Adverse reactions associated with long-term drug administration in Mycobacterium avium complex lung disease

• Published in: The international journal of tuberculosis and lung disease Vol. 22; no. 12; pp. 1505 - 1510
• Main Authors: Kamii, Y., Nagai, H., Kawashima, M., Matsuki, M., Nagoshi, S., Sato, A., Kohno, S., Ohgiya, M., Ohta, K.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01.12.2018; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Creatinine; Desensitization; Drug development; Drug Therapy; Drugs; Ethambutol; Health risk assessment; Hepatotoxicity; Liver; Long-Term Care; Lung diseases; Mac; Multivariate analysis; Mycobacterium avium; Non-Tuberculous Mycobacteria; Patients; Respiratory Tract Infection; Rifampin; Side effects; Therapy; Thrombocytopenia; Toxicity; Tuberculosis
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.18.0171

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.