Impact of timing of nontuberculous mycobacterial pulmonary disease antibiotic initiation on hospitalizations in Japan

BACKGROUND: Japan has the highest prevalence of nontuberculous mycobacterial pulmonary disease (NTMPD) globally. While antibiotic treatment is recommended in NTMPD, there is limited data on the appropriate time to initiate treatment. This real-world evidence study examined the impact of timing of NTMPD antibiotic initiation on hospitalizations in Japan. METHODS: A retrospective claims analysis using the JMDC, Inc database (2015-2022). Patients with NTMPD were divided into early (≤3 months from first diagnosis [index]) and delayed (>3 months from index) antibiotic-initiation groups. All-cause hospitalizations at years 1 and 2 post-index were compared with baseline (12 months pre-index). NTM-related hospitalizations were compared between year 1 and year 2 post-index. RESULTS: A total of 229 and 191 patients had early and delayed antibiotic initiation, respectively. The early antibiotic-initiation group had a 38.6% nonsignificant increase in patients with all-cause hospitalizations from baseline at year 1 (P = 0.09), followed by a 45.5% significant decrease from baseline at year 2 (P = 0.01). The delayed antibiotic-initiation group had an 81.1% significant increase in patients with all-cause hospitalizations at year 1 (P < 0.001), and a 35.1% decrease at year 2 (P = 0.07). From years 1 to 2, patients with NTM-related hospitalizations decreased by 75.6% and 65.4% in the early and delayed group, respectively. CONCLUSIONS: Patients with early antibiotic initiation for NTMPD had lower hospitalization burden over time than patients with delayed initiation. The early treatment group had a smaller increase in all-cause hospitalizations at year 1, larger decrease at year 2, and larger reduction in NTM-related hospitalizations from year 1 to 2.