P5 Increasing NTM caseload within the BTS MDR TB national clinical advice service: the tip of an iceberg?

<h3>Introduction and Objectives</h3> The BTS Multidrug Resistant (MDR) Tuberculosis (TB) Clinical Advice Service (CAS) provides an electronic forum to review, discuss and record formal feedback through an MDT delivered by national experts for cases of MDR and complex TB, submitted by local managing clinicians. This process provides specialist peer-review to support clinical requests for the use of new or high-cost drugs. The service also receives requests for advice on Non-Tuberculous Mycobacteria (NTM). Here we report CAS activity for referred NTM cases posted January 2018-June 2022. <h3>Methods</h3> NTM cases submitted to the service during this period were extracted from the CAS data platform using a reporting template developed to capture data on TB patients and their illness – with the first records representing the start of the current CAS. <h3>Results</h3> 85 patients with NTM were referred to the CAS (49% pulmonary disease). This comprised 18% of all CAS cases – making it the largest group discussed that were not known or suspected MDR/XDR TB. The percentage increased from 8.7% in 2018 to 31% in 2022 (p=0.001, test for trend). The median age was 52.7 years (IQR 34.5), 60% were male and 80% were UK-born, with a similar proportion of white ethnicity. Underlying clinical risk factors for NTM were noted in &gt;95% and ranged from COPD or bronchiectasis to immunosuppression in 1/3rd. No cases with underlying Cystic fibrosis were reported. The commonest organisms were <i>M. avium</i> complex and <i>M. abscessus</i>. Referrals were generally for advice on treatment. 85% were discussed at the MDT, with 73% discussed once. 24 cases requested support for bedaquiline use – and 13 (54%) were approved. Additionally, there were 5 cases where the panel recommended bedaquiline, though the managing clinician had not requested it. <h3>Conclusions</h3> The data indicate there is considerable and increasing demand for expert advice to manage patients with NTM. This appears to be in non-CF NTM, implying other networks may provide similar support for CF patients. The case-mix argues for regional NTM networks that could manage most current referrals – enabling a national group to focus on highly complex patients being considered for new and/or high-cost therapies. The authors have produced this abstract on behalf of the BTS MDR TB CAS, London, UK.