<i>M</i> <i>ycobacterium abscessus</i> pulmonary disease: individual patient data meta-analysis

Treatment of <i>Mycobacterium abscessus</i> pulmonary disease (MAB-PD), caused by <i>M. abscessus</i> subsp. <i>abscessus</i>, <i>M. abscessus</i> subsp. <i>massiliense</i> or <i>M. abscessus</i> subsp. <i>bolletii</i>, is challenging.We conducted an individual patient data meta-analysis based on studies reporting treatment outcomes for MAB-PD to clarify treatment outcomes for MAB-PD and the impact of each drug on treatment outcomes. Treatment success was defined as culture conversion for ≥12 months while on treatment or sustained culture conversion without relapse until the end of treatment.Among 14 eligible studies, datasets from eight studies were provided and a total of 303 patients with MAB-PD were included in the analysis. The treatment success rate across all patients with MAB-PD was 45.6%. The specific treatment success rates were 33.0% for <i>M. abscessus</i> subsp. <i>abscessus</i> and 56.7% for <i>M. abscessus</i> subsp. <i>massiliense</i> For MAB-PD overall, the use of imipenem was associated with treatment success (adjusted odds ratio (aOR) 2.65, 95% CI 1.36-5.10). For patients with <i>M. abscessus</i> subsp. <i>abscessus</i>, the use of azithromycin (aOR 3.29, 95% CI 1.26-8.62), parenteral amikacin (aOR 1.44, 95% CI 1.05-1.99) or imipenem (aOR 7.96, 95% CI 1.52-41.6) was related to treatment success. For patients with <i>M. abscessus</i> subsp. <i>massiliense</i>, the choice among these drugs was not associated with treatment outcomes.Treatment outcomes for MAB-PD are unsatisfactory. The use of azithromycin, amikacin or imipenem was associated with better outcomes for patients with <i>M. abscessus</i> subsp. <i>abscessus</i>.