Treatment of severe Mycobacterium avium complex pulmonary disease with a adjunctive amikacin and clofazimine versus standard regimen alone, a retrospective study

Mycobacterium avium complex pulmonary disease (MAC-PD) is the most frequent non-tuberculous mycobacterial (NTM) disease . Outcomes of the currently recommended treatment regimen for MAC-PD, rifampicin (R), ethambutol (E) and macrolides (M), are poor. In case of extensive fibro-cavitary lesions, addition of amikacin (A) is recommended. Based on an a synergistic effect between amikacin and clofazimine (C) for MAC, we have treated patients with severe MAC-PD with additional amikacin and clofazimine (REMAC). We performed a retrospective (2007-2017) cohort study to compare treatment outcomes of MAC-PD treated with either REM or REMAC, applying NTM-NET definitions. Forty-four patients were included, 25 received REM and 19 received the REMAC regimen. Microbiological cure rates were 52% (REM) vs. 74% (REMAC) (p=0.337). Median time-to-sputum conversion was shorter in the REMAC (15 weeks; range 4-26) than in the REM group (18 weeks, range 9-27). [JvI1] In conclusion, we recorded a trend towards better cure rates and faster culture conversion in the REMAC group. The REMAC regimen may improve treatment outcomes in severe MAC-PD and we recommend a randomized controlled trial to further investigate this regimen.