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Volume 25, Number 7—July 2019
CME ACTIVITY - Synopsis

Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease in Ontario, Canada, 2001–2013

Sarah K. BrodeComments to Author , Hannah Chung, Michael A. Campitelli, Jeffrey C. Kwong, Alex Marchand-Austin, Kevin L. Winthrop, Frances B. Jamieson, and Theodore K. Marras
Author affiliations: West Park Healthcare Centre, Toronto, Ontario, Canada (S.K. Brode); ICES, Toronto (S.K. Brode, H. Chung, M.A. Campitelli, J.C. Kwong); University of Toronto, Toronto (S.K. Brode, J.C. Kwong, F.B. Jamieson, T.K. Marras); University Health Network and Sinai Health System, Toronto (S.K. Brode, T.K. Marras); Toronto Western Family Health Team, Toronto (J.C. Kwong); Public Health Ontario, Toronto (J.C. Kwong, A. Marchand-Austin, F.B. Jamieson); Oregon Health and Science University, Portland, Oregon, USA (K.L. Winthrop)

Main Article

Table 4

Characteristics of MAC PD patients according to initial treatment regimen, Ontario, Canada, 2001–2013*

Characteristic Macrolide monotherapy, n = 95† Other regimen, n = 593 Unadjusted OR (95% CI) p value Adjusted OR (95% CI)‡ p value
Sex
F 52 (54.7) 357 (60.2) 0.80 (0.52–1.24) 0.314 0.92 (0.57–1.48) 0.738
M
 43 (45.3) 
 236 (39.8) 
 Referent
  NA
 Referent
 NA 
Age, mean ± SD
 76.21 ± 6.67
 75.52 ± 5.81
 1.02 (0.98–1.06)
 0.292
 1.03 (0.99–1.07)
 0.123
Income quintile
1 (lowest) 19 (20.0) 123 (20.7) Referent 0.682 NA NA
2 22 (23.2) 124 (20.9) 1.15 (0.59–2.23) 0.470 NA NA
3 13 (13.7) 111 (18.7) 0.76 (0.36–1.61) 0.945 NA NA
4 16 (16.8) 101 (17.0) 1.03 (0.50–2.10) 0.752 NA NA
5 (highest) 21–25 (22.1–26.3) 134 (22.6) 1.11 (0.58–2.14) 0.986 NA NA
Missing data
 <5 (≤2.1)
 0
 NA
NA
 NA
Residency§
Rural <5 (<2.1) 35 (5.9) 0.33 (0.08–1.40) 0.132 NA NA
Suburban 8–12 (8.4–12.6) 79 (13.3) 0.73 (0.36–1.47) 0.378 NA NA
Urban
 83 (87.4)
 479 (80.8)
 Referent
 NA
 NA
 NA
ADGs, mean ± SD
 10.45 ± 3.90
 10.36 ± 3.42
 1.01 (0.95–1.07)
 0.805
 NA
 NA
Underlying conditions¶
Asthma 47 (49.5) 218 (36.8) 1.68 (1.09–2.60) 0.019 1.22 (0.72–2.07) 0.451
Bronchiectasis 27 (28.4) 142 (23.9) 1.26 (0.78–2.05) 0.347 1.19 (0.71–1.99) 0.504
Chronic kidney disease 7 (7.4) 133 (5.6) 1.35 (0.58–3.15) 0.486 NA NA
COPD 75 (78.9) 387 (65.3) 2.00 (1.19–3.36) 0.009 1.47 (0.81–2.66) 0.208
Diabetes mellitus 21 (22.1) 100 (16.9) 1.40 (0.82–2.38) 0.214 NA NA
GERD 21 (22.1) 118 (19.9) 1.14 (0.68–1.93) 0.619 NA NA
Interstitial lung disease 14 (14.7) 67 (11.3) 1.36 (0.73–2.53) 0.335 NA NA
Lung cancer <5 (<2.1) 17 (2.9) 0.73 (0.17–3.21) 0.676 NA NA
Rheumatoid arthritis
 <5 (<2.1)
 25 (4.2)
 0.49 (0.11–2.10)
 0.335
 NA
 NA
Drug exposure within 1 y#
Short-acting BD 49 (51.6) 271 (45.7) 1.27 (0.82–1.95) 0.287 0.69 (0.38–1.26) 0.225
Long-acting BD 52 (54.7) 248 (41.8) 1.68 (1.09–2.60) 0.019 1.16 (0.56–2.39) 0.694
ICS 55 (57.9) 287 (48.4) 1.47 (0.95–2.27) 0.087 0.89 (0.42–1.87) 0.754
OCS 38 (40.0) 130 (21.9) 2.37 (1.51–3.74) <0.001 2.01 (1.16–3.50) 0.013
Methylxanthine
 9 (9.5)
 28 (4.7)
 2.11 (0.96–4.63)
 0.062
 1.52 (0.64–3.57)
 0.340
ED visit/hospitalization for asthma or COPD within 2 y#
 22 (23.2)
 88 (14.8)
 1.73 (1.02–2.93)
 0.042
 0.92 (0.48–1.77)
 0.799
Prior/current home oxygen therapy
 12 (12.6)
 31 (5.2)
 2.62 (1.30–5.31)
 0.007
 1.83 (0.84–3.98)
 0.128
PFTs within 5 y#
 78 (82.1)
 416 (70.2)
 1.95 (1.12–3.39)
 0.018
 1.52 (0.82–2.78)
 0.180
Pulmonologist prescriber 55 (57.9) 328 (55.3) 1.11 (0.72–1.72) 0.638 1.03 (0.66–1.63) 0.889

*Values are no. (%) except as indicated. According to privacy regulations, values representing <6 persons are reported as <5, and data are presented as a range of values for categorical variables where back-calculation is possible. ADGs, aggregated diagnostic groups (from the adjusted clinical group case mix system); BD, bronchodilator; COPD, chronic obstructive pulmonary disease; ED, emergency department; GERD, gastroesophageal reflux disease; ICS, inhaled corticosteroid; MAC, Mycobacterium avium complex; NA, not applicable; NTM, nontuberculous mycobacteria; OCS, oral corticosteroid; OR, odds ratio; PD, pulmonary disease; PFTs, pulmonary function tests.
†Macrolide monotherapy was the first antibiotic regimen given after NTM PD diagnosis, and was considered ≥60 d with no companion drugs of interest.
‡Variables were selected for inclusion in the multivariable model a priori, based on clinical relevance.
§Derived from rural index for Ontario group, a measure of rurality designed for Ontario (9).
¶Defined according to inpatient and outpatient diagnostic codes in databases of hospital discharges and physicians’ services claims, respectively. Definitions have been validated for all underlying conditions with the exception of bronchiectasis and interstitial lung disease.
#Before NTM PD diagnosis.

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Page updated: June 17, 2019
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