Temporal trends in treatment strategies and outcomes of newly diagnosed Mycobacterium avium complex pulmonary disease

BACKGROUND This study aimed to investigate the trends in treatment patterns and outcomes over the past 15 years among patients with Mycobacterium avium complex pulmonary disease (MAC-PD) treated at a tertiary hospital in South Korea. METHODS Patients with newly diagnosed MAC-PD, who were treated at Seoul National University Hospital between 1 January 2011 to 31 August 2024, were categorised into three groups according to the date of initial treatment: group 1 (2011-2015), group 2 (2016-2020), and group 3 (2021-2024). Changes in patient characteristics, treatment patterns, and clinical outcomes were analysed. RESULTS A total of 624 patients were included (141, 240, and 243 in groups 1, 2, and 3, respectively). While the use of rifampicin declined, the use of azithromycin, inhaled or intravenous amikacin, and clofazimine increased over time. The probability of culture conversion progressively improved (Tarone-Ware test, P < 0.001), and the microbiological cure rate increased from 39.0% in group 1 to 49.2% and 61.8% in groups 2 and 3, respectively (P for trend < 0.001). CONCLUSION Since 2011, treatment strategies for MAC-PD have evolved toward a more proactive approach, accompanied by a gradual improvement in treatment outcomes. .