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Treatment of Mycobacterium avium–intracellulare complex lung disease in the real world: a retrospective big data analysis

  • Tomohide IwaoEmail author
  • Genta Kato
  • Isao Ito
  • Toyohiro Hirai
  • Tomohiro Kuroda
Original Research Article
  • 5 Downloads

Abstract

Introduction

The chemotherapeutic regimen recommended by guidelines to prevent the development of a drug-resistant strain of Mycobacterium avium complex (MAC) consists of a combination of clarithromycin, rifampicin, and ethambutol. In severe cases, it is desirable to use either kanamycin or streptomycin in addition to these three drugs. However, it is unclear whether treatment is administered in accordance with the guidelines in real-world clinical settings.

Objectives

This study aimed to determine the chemotherapy patterns among patients treated for MAC lung disease in medical facilities in Japan.

Methods

We investigated treatment patterns regarding patients treated for MAC lung disease between 2007 and 2017, in relation to the latest Japanese guidelines for the treatment of MAC lung disease, using insurance claims data of 378 patients.

Results

The basic triple-agent regimen of clarithromycin, ethambutol, and rifampicin was received by 238 (63%) of the 378 patients. Of these, 115 (48.3%) received the regimen for the recommended period of > 1 year. Therefore, widely publicizing the need for application of standard treatment for at least 2 years is necessary, as is the need to develop methods to overcome adverse effects.

Conclusion

Many patients with MAC lung disease do not complete a full course of treatment over the standard treatment period. Therefore, it is important to develop methods to overcome adverse effects or to develop an alternative treatment regimen for MAC lung disease.

Notes

Acknowledgments

Tomohide Iwao wishes to thank Ms. Shigeko Noguchi for giving the opportunity to conduct this research.

Compliance with ethical standards

Funding

This study was undertaken with the help of a research grant from the Japan Society for the Promotion of Science (grant number 17K17816) and the RintyuNet project led by the Japan Agency for Medical Research and Development.

Conflicts of interest

Tomohide Iwao, Genta Kato, Isao Ito, Toyohiro Hirai, and Tomohiro Kuroda declare no conflicts of interest.

Ethical approval

The insurance claims data was obtained from the JMDC in a completely anonymized form, therefore, approval from an Ethics Committee was not required, according to the rules of our organization.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Medical Information Technology and Administration PlanningKyoto University HospitalKyotoJapan
  2. 2.Solutions Center for Health Insurance Claims, Kyoto University HospitalKyotoJapan
  3. 3.Department of Respiratory Medicine, Graduate School of MedicineKyoto UniversityKyotoJapan

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