Tolerability and efficacy of Mycobacterium avium complex pulmonary disease treatment in elderly patients
Abstract Background Mycobacterium avium complex pulmonary disease (MAC-PD) is considered to be increasing worldwide. In Japan, the number of elderly MAC-PD patients requiring treatment is also expected to increase due to the aging society. However, reduced organ function in elderly patients makes it...
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BMC
2025-02-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-025-03504-4 |
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| author | Kyota Shinfuku Hiromichi Hara Keitaro Okuda Hanae Miyagawa Naoki Takasaka Takeo Ishikawa Jun Araya |
| author_facet | Kyota Shinfuku Hiromichi Hara Keitaro Okuda Hanae Miyagawa Naoki Takasaka Takeo Ishikawa Jun Araya |
| author_sort | Kyota Shinfuku |
| collection | DOAJ |
| description | Abstract Background Mycobacterium avium complex pulmonary disease (MAC-PD) is considered to be increasing worldwide. In Japan, the number of elderly MAC-PD patients requiring treatment is also expected to increase due to the aging society. However, reduced organ function in elderly patients makes it often difficult to continue or complete multidrug treatment due to adverse drug reactions (ADRs). Therefore, this study aimed to identify clinical factors associated with treatment tolerability, efficacy, and ADRs in elderly MAC-PD patients. Methods We retrospectively reviewed the medical records of 102 patients with MAC-PD aged ≥ 75 years between January 2014 and March 2023. Forty-six patients were treated with multidrug regimens (treatment group), and 56 were observed without treatment (observation group). The treatment group was divided into the treatment continuation group (n = 28) who were treated without interruption for ≥ 12 months, and the treatment interruption group (n = 18). A comparative study was conducted in each group to examine tolerability, efficacy, and ADRs. Results A two-drug regimen of ethambutol (EB) and macrolides without rifampicin (RFP) was associated with treatment continuation (p = 0.026). The treatment continuation group was superior to the observation group regarding symptoms change, sputum conversion rate, and chest computed tomography scores. The most common ADRs were gastrointestinal disorders, which may be related to RFP. Treatment efficacy of the two-drug regimen was non-inferior, and no cases of macrolide resistance were observed. Conclusions The two-drug regimen of EB and macrolide without RFP may be a tolerable and effective treatment for elderly MAC-PD patients. |
| format | Article |
| id | doaj-art-576402043a8b439e8874c98684ed8d95 |
| institution | Kabale University |
| issn | 1471-2466 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj-art-576402043a8b439e8874c98684ed8d952025-02-09T12:09:36ZengBMCBMC Pulmonary Medicine1471-24662025-02-012511810.1186/s12890-025-03504-4Tolerability and efficacy of Mycobacterium avium complex pulmonary disease treatment in elderly patientsKyota Shinfuku0Hiromichi Hara1Keitaro Okuda2Hanae Miyagawa3Naoki Takasaka4Takeo Ishikawa5Jun Araya6Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan HospitalDivision of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of MedicineDivision of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of MedicineDivision of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of MedicineDivision of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan HospitalDivision of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan HospitalDivision of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of MedicineAbstract Background Mycobacterium avium complex pulmonary disease (MAC-PD) is considered to be increasing worldwide. In Japan, the number of elderly MAC-PD patients requiring treatment is also expected to increase due to the aging society. However, reduced organ function in elderly patients makes it often difficult to continue or complete multidrug treatment due to adverse drug reactions (ADRs). Therefore, this study aimed to identify clinical factors associated with treatment tolerability, efficacy, and ADRs in elderly MAC-PD patients. Methods We retrospectively reviewed the medical records of 102 patients with MAC-PD aged ≥ 75 years between January 2014 and March 2023. Forty-six patients were treated with multidrug regimens (treatment group), and 56 were observed without treatment (observation group). The treatment group was divided into the treatment continuation group (n = 28) who were treated without interruption for ≥ 12 months, and the treatment interruption group (n = 18). A comparative study was conducted in each group to examine tolerability, efficacy, and ADRs. Results A two-drug regimen of ethambutol (EB) and macrolides without rifampicin (RFP) was associated with treatment continuation (p = 0.026). The treatment continuation group was superior to the observation group regarding symptoms change, sputum conversion rate, and chest computed tomography scores. The most common ADRs were gastrointestinal disorders, which may be related to RFP. Treatment efficacy of the two-drug regimen was non-inferior, and no cases of macrolide resistance were observed. Conclusions The two-drug regimen of EB and macrolide without RFP may be a tolerable and effective treatment for elderly MAC-PD patients.https://doi.org/10.1186/s12890-025-03504-4Elderly patientsTolerabilityEfficacyMycobacterium avium complex pulmonary diseaseNontuberculous mycobacteria |
| spellingShingle | Kyota Shinfuku Hiromichi Hara Keitaro Okuda Hanae Miyagawa Naoki Takasaka Takeo Ishikawa Jun Araya Tolerability and efficacy of Mycobacterium avium complex pulmonary disease treatment in elderly patients BMC Pulmonary Medicine Elderly patients Tolerability Efficacy Mycobacterium avium complex pulmonary disease Nontuberculous mycobacteria |
| title | Tolerability and efficacy of Mycobacterium avium complex pulmonary disease treatment in elderly patients |
| title_full | Tolerability and efficacy of Mycobacterium avium complex pulmonary disease treatment in elderly patients |
| title_fullStr | Tolerability and efficacy of Mycobacterium avium complex pulmonary disease treatment in elderly patients |
| title_full_unstemmed | Tolerability and efficacy of Mycobacterium avium complex pulmonary disease treatment in elderly patients |
| title_short | Tolerability and efficacy of Mycobacterium avium complex pulmonary disease treatment in elderly patients |
| title_sort | tolerability and efficacy of mycobacterium avium complex pulmonary disease treatment in elderly patients |
| topic | Elderly patients Tolerability Efficacy Mycobacterium avium complex pulmonary disease Nontuberculous mycobacteria |
| url | https://doi.org/10.1186/s12890-025-03504-4 |
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