OBJECTIVES: Non-tuberculous mycobacteria (NTM) are opportunistic pathogens to humans causing in particular pulmonary disease (PD) in the susceptible host. Despite availability of international guidelines, NTM-PD management is challenging because antibiotic regimens arelengthy and poorly tolerated resulting in often suboptimal patient outcomes. The aim of this study was to describe treatment patterns of NTM-PD in Belgium using medication dispensing data.

METHODS: A retrospective study was performed using IQVIA’s longitudinal pharmacy dataset covering approximately 30% of retail prescriptions in Belgium. Patients that initiated on an NTM treatment regimen from October 2015 until September 2019 were included. The outcomes of interest were: initial treatment regimens, treatment adherence in terms of medication possession rate (MPR), persistence on treatment, treatment switching to a different combination of molecules than their initial/previous regimen and restarts of treatment defined as stopping for more than 60 days but restarting therapy within one year.

RESULTS: There were 72 triple- and 130 dual-drug regimen initiations among 199 included unique patients. Triple-drug regimens were most often prescribed by a pneumologist (53%). The average MPR for patients initiated on triple-drug therapy was 88%. The median time on therapy for these patients was 225 days. Sixty and 30% of patients were still on therapy after 6 and 12 months, respectively. Switches were common, with up to 5.4 switches per patient over the treatment period. Seventeen percent of initiated therapies were stopped for more than 60 days but restarted within one year.

CONCLUSIONS: When on therapy, adherence to NTM-PD therapy was high. However, the results show that treatment persistence is low, with frequent therapy switches observed. Almost one-fifth of the initiated therapies were restarted which may be indicative of disease recurrence. Therapy management for NTM-PD could be improved through increasing guideline adherence, patient motivation and appropriate involvement of expert centres.