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Adverse reactions associated with long-term drug administration in Mycobacterium avium complex lung disease
Y Kamii1, H Nagai1, M Kawashima1
1Centre for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
Setting:
The number of patients with non-tuberculous mycobacterial lung disease (NTM-LD) worldwide has been increasing. Mycobacterium avium complex lung disease (MAC-LD) accounts for 90% of NTM-LD. MAC-LD necessitates long-term treatment, but adverse reactions with long-term administration of drugs are poorly understood.
Objective:
To evaluate adverse reactions with long-term administration of drugs for MAC-LD.
Design:
We conducted a retrospective single-centre medical chart review of 364 patients administered two or more drugs between July 2010 and June 2015.
Results:
The prevalence and median time to onset of adverse reactions were as follows: hepatotoxicity 19.5%, 55 days; leucocytopaenia 20.0%, 41 days; thrombocytopaenia 28.6%, 61.5 days; cutaneous reactions 9.3%, 30 days; ocular toxicity 7.7%, 278 days; and increase in serum creatinine 12.4%, 430.5 days. Multivariate analysis showed that rifampicin use was independently associated with thrombocytopaenia, and ethambutol use was independently associated with increases in serum creatinine.
Conclusion:
The main adverse reactions appeared within 3 months after start of treatment. Most patients were able to continue treatment with liver-supporting therapy, antihistamine agents or desensitisation therapy; however, ocular toxicity must be monitored for up to 1 year after start of treatment.
Insights
Adverse reactions are common in long-term treatment for Mycobacterium avium complex lung disease (MAC-LD). Most reactions appear within 3 months, but ocular toxicity requires monitoring up to 1 year.
Area of Science:
- Pulmonology
- Infectious Diseases
- Pharmacology
Background:
- Non-tuberculous mycobacterial lung disease (NTM-LD) is increasing globally.
- Mycobacterium avium complex lung disease (MAC-LD) comprises 90% of NTM-LD cases.
- Long-term treatment for MAC-LD carries risks of poorly understood adverse drug reactions.
Purpose of the Study:
- To evaluate the adverse reactions associated with long-term drug administration for MAC-LD.
Main Methods:
- Retrospective single-center medical chart review.
- Analysis of 364 patients receiving two or more drugs between July 2010 and June 2015.
Main Results:
- Prevalence of adverse reactions: hepatotoxicity (19.5%), leucocytopaenia (20.0%), thrombocytopaenia (28.6%), cutaneous reactions (9.3%), ocular toxicity (7.7%), increased serum creatinine (12.4%).
- Median onset times varied, with most reactions appearing within 3 months.
- Rifampicin linked to thrombocytopaenia; ethambutol linked to increased serum creatinine.
Conclusions:
- Most adverse reactions manifest within the first three months of treatment.
- Management strategies like supportive therapy and desensitization allow continued treatment for many patients.
- Ocular toxicity necessitates monitoring for up to one year post-treatment initiation.
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