Randomized Trial of Liposomal Amikacin for Inhalation in Nontuberculous Mycobacterial Lung Disease

• Published in: American journal of respiratory and critical care medicine Vol. 195; no. 6; pp. 814 - 823
• Main Authors: Olivier, Kenneth N, Griffith, David E, Eagle, Gina, McGinnis, 2nd, John P, Micioni, Liza, Liu, Keith, Daley, Charles L, Winthrop, Kevin L, Ruoss, Stephen, Addrizzo-Harris, Doreen J, Flume, Patrick A, Dorgan, Daniel, Salathe, Matthias, Brown-Elliott, Barbara A, Gupta, Renu, Wallace, Jr, Richard J
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 15.03.2017
• Subjects: Administration, Inhalation; Amikacin - administration & dosage; Amikacin - therapeutic use; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Double-Blind Method; Female; Humans; Male; Middle Aged; Mycobacterium Infections, Nontuberculous - drug therapy; Nontuberculous Mycobacteria - drug effects; Original; Prospective Studies; Treatment Outcome; nontuberculous mycobacteria; culture conversion; safety; efficacy
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201604-0700oc

Lengthy, multidrug, toxic, and low-efficacy regimens limit management of pulmonary nontuberculous mycobacterial disease. In this phase II study, we investigated the efficacy and safety of liposomal amikacin for inhalation (LAI) in treatment-refractory pulmonary nontuberculous mycobacterial (Mycobacterium avium complex [MAC] or Mycobacterium abscessus) disease. During the double-blind phase, patients were randomly assigned to LAI (590 mg) or placebo once daily added to their multidrug regimen for 84 days. Both groups could receive open-label LAI for 84 additional days. The primary endpoint was change from baseline to Day 84 on a semiquantitative mycobacterial growth scale. Other endpoints included sputum conversion, 6-minute-walk distance, and adverse events. The modified intention-to-treat population included 89 (LAI = 44; placebo = 45) patients. The average age of the sample was 59 years; 88% were female; 92% were white; and 80 and 59 patients completed study drug dosing during the double-blind and open-label phases, respectively. The primary endpoint was not achieved (P = 0.072); however, a greater proportion of the LAI group demonstrated at least one negative sputum culture (14 [32%] of 44 vs. 4 [9%] of 45; P = 0.006) and improvement in 6-minute-walk test (+20.6 m vs. -25.0 m; P = 0.017) at Day 84. A treatment effect was seen predominantly in patients without cystic fibrosis with MAC and was sustained 1 year after LAI. Most adverse events were respiratory, and in some patients it led to drug discontinuation. Although the primary endpoint was not reached, LAI added to a multidrug regimen produced improvements in sputum conversion and 6-minute-walk distance versus placebo with limited systemic toxicity in patients with refractory MAC lung disease. Further research in this area is needed. Clinical trial registered with www.clinicaltrials.gov (NCT01315236).