Table 1.
Characteristics of the identified studies
| Data set | Country and year | Diagnosis | N | Age (years) | Female sex (%) | NB (%) | FC (%) | NB + FC (%) | Unknown, unclassified or other (%) | Therapy | Five-year mortality rate (%) (95% CI) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Retrospective medical chart reviews | |||||||||||
| 1 | USA, 1973 [12] | MAC lung diseaseb | 45 | 49% > 50 | 0 | NR | 81.0 (multiple cavities in 50%) | NR | 11.0 (unknown) | 1–3 drugs: 53% ≥4 drugs: 47% Adjunctive surgical treatment: 42% Duration: 5 years |
40 (21.5–58.5) |
| 2 | Japan, 2012 [13] | Newly-diagnosed MAC lung disease‡ | 634 | 68.9 (mean) ± 11.4 (SD) | 58.5 | 82.9 | 11.5 | 3.3 | 2.3 (unclassified) | First-line antibiotic therapy: 50.9% Duration > 3 months |
23.9 (20.1–27.7) |
| 3 | Japan, 2012 [14] | Newly diagnosed MAC lung disease‡ | 78 | 65.2 (mean) ± 12.6 (SD) | 60.3 | 59.0 (bronchiectatic) | 26.0 | NR | NR | Various treatment regimens: 69% Untreated: 31% Duration NR |
25.6 (14.4–36.8) |
| 4 | Japan, 2013 [15] | Rheumatoid arthritis and MAC lung disease‡ | 82 | 67.6 (mean) ± 10.3 (SD) | 70.7 | 59.8 | 13.4 | 18.3 | 8.5 (other) |
1 or 2 drug regimens, Treatment for rheumatic disease Duration > 3 months |
32.8 (20.4–45.2) |
| 5 | Japan, 2014 [16] | MAC lung disease‡ | 309 | 67.0 (mean) ± 13.7 (SD) | 64.7 | NR | NR | NR | NR | Standard 3-drug regimen including clarithromycin: 131 patients (42.4%) Duration > 6 months for 108 regimens. Pulmonary resection: 5.1% |
10.0 (6.8–13.1) |
| 6 | UK, 2014 [17] | Non-cystic fibrosis bronchiectasis and coexisting MAC infection | 52 | 63.1 ± 12.7 | 69.2 | NR | NR | NR | NR | NR | 21 (8.5–33.5) |
| 7 | Japan, 2015 [18] | Nodular/ bronchiectatic MAC lung disease, based on HRCT of the chest‡ | 782 | 68.1 (mean) ± 11.1 (SD) | 68.5 | NR | 15.0 | NR | NR | First line antibiotic therapy, 1–5 drug regimen: 19.6% Duration > 3 months |
12.5 (10.0–15.0) |
| 8 | Japan, 2017 [19],a | MAC lung disease | 368 | 72 (mean) ± 10 (SD) | 59.0 | 81.0 | 11.1 | 1.6 | 9.5 | 165 treated patients; Clarithromycin + ethambutol + rifampicin (79.3%); other regimens (20.7%) | 23 (17.7–27.3) |
| 9 | Japan, 2017 [19],a | MAC lung disease | 118 | 70 (mean) ± 10 (SD) | 55 | 85.6 | 11.9 | 0 | 2.5 | 66 treated patients; Clarithromycin + ethambutol + rifampicin (79.3%); other regimens (20.7%) | 15 (7.8–21.6) |
| Retrospective population registry analyses | |||||||||||
| 10 | Denmark, 2010 [20] | Prevalent NTM-PD‡ (MAC subgroup considered) | 425 | 61.2 (mean) ± 16.5 (SD) | 41.0 | NR | NR | NR | NR | NR | 39.7 (33.7–45.7) |
| 11 | Canada, 2017 [21] | MAC lung disease‡ | 5543 | 70 (median), IQR 50–78 | 53.0 | NR | NR | NR | NR | NR | 33.3 (31.8–34.8) |
| 12 | Japan, 2017 [22] | NTM-PD§ | 125 | 60 (median) IQR 49–66 | 66.0% | NR | NR | NR | NR | ≥3 drug regimen including clarithromycin 76%; 2 drug regimen including clarithromycin 2%; clarithromycin monotherapy 4%; non-clarithromycin regimen 5% | 16 (7.8–21.6) |
| 13 | USA 2017 [23],a | NTM-PD (meeting ATS/IDSA criteria) treated with pulmonary resection‖ | 178 | 66.1 (mean) ±14.6 (SD) | 60 | NR | NR | NR | NR | 37 (27.6–45.4) | |
| 14 | USA, 2017 [23],a | NTM-PD (not meeting ATS/IDSA criteria) treated with pulmonary resection‖ | 138 | 62.4 (mean) ±17.3 (SD) | 51 | NR | NR | NR | NR | NR | 33 (23.7–43.0) |
| Prospective, randomized studies | |||||||||||
| 15 | UK and Scandinavia, 2002 [24] | MAC lung disease¶ | 75 | 64 (mean) | 46.7 | NR | 61 | NR | NR | Rifampicin +ethambutol ±isoniazid Duration: 2 years |
36.0 (22.4–49.6) |
| 16 | UK, Denmark, Sweden and Italy, 2008 [25],a | MAC lung disease¶ | 83 | 65 (mean) | 51.8 | NR | 69 | NR | NR | Rifampicin +ethambutol +clarithromycin ±immunotherapy Duration: 2 years |
48.0 (33.1–62.9) |
| 17 | UK, Denmark, Sweden and Italy, 2008 [25],a | MAC lung disease¶ | 87 | 65 (mean) | 49.4 | NR | 66 | NR | NR | Rifampicin +ethambutol +ciprofloxacin ±immunotherapy Duration: 2 years |
30.0 (18.5–41.5) |
Studies are ordered within categories by year of publication
ATS/IDSA American Thoracic Society/Infectious Diseases Society of America, CI confidence interval, FC fibrocavitary disease, HRCT high resolution computed tomography, IQR interquartile range, MAC Mycobacterium avium complex, NB nodular/bronchiectatic disease, NR not reported, NTM nontuberculous mycobacterium, PD pulmonary disease, SD standard deviation
aMortality data were provided for two differently treated cohorts of patients with MAC lung disease. bPulmonary parenchymal disease by chest radiograph, sputum or bronchial wash containing M. intracellulare, physician’s opinion that M. intracellulare caused the disease. ‡Disease fulfilled 2007 ATS/IDSA criteria. [2] §This study included primarily patients with MAC lung disease (86%) [22]. ‖These data sets included primarily MAC lung disease patients (84% in full cohort, 89% of those meeting ATS/IDSA criteria [data set 13], 78% of those not meeting ATS/IDSA criteria [data set 14]) [23]. ¶Sputum culture positive for MAC on at least two occasions separated by at least a week, radiographic changes compatible with mycobacterial pulmonary disease, and/or clinical evidence of such disease