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. 2020 Aug 6:20:100178.
doi: 10.1016/j.jctube.2020.100178. eCollection 2020 Aug.

Real-world treatment patterns in patients with nontuberculous mycobacterial lung disease in general and pneumologist practices in Germany

R Diel  1 , M Obradovic  2 , S Tyler  2 , J Engelhard  3 , K Kostev  3
Affiliations

Real-world treatment patterns in patients with nontuberculous mycobacterial lung disease in general and pneumologist practices in Germany

R Diel et al. J Clin Tuberc Other Mycobact Dis. .

Erratum in

  • Erratum regarding previously published articles.
    [No authors listed] [No authors listed] J Clin Tuberc Other Mycobact Dis. 2021 May 6;24:100242. doi: 10.1016/j.jctube.2021.100242. eCollection 2021 Aug. J Clin Tuberc Other Mycobact Dis. 2021. PMID: 34095548 Free PMC article.

Abstract

Background: Nontuberculous mycobacterial lung disease (NTMLD) is a rare, progressive disease with an increasing incidence worldwide.

Aims: The aim of this retrospective study was to analyze the baseline characteristics and management of NTMLD in general and pneumologist practices in Germany.

Methods: This retrospective study included patients with a culture-confirmed diagnosis of NTMLD documented between October 1, 2014 and September 30, 2019 by 125 general practitioners (GP) and 31 office-based pulmonologists from the IMS Disease Analyzer Database (IQVIA).

Results: A total of 159 patients managed by German GPs (mean age 59 ± 19 years, 51% female) and 236 patients managed by pulmonologists (mean age 62 ± 14 years, 58% female) were analyzed. In total, 45% (72/159) and 40% (94/236) of patients managed by GPs and pulmonologists respectively received antibiotic therapy for NTMLD. This therapy lasted for ≥ 6 months in 42%, for ≥ 12 months in 24%, and ≥ 18 months in 8% of patients. The average therapy duration was longer in patients treated by pulmonologists (241 ± 196 days) than in patients treated by GPs (113 ± 152 days). A total of 27% of patients managed by GPs and 45% of those managed by pulmonologists respectively received guideline-based therapy (GBT), defined as combination therapy with macrolide (azi-/ clarithromycin) + ethambutol + rifabutin/rifampicin, at least once; however, almost all patients (100% in the GP group, 96% in the pulmonologist group) also received non-GBT regimens intermediately.

Conclusions: A considerable number of patients with NTMLD were not managed in accordance with the German guidelines and a substantial proportion also discontinue therapy prematurely. NTMLD management should be improved through appropriate referral pathways and collaboration between expert centers and primary or secondary care physicians.

Keywords: Antibiotic; Guideline-based therapy; Nontuberculous mycobacterial lung disease; Outpatients.

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Figures

Fig. 1
Fig. 1
Proportions of NTMLD patients receiving antibiotic treatment and GBT.
Fig. 2
Fig. 2
Time from first NTMLD diagnosis to onset of antibiotic treatment (for patients with at least 18 months follow-up time after diagnosis).
Fig. 3
Fig. 3
Treatment persistence over time (for patients with at least 18 months follow-up time after diagnosis).
Fig. 4
Fig. 4
Average antibiotic therapy duration in patients with NTMLD.
Fig. 5
Fig. 5
Number of therapy switches before termination of therapy.
See this image and copyright information in PMC

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