Open-Label Trial of Amikacin Liposome Inhalation Suspension in Mycobacterium abscessus Lung Disease.

BACKGROUND

Mycobacterium abscessus is the second most common nontuberculous mycobacterium respiratory pathogen and shows in vitro resistance to nearly all oral antimicrobials. M abscessus treatment success is low in the presence of macrolide resistance.

RESEARCH QUESTION

Does treatment with amikacin liposome inhalation suspension (ALIS) improve culture conversion in patients with M abscessus pulmonary disease who are treatment naive or who have treatment-refractory disease?

STUDY DESIGN AND METHODS

In an open-label protocol, patients were given ALIS (590 mg) added to background multidrug therapy for 12 months. The primary outcome was sputum culture conversion defined as three consecutive monthly sputum cultures showing negative results. The secondary end point included development of amikacin resistance.

RESULTS

Of 33 patients (36 isolates) who started ALIS with a mean age of 64 years (range, 14-81 years), 24 patients (73%) were female, 10 patients (30%) had cystic fibrosis, and nine patients (27%) had cavitary disease. Three patients (9%) could not be evaluated for the microbiologic end point because of early withdrawal. All pretreatment isolates were amikacin susceptible and only six isolates (17%) were macrolide susceptible. Eleven patients (33%) were given parenteral antibiotics. Twelve patients (40%) received clofazimine with or without azithromycin as companion therapy. Fifteen patients (50%) with evaluable longitudinal microbiologic data demonstrated culture conversion, and 10 patients (67%) sustained conversion through month 12. Six of the 33 patients (18%) demonstrated mutational amikacin resistance. All were patients using clofazimine or clofazimine plus azithromycin as companion medication(s). Few serious adverse events occurred for ALIS users; however, reduction of dosing to three times weekly was common (52%).

INTERPRETATION

In a cohort of patients primarily with macrolide-resistant M abscessus, one-half of the patients using ALIS showed sputum culture conversion to negative findings. The emergence of mutational amikacin resistance was not uncommon and occurred with the use of clofazimine monotherapy.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT03038178; URL: www.

CLINICALTRIALS

gov.

Informations de copyright

Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: D. E. G. received support as a consultant from Insmed, Inc., AN2 Therapeutics, and Paratek Pharmaceuticals and received research support from Insmed, Inc. J. V. P. received support as part of advisory boards for Insmed, Inc., AN2 Therapeutics, and Paratek Pharmaceuticals and received research support from Insmed, Inc., AN2 Therapeutics, Paratek Pharmaceuticals, Electromed, Inc., Hillrom, and Zambon. R. J. W. received research support from Insmed, Inc. K. L. W. received support as a consultant from Insmed, Inc., AN2 Therapeutics, Paratek Pharmaceuticals, RedHill Biopharma, Renovion, Inc., and Spero Therapeutics and received research support from Insmed, Inc., AN2 Therapeutics, Paratek Pharmaceuticals, RedHill Biopharma, and Renovion, Inc. None declared (S. A. R. S., B. A. B.-E., A. E. B., P. E. S., C. F., L. S.).