Factors related to response to intermittent treatment of Mycobacterium avium complex lung disease

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

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

Rationale: Mycobacterium avium complex pulmonary disease (MACPD) 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 MACPD, 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.

Original languageEnglish (US)
Pages (from-to)1283-1289
Number of pages7
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume173
Issue number11
DOIs
StatePublished - Jun 1 2006

Fingerprint

Mycobacterium avium Complex
Lung Diseases
Confidence Intervals
Tomography
Ethambutol
Bronchiectasis
Chronic Obstructive Pulmonary Disease
Therapeutics
Clarithromycin
Rifampin
Sputum
Reaction Time
HIV
Morbidity
Lung
Research

Keywords

  • Clarithromycin
  • Ethambutol
  • Mycobacterium avium complex
  • Rifampin
  • Risk factors

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Factors related to response to intermittent treatment of Mycobacterium avium complex lung disease. / Lam, Phung K.; Griffith, David E.; Aksamit, Timothy; Ruoss, Stephen J.; Garay, Stuart M.; Daley, Charles L.; Catanzaro, Antonino.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 173, No. 11, 01.06.2006, p. 1283-1289.

Research output: Contribution to journalArticle

Lam, Phung K. ; Griffith, David E. ; Aksamit, Timothy ; Ruoss, Stephen J. ; Garay, Stuart M. ; Daley, Charles L. ; Catanzaro, Antonino. / Factors related to response to intermittent treatment of Mycobacterium avium complex lung disease. In: American Journal of Respiratory and Critical Care Medicine. 2006 ; Vol. 173, No. 11. pp. 1283-1289.
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AU - Daley, Charles L.

AU - Catanzaro, Antonino

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N2 - Rationale: Mycobacterium avium complex pulmonary disease (MACPD) 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 MACPD, 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.

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