Nontuberculous mycobacterial (NTM) infections in bronchiectasis patients: A retrospective US registry cohort study.

Longitudinal epidemiological and clinical data are needed to improve the management of patients with bronchiectasis developing nontuberculous mycobacterial (NTM) pulmonary disease. To describe the epidemiology, patient management, and treatment outcomes of NTM infections in patients with bronchiectasis enrolled in the United States Bronchiectasis and NTM Research Registry (US BRR). This was a retrospective cohort study of patients with bronchiectasis and NTM infections enrolled with follow-up in the US BRR in 2008-2019. The study included patients with ≥1 positive NTM respiratory culture in the 24-month baseline period (baseline NTM cohort) and/or during the annual follow-up visits (incident NTM cohort). Incidence, prevalence, baseline patient characteristics, treatment exposure, treatment outcomes, and respiratory clinical outcomes were described in the baseline NTM cohort, incident NTM cohort, and both cohorts combined (prevalent NTM cohort). Between 2008 and 2019, 37.9% (1457/3840) of patients with bronchiectasis in the US BRR met the inclusion criteria for this study and were reported to have Mycobacterium avium complex (MAC) and/or Mycobacterium abscessus complex (MABSC) infections. MAC prevalence increased steadily in the US BRR during 2009-2019; incidence was relatively stable, except for a peak in 2011 followed by a slow decrease. MABSC and mixed MAC/MABSC infections were rare. Most patients with bronchiectasis and NTM infections in the registry were female, White, and aged >65 years. The antibiotics administered most commonly reflected current guidelines. In the prevalent cohort, 44.9% of MAC infections and 37.1% of MABSC infections remained untreated during follow-up, and MAC treatment was initiated with delay (>90 days after positive NTM respiratory culture) twice as frequently as promptly (≤90 days after positive NTM respiratory culture) (68.6% vs 31.4%, respectively). The median time from diagnosis to treatment was shorter for MABSC versus MAC infections (194.0 days [interquartile range (IQR) 8.0, 380.0] vs 296.0 days [IQR 35.0, 705.0], respectively). Among patients with MAC infections who completed treatment, 27.6% were classified as cured and 29.6% as treatment failure during the annual follow-up visit window. For MABSC, these proportions were 25.0% and 28.0%, respectively. A considerable proportion of MAC and MABSC infections were untreated or treated after initial delay/observation. MABSC infections were more likely to be treated and start treatment sooner than MAC infections. Further longitudinal studies are warranted to evaluate the monitor-with-delay approach and inform clinical guidelines.

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Déclaration de conflit d'intérêts

Declaration of competing interest MD, HS, IG, ST, SS: employees of GSK and GSK shareholders at the time of this study; all GSK employees were involved in the study design, decision to publish, data analysis and interpretation, and preparation of the manuscript. ST: scientific liaison officer of The Union; deputy editor of the International Journal of Tuberculosis and Lung Disease. CS: speaker fees from Insmed. DM: consulting fees from AstraZeneca and COPD Foundation; honoraria from Medscape; payment for expert testimony from Schlesinger Law Firm; stock or stock options with GSK and Johnson and Johnson. MM: advisory board, grants, and consulting fees from Insmed. NL: grants for educational projects and conference travel fees from Insmed. PMS: grants as primary investigator for clinical trials from AN2 Therapeutics, Boehringer Ingelheim, Electromed, Hillrom, Insmed, Parateck, RedHill Biopharma, and Revovion; honorarium for steering committee from Insmed; speaker fees for Arikayce from Insmed. KW: grants and/or consulting fees from AN2, Insmed, Paratek, Renovion, RedHill Biopharma, and Vast; advisory board fees from RedHill Biopharma.