Diel R, Obradovic M, Tyler S, Engelhard J, Kostev K
Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany.
Insmed Germany GmbH, Frankfurt, Germany.
J Clin Tuberc Other Mycobact Dis. 2020 Aug 6;20:100178. doi: 10.1016/j.jctube.2020.100178. eCollection 2020 Aug.
Nontuberculous mycobacterial lung disease (NTMLD) is a rare, progressive disease with an increasing incidence worldwide.
The aim of this retrospective study was to analyze the baseline characteristics and management of NTMLD in general and pneumologist practices in Germany.
This retrospective study included patients with a culture-confirmed diagnosis of NTMLD documented between October 1, 2014 and September 30, 2019 by 125 general practitioners (GP) and 31 office-based pulmonologists from the IMS Disease Analyzer Database (IQVIA).
A total of 159 patients managed by German GPs (mean age 59 ± 19 years, 51% female) and 236 patients managed by pulmonologists (mean age 62 ± 14 years, 58% female) were analyzed. In total, 45% (72/159) and 40% (94/236) of patients managed by GPs and pulmonologists respectively received antibiotic therapy for NTMLD. This therapy lasted for ≥ 6 months in 42%, for ≥ 12 months in 24%, and ≥ 18 months in 8% of patients. The average therapy duration was longer in patients treated by pulmonologists (241 ± 196 days) than in patients treated by GPs (113 ± 152 days). A total of 27% of patients managed by GPs and 45% of those managed by pulmonologists respectively received guideline-based therapy (GBT), defined as combination therapy with macrolide (azi-/ clarithromycin) + ethambutol + rifabutin/rifampicin, at least once; however, almost all patients (100% in the GP group, 96% in the pulmonologist group) also received non-GBT regimens intermediately.
A considerable number of patients with NTMLD were not managed in accordance with the German guidelines and a substantial proportion also discontinue therapy prematurely. NTMLD management should be improved through appropriate referral pathways and collaboration between expert centers and primary or secondary care physicians.
非结核分枝杆菌肺病（NTMLD）是一种罕见的进行性疾病，在全球范围内发病率呈上升趋势。
这项回顾性研究的目的是分析德国普通医生和肺科医生诊所中NTMLD的基线特征及治疗情况。
这项回顾性研究纳入了2014年10月1日至2019年9月30日期间由125名全科医生（GP）和31名来自IMS疾病分析数据库（IQVIA）的门诊肺科医生记录的经培养确诊为NTMLD的患者。
共分析了由德国全科医生管理的159例患者（平均年龄59±19岁，51%为女性）和由肺科医生管理的236例患者（平均年龄62±14岁，58%为女性）。分别有45%（72/159）和40%（94/236）由全科医生和肺科医生管理的患者接受了NTMLD的抗生素治疗。42%的患者该治疗持续≥6个月，24%的患者持续≥12个月，8%的患者持续≥18个月。肺科医生治疗的患者平均治疗持续时间（241±196天）比全科医生治疗的患者（113±152天）更长。分别有27%由全科医生管理的患者和45%由肺科医生管理的患者至少接受过一次基于指南的治疗（GBT），定义为大环内酯类（阿奇霉素/克拉霉素）+乙胺丁醇+利福布汀/利福平的联合治疗；然而，几乎所有患者（全科医生组100%，肺科医生组96%）在此期间也接受了非GBT治疗方案。
相当数量的NTMLD患者未按照德国指南进行治疗，且很大一部分患者也过早停止治疗。应通过适当的转诊途径以及专家中心与初级或二级护理医生之间的合作来改善NTMLD的管理。
