Old age is associated with worse treatment outcome and frequent adverse drug reaction in Mycobacterium avium complex pulmonary disease

Abstract

Background The number of patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) is rapidly increasing globally, especially in the older population. However, there is a dearth of evidence regarding the impact of aging on the treatment outcomes of NTM-PD. Methods We analyzed consecutive patients who satisfied the diagnostic criteria for Mycobacterium avium complex (MAC)-PD and received antibiotic treatment between January 2009 and December 2020 at a tertiary referral hospital in Korea. The main outcomes were (1) long-term treatment success, defined by negative culture conversion for more than 12 months; and (2) adverse drug reactions (ADRs). Multivariable logistic regression model was used to evaluate the association between age and main outcomes. Results A total of 614 patients (median age, 65 years, interquartile range [IQR] 57–73 years; men, 35.3%) were included. Median treatment duration (530 days, IQR 290–678 days; P for trend < 0.001) and long-term treatment success (P for trend = 0.026) decreased, whereas ADRs (P for trend < 0.001) increased significantly with age. Multivariable analyses demonstrated that age ≥ 80 years was an independent factor associated with ADRs (adjusted odds ratio [aOR] 3.29; 95% confidence interval [CI] 1.05–10.28) and worse treatment outcome (aOR 0.42; 95% CI 0.19–0.91). Conclusions Aging is associated with worse treatment outcome and frequent ADRs of patients with MAC-PD. Individualized treatment with reduced-intensity may be a reasonable alternative for older adults.

Impact of aging on the immunological and microbial landscape of the lung during non-tuberculous mycobacterial infection

“…Despite the small group size, a more severe disease was noted in aged compared to young animals in the form of pulmonary consolidation and lesions, which is in line with established clinical literature [61–63]. Increased lung damage in aged animals was also evident from histological analyses that revealed presence of lymphoid aggregates, interstitial fibrosis, pulmonary edema, and bronchopneumonia.…”

Trends of non-tuberculous mycobacterial disease in a low-tuberculosis prevalence setting

“…One study from South Korea demonstrated that long-term treatment success rate decreased with age, particularly in patients aged=≥80 years. Whereas the rate of adverse drug reactions requiring discontinuation of treatment increased with age, and the number was twice as high in patients aged=≥80 years than in those aged=<50 years [17]. These findings support the decision to treat relatively younger patients where better treatment outcomes are expected with lesser side effects.…”

Trends in Non-Tuberculous Mycobacterial Lung Disease and Treatment Outcomes in a Low-Tuberculosis Prevalence Setting: A Retrospective Analysis

“…However, a previous study has shown that cavitation on CT imaging, the presence of night sweats, and weight loss were associated with treatment initiation [ 16 ]. One study from South Korea demonstrated that the long-term treatment success rate decreased with age, and the rate of adverse drug reactions requiring a discontinuation of treatment increased with age, particularly in patients aged ≥80 years [ 17 ]. These findings support the decision to treat relatively younger patients, where better treatment outcomes are expected with fewer side effects.…”