A survey of clarithromycin monotherapy and long-term administration of ethambutol for patients with MAC lung disease in Japan: A retrospective cohort study using the database of health insurance claims
A survey of clarithromycin monotherapy and long-term administration of ethambutol for patients with MAC lung disease in Japan: A retrospective cohort study using the database of health insurance claims
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DOI：
10.1002/pds.4951
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发表时间：
2019-12-25
影响因子：
2.6
通讯作者：
Kuroda, Tomohiro
中科院分区：
文献类型：
--
作者：
Iwao, Tomohide;Kato, Genta;Kuroda, Tomohiro
背景：近年来，非结核分枝杆菌病(NTM)的患者数量呈指数增长。在日本，大约88.8%的NTM患者患有鸟分枝杆菌-细胞内复合体(MAC)肺部疾病。由于非结核分枝杆菌感染的迅速增加，MAC肺病的发病率正在增加，特别是在中老年妇女中。MAC型肺病的一般治疗方法是化疗。专家建议的预防该细菌耐药菌株发展的化疗类型包括克拉霉素(CAM)、利福平和乙胺丁醇(EB)的组合。CaM单一疗法因其在MAC肺病患者中诱导耐药细菌株的高潜力而被专家禁忌。此外，为避免药物不良反应，不建议使用剂量不低于1000 mg d(-1)的EB。然而，目前还不清楚在现实世界的临床环境中有多少这样的治疗病例。这是因为没有进行长期调查。材料与方法本研究以医保理赔数据库为基础，对2005-2017年间1135例MAC肺病患者的用药情况进行了调查。结果约9.2%(101例)的患者长期服用CAM单药3个月或以上，约3.6%(18例)的患者服用大剂量EB。结论长期单一应用CAM对部分患者有潜在的不良影响。更好地了解治疗的类型及其潜在的负面影响将对临床从业者有利。
Background The number of patients with nontuberculous mycobacteriosis (NTM) has increased exponentially in recent years. In Japan, approximately 88.8% of patients with NTM suffer from Mycobacterium avium-intracellulare complex (MAC) lung disease. Incidence of MAC lung disease is increasing in particularly among the middle-aged and elderly women owing to a rapid increase in nontuberculous mycobacterial infections. General treatment for MAC lung disease is chemotherapy. The type of chemotherapy recommended by specialists to prevent the development of a drug-resistant strain of the bacteria consists of a combination of clarithromycin (CAM), rifampicin, and ethambutol (EB). CAM monotherapy is contraindicated by specialists owing to its high potential to induce drug-resistant bacterial strains in patients with MAC lung disease. In addition, administering EB at doses not less than 1000 mg d(-1) is not recommended to avoid adverse drug reactions. However, it is unclear how much such treatment cases exist in real world clinical settings. This is because no long-term investigation has been carried out. Materials and Methods This study investigated treatment with these drugs from 2005 to 2017, by studying 1135 patients with MAC lung disease based on health insurance claims database. Results Results showed that approximately 9.2% (101 cases) were prescribed long-term CAM monotherapy for 3 months or longer and approximately 3.6% (18 cases) were prescribed high doses of EB. Conclusion CAM monotherapy over a long period of time is potentially detrimental to some patients. Better awareness of the types of treatments and their potential negative effects will be beneficial to clinical practitioners.