The use of bedaquiline in the treatment of NTM disease in the UK

Bedaquiline is a diaryloquinolone antimicrobial drug that inhibits mycobacterial adenosine triphosphate synthase and is used in the treatment of multidrug resistant tuberculosis. There has been growing interesting in the utility of bedaquiline in the treatment of NTM infections, as in vitro studies have demonstrated that it may have efficacy against isolates of Mycobacterium abscessus (MAB) and Mycobacterium avium complex (MAC). as well against NTM strains that are resistant to macrolide antibiotics. However, there are currently no data from clinical trials regarding the efficacy of bedaquiline in the clinical treatment of NTM infection, and there is a lack of robust evidence regarding which patients would most likely benefit from its use.

This study aims to address this important area of unmet need and to increase the existing evidence base by creating a UK-wide case series on the use of bedaquiline to treat both pulmonary and extrapulmonary NTM infections. We aim to collate information regarding the clinical histories and outcomes of patients who have had NTM infection treated with bedaquiline, which in turn will provide a greater understanding of when its use in NTM treatment regimens should be considered. This will the first such national case series on bedaquiline use for NTM infections in the UK and will help to inform national guidance in the future.

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NTM Patient Survey

Patient surveys conducted across European countries have reported considerable unmet need in the management of patients living with NTM infection. However, a survey focussing on and exploring patient experience in the UK has not yet been published. This study aims to gather the views of patients living with either pulmonary or extrapulmonary NTM infection on their experience of diagnosis, treatment and navigating outpatient care services in the UK. Data gathered could help to direct areas of future development in local, regional and national NTM patient care services.

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OPTIMAL

The Optimised Personalised Therapy In Mycobacterium Avium Lung Disease study is being developed by Professor Gerry Davies, Professor of Infection Pharmacology at the University of Liverpool, in conjunction with NTM Network UK. It aims to determine the relative activity of combinations of common agents used for the treatment of Mycobacterium Avium complex (MAC), to explore early biomarkers of response to therapy for MAC, and to evaluate pharmacokinetic/pharmacodynamic relationships of key drugs used in the treatment of MAC.

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Articles for Clinical Medicine

NTM Network UK is currently developing a series of six Continuing Medical Education (CME) articles based around the theme of Respiratory Infection to appear in the journal Clinical Medicine. These articles will be published early in 2024 and cover the following topics: NTM pulmonary disease, extrapulmonary NTM disease, Aspergillus lung infections, endemic mycoses, parasitic lung diseases, and respiratory infections due to immunosuppressants & immunotherapy.

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