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

• Main Authors: R. Diel, M. Obradovic, S. Tyler, J. Engelhard, K. Kostev
• Format: Article
• Language: English
• Published: Elsevier 2020-08-01
• Series: Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
• Subjects: Nontuberculous mycobacterial lung disease; Outpatients; Antibiotic; Guideline-based therapy
• Online Access: http://www.sciencedirect.com/science/article/pii/S2405579420300425

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.