Department of Internal Medicine, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, South Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea.
J Glob Antimicrob Resist. 2020 Sep;22:106-112. doi: 10.1016/j.jgar.2020.01.004. Epub 2020 Jan 28.
This study aimed to compare the discontinuation rates attributed to adverse events and treatment outcomes between clarithromycin (CLR) and azithromycin (AZM) in patients with Mycobacterium avium complex lung disease (MAC-LD).
Among patients diagnosed with MAC-LD during 2001-2013, 560 for whom treatment was initiated as a guideline-based therapy until May 2018 were selected for adverse event analysis. Of them, 316 who underwent treatment for ≥12 months were selected for outcome analysis. Their medical records were retrospectively reviewed. The discontinuation and treatment success rates were analysed after adjustments using the inverse probability of treatment weighted (IPTW) method.
Among the 560 patients, 466 (83.2%) and 94 (16.8%) started CLR-containing and AZM-containing regimens, respectively. The IPTW method using propensity scoring revealed that the discontinuation rate attributed to adverse events was significantly higher with CLR than AZM use (24.6% vs. 9.6%; P=0.001). The overall treatment success rate of the 316 patients who received guideline-based therapy for ≥12 months was 83.2%. Analysis adjusted by the IPTW method showed no significant difference in the treatment success rate between the use of CLR and AZM. Furthermore, 1-year and 3-year recurrence rates were similar with the two drugs (6.8% vs. 6.0%; P>0.999 and 31.0% vs. 37.5%; P=0.482, respectively).
These findings suggest that an AZM-containing regimen may be the better initial treatment choice for MAC-LD as it resulted in lesser discontinuation rates attributed to adverse events while offering similar patient outcomes when compared with CLR.
本研究旨在比较克拉霉素（CLR）和阿奇霉素（AZM）治疗鸟分枝杆菌复合体肺病（MAC-LD）患者时因不良反应和治疗结局导致的停药率。
在 2001 年至 2013 年间诊断为 MAC-LD 的患者中，选择了 560 名接受了以指南为基础的治疗的患者进行不良反应分析，这些患者的治疗一直持续到 2018 年 5 月。其中，选择了 316 名接受了≥12 个月治疗的患者进行结局分析。回顾性分析了他们的病历。采用逆概率治疗加权（IPTW）方法调整后，分析了停药率和治疗成功率。
在 560 名患者中，分别有 466 名（83.2%）和 94 名（16.8%）患者开始使用含 CLR 和含 AZM 的方案。采用倾向评分的 IPTW 方法显示，CLR 组因不良反应导致的停药率显著高于 AZM 组（24.6%比 9.6%；P=0.001）。接受了≥12 个月以指南为基础的治疗的 316 名患者的总体治疗成功率为 83.2%。经 IPTW 方法调整后的分析显示，CLR 和 AZM 的治疗成功率无显著差异。此外，两种药物的 1 年和 3 年复发率相似（6.8%比 6.0%；P＞0.999 和 31.0%比 37.5%；P=0.482）。
这些发现表明，与 CLR 相比，含 AZM 的方案可能是 MAC-LD 的更好初始治疗选择，因为它导致的因不良反应导致的停药率较低，同时提供了相似的患者结局。
