Population based survey on the NTM pulmonary disease treatment in Japan

Introduction: Little is known about the treatment situation among nontuberculosis mycobacteria pulmonary disease (NTM-PD) cases in Japan. We aimed to clarify the treatment situation, focusing on the therapeutic regimen potentially related to development of macrolide resistant (RMR-therapy). Methods: We identified incident NTM-PD cases aged ≥40 years in 2011 who were followed up for at least 24 months using the national database of medical claims. We counted following case; standard-therapy case who had received any combinations of medications; 1) macrolide and rifamycin and ethambutol; and 2) macrolide and ethambutol; RMR-therapy case who had received; 1) only macrolide; 2) macrolide and rifamycin; and 3) macrolide and fluoroquinolone; non-therapy case who had not received above therapies. Multinomial logistic regression was used to evaluate standard-therapy and RMR-therapy cases with baseline of non-therapy. Results: Of the 22,664 cases identified, 6,971 (30.8%) were standard-therapy cases, 8,460 (37.3%) were RMR-therapy cases, and 7,233 (31.9%) were no-therapy cases. Probability of receiving standard-therapy decreased with age, while RMR-therapy increased. Females were significantly more likely to receive standard-therapy (OR 1.25, 95%CI 1.16-1.35) and RMR-therapy (OR 1.20, 95%CI 1.12-1.28) compared with male. Having any comorbidities was associated with standard-therapy (OR 1.36, 95%CI 1.27-1.46) and RMR-therapy (OR 1.57, 95%CI 1.47-1.67). Conclusion: Sex, age, and comorbidity contributed to make treatment decisions. Caution may need to be exercised in those receiving RMR-therapy, especially elderly female with comorbidities to avoid emergence of macrolide resistance. Funding support by AMED (16fk0108306h0103)