Airway and Lung Infection, Airway Disease, Bronchiectasis CE/CME ACCREDITED Watch Time: 37 mins

touchEXPERT OPINIONS New guideline-based strategies for improving outcomes in patients with NTM-LD

Watch leading experts provide advice on how clinicians should manage their patients with NTM-LD within the context of recently updated guidelines.

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Dr Juzar Ali
LSU Health Sciences Center, New Orleans, LA, USA
Can we reduce time to diagnosis and initiation of treatment?

Dr Juzar Ali outlines the current burden of NTM-LD, the common comorbidities associated with NTM-LD, and how clinicians can reduce the time to diagnosis for their patients.

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In this interview, Dr Juzar Ali answers the following questions:

  • What is the incidence and prevalence of NTM-LD, and how does it vary at a geographic and individual level?
  • What is the link between bronchiectasis and NTM-LD?
  • What are the common pulmonary comorbidities associated with NTM-LD?
  • What considerations should clinicians have when performing sputum collection and microbiological assessment?
  • What are the benefits of radiological assessment in patients with NTM-LD?

Dr Ali is a Professor of Medicine at Louisiana State University (LSU) Health Sciences Center, New Orleans, LA, USA, and Director of the LSU-Wetmore Mycobacterial programme. read more

He has worked nationally and internationally in the field of tuberculosis, and has developed programmes that contribute to the education of medical students, allied health professionals and the community. His clinical, academic and research interests include the diagnosis and management of tuberculous and nontuberculous mycobacterial disease and related co-morbidities in pulmonary medicine.

Dr Juzar Ali discloses: Advisory board/panel fees from Insmed and Oxford Immunotec. Consultant fees from Insmed and Oxford Immunotec. Grants/research support from Insmed and Oxford Immunotec. Speaker’s bureau fees from Insmed and Oxford Immunotec.

 
Dr Doreen Addrizzo-Harris
NYU Grossman School of Medicine, New York, NY, USA
What do clinicians need to know about new guideline-based treatment options to individualize treatment goals?

Dr Doreen Addrizzo-Harris outlines the recent guidelines for the treatment of NTM-LD, and how she applies these guidelines within her own clinical practice.

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In this interview, Dr Doreen Addrizzo-Harris answers the following questions:

  • Should patients with NTM-LD be treated with antimicrobial therapy or is watchful waiting preferred?
  • Should drug-susceptibility testing be performed before initiating treatment?
  • What are the treatment options for patients with macrolide-susceptible MAC NTM-LD?
  • What are the treatment options for MAC NTM-LD for patients who have failed previous therapy?
  • What are the treatment options for patients with non-MAC NTM-LD?

Dr Addrizzo-Harris is currently a Professor of Medicine at the NYU Grossman School of Medicine, New York, NY, USA. She serves as the Associate Division Director for Clinical and Faculty Affairs, is the Director of the NYU Bronchiectasis and NTM Program, and is Co-Director of the NYU Pulmonary Faculty Practice. read more

Dr Addrizzo-Harris has served on the board of the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD), including serving as President from 2006–2007. Academically, she authored 44 peer-reviewed publications and 57 scientific abstracts presented at international conferences. She has participated in numerous clinical trials, many as principal investigator. Dr Addrizzo-Harris has been recognized as a Distinguished CHEST Educator each year since its inception in 2017, and received the Distinguished Service Award in 2019.

Dr Doreen Addrizzo-Harris discloses: Grants/research support from Insmed and Zambon.

 
Dr Kevin Winthrop
Oregon Health & Science University, Portland, OR, USA
How can we manage adverse events to improve adherence?

Dr Kevin Winthrop outlines recent guideline recommendations for the management of possible adverse events associated with NTM-LD treatments, and how he manages adverse events within his own clinical practice.

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In this interview, Dr Kevin Winthrop answers the following questions:

  • What do real-word data tell us about adverse events leading to treatment discontinuation?
  • What key points should clinicians discuss with patients regarding possible adverse events before initiating therapy?
  • How should clinicians manage adverse events when treating patients with macrolide-susceptible MAC NTM-LD?
  • How should clinicians manage adverse events when treating patients with treatment-refractory MAC NTM-LD who are receiving treatment with ALIS?
  • How should clinicians manage adverse events when treating patients with non-MAC NTM-LD?

Dr Winthrop is a Professor of Public Health at the Oregon Health & Science University-Portland State University School of Public Health (OHSU-PSU SPH), and a Professor of Infectious Diseases and Ophthalmology at the School of Medicine at Oregon Health & Science University in Portland, OR, USA. read more

A former infectious disease epidemiologist in the Division of Tuberculosis Elimination at the US Centers for Disease Control and Prevention (CDC), Dr Winthrop has co-authored over 300 publications, many regarding the epidemiological and clinical aspects of opportunistic infections associated with immune-mediated inflammatory diseases, particularly those related to biologic immunosuppressive therapies.

As a primary or senior investigator in many clinical or epidemiological studies in these fields, he has collaborated closely with the rheumatology community in the evaluation and prevention of opportunistic infections in that setting. In addition, he is also a member of the graduate faculty at OHSU, where he mentors public health students, medical students and physicians in post-graduate training. At OHSU, he directs a national referral centre for chronic chest infections, and he serves as the medical consultant to the State of Oregon’s Tuberculosis control programme.

Dr Kevin Winthrop discloses: Consultant fees from Insmed, Paratek, RedHill Biopharma and Spero Therapeutics. Grants/research support from Insmed, Paratek and RedHill Biopharma.

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Learning Objectives & Overview
Overview

In this activity, the expert faculty consider how to optimize the diagnosis of nontuberculous mycobacterial lung disease (NTM-LD) and how to manage patients with NTM-LD considering the latest treatment guidelines.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of pulmonologists, infectious disease specialists including specialist infectious disease nurses, radiologists and hospital pharmacists involved in the management of NTM-LD.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty 

Dr Juzar Ali discloses: Advisory board/panel fees from Insmed and Oxford Immunotec. Consultant fees from Insmed and Oxford Immunotec. Grants/research support from Insmed and Oxford Immunotec. Speaker’s bureau fees from Insmed and Oxford Immunotec.

Dr Doreen Addrizzo-Harris discloses: Grants/research support from Insmed and Zambon.

Dr Kevin Winthrop discloses: Consultant fees from Insmed, Paratek, RedHill Biopharma and Spero Therapeutics. Grants/research support from Insmed, Paratek and RedHill Biopharma.

Content reviewer

Carolina Leon BSN, MSN, ARNP-BC has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Hannah Fisher has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have any questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credit for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Nurses

USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 0.75 contact hour may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

Pharmacists

USF Health is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This knowledge-based program has been approved for 0.75 contact hours (0.0075 CEUS). Universal program number is as follows: 0230-9999-21-007-H01-P.

This activity can be viewed on any web browser such as, but not limited to, Google Chrome, Firefox, Safari, Opera, Microsoft Edge and Internet Explorer.

This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

Date of original release: 30 November 2021. Date credits expire: 30 November 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Identify the clinical presentations associated with NTM-LD which can help reduce time to diagnosis and initiation of treatment
  • Apply guideline-based treatment options to set individualized treatment goals in collaboration with patients with NTM-LD
  • Evaluate strategies to improve adherence and manage adverse events in patients with NTM-LD
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Question 1/4
A patient presenting with which of the following conditions is most likely to also have NTM-LD-associated disease?

COPD, chronic obstructive pulmonary disease; NTM-LD, nontuberculous mycobacterial lung disease.
Correct

COPD, with or without bronchiectasis, is the most frequently observed comorbidity with NTM-LD. It causes increased disease severity and more exacerbations per year, as well as higher rates of mortality.1

Abbreviations

COPD, chronic obstructive pulmonary disease; NTM-LD, nontuberculous mycobacterial lung disease.

Reference

  1. Ali J. Expert Rev Respir Med. 2021;15:663–73.
Question 2/4
A 52-year-old patient is diagnosed with macrolide-susceptible MAC NTM-LD. When initiating therapy in this patient, following the ATS/ERS/ESCMID/IDSA Clinical Practice Guidelines, what would be your preferred treatment regimen?

ATS, American Thoracic Society; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; ERS, European Respiratory Society; IDSA, Infectious Diseases Society of America; MAC, M. avium complex; NTM-LD, nontuberculous mycobacterial lung disease.
Correct

The current ATS/ERS/ESCMID/IDSA Clinical Practice Guidelines recommend the use of a three-drug azithromycin-based treatment regimen. Not using a macrolide is associated with a reduced rate of conversion of sputum cultures to negative for disease and higher mortality. Azithromycin-based regimens have been shown to be as efficacious as clarithromycin-based regimens with the advantages of lower treatment burden, greater tolerance to treatment and less drug–drug interactions.1

Abbreviations

ATS, American Thoracic Society; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; ERS, European Respiratory Society; IDSA, Infectious Diseases Society of America; MAC, M. avium complex; NTM-LD, nontuberculous mycobacterial lung disease.

Reference

  1. Daley CL, et al. Eur Respir J. 2020;56:2000535.
Question 3/4
The same patient received 6 months of guideline-based therapy; however, they were still sputum-culture positive after this time. Treatment is therefore initiated with amikacin liposome inhalation suspension (ALIS). Which of the following monitoring methods would you use to identify potential side effects in this patient?
Correct

The ATS/ERS/ESCMID/IDSA Clinical Practice Guidelines recommend that patients receiving amikacin liposome inhalation suspension (ALIS) should receive clinical monitoring, audiograms, and blood urea nitrogen and creatinine testing.1 A 12-month open-label safety and tolerability extension trial reported that treatment-emergent adverse events of special interest, including ototoxicity, nephrotoxicity and neuromuscular disorders, were infrequent. Of patients who had not received previous treatment with ALIS, 6.7% (n=6) experienced tinnitus.2

Abbreviations

ATS, American Thoracic Society; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; ERS, European Respiratory Society; IDSA, Infectious Diseases Society of America.

References

  1. Daley CL, et al. Eur Respir J. 2020;56:2000535.
  2. Winthrop KL, et al. Ann Am Thorac Soc. 2021;18:1147–57.
Question 4/4
For your patient with M. kansasii NTM-LD, which of the following regimens would you initiate treatment with?

NTM-LD, nontuberculous mycobacterial lung disease.
Correct

The ATS/ERS/ESCMID/IDSA Clinical Practice Guidelines recommend that patients with M. kansasii NTM-LD receive a regimen of rifampicin, ethambutol, and either an isoniazid or macrolide.1

Abbreviations

ATS, American Thoracic Society; ESCMID, European Society of Clinical Microbiology and Infectious Diseases; ERS, European Respiratory Society; IDSA, Infectious Diseases Society of America; NTM-LD, nontuberculous mycobacterial lung disease.

Reference

  1. Daley CL, et al. Eur Respir J. 2020;56:2000535.
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