Early treatment interruption and nutritional status as predictors of mortality in Mycobacterium avium complex pulmonary disease
Hye Young Hong, Youngmok Park, Song Yee Kim, A La Woo, Hye-Jeong Lee, Young Ae Kang
Abstract:
Mycobacterium avium complex pulmonary disease (MAC-PD) requires prolonged multidrug therapy. However, treatment outcomes remain suboptimal due to limited antibiotic efficacy, disease chronicity, and frequent early treatment interruption (ETI). Despite its clinical significance, data on the prevalence, risk factors, and long-term outcomes of ETI remain limited.
Introduction
The treatment of Mycobacterium avium complex pulmonary disease (MAC-PD) presents significant clinical challenges. Effective management of MAC-PD requires a multidrug regimen, typically including macrolides, ethambutol, and rifamycins, administered for at least 12 months after microbiologic culture conversion [1].
Material and methods
We conducted a retrospective cohort study of adults treated with MAC-PD between 2010 and 2023, including only cases that met the 2007 American Thoracic Society and the Infectious Diseases Society of America criteria for nontuberculous mycobacterial pulmonary disease (NTM-PD) [12].
Results:
As illustrated in the study flow diagram (Fig 1), a total of 586 patients were initially screened, 166 were excluded based on the predefined criteria, resulting in a final analytic cohort of 420 patients.
Discussion
In this study, approximately 30% of patients with MAC-PD discontinued the treatment early, defined as cessation of therapy within 12 months. ETI was markedly associated with the occurrence of ADRs and poor nutritional status, as indicated by low PNI scores. Furthermore, ETI and poor nutritional status emerged as significant risk factors for increased long-term mortality, highlighting their critical impact on treatment outcomes in patients with MAC-PD.
Conclusions
This study highlights the significant burden of ETI in MAC-PD, primarily driven by ADRs and poor nutritional status. Both factors were also associated with increased long-term mortality. These findings underscore the urgent need for enhanced multidisciplinary strategies focusing on ADR management, nutritional support, and treatment adherence to optimize clinical outcomes in patients with MAC-PD.
Citation: Hong HY, Park Y, Kim SY, La Woo A, Lee H-J, Kang YA (2026) Early treatment interruption and nutritional status as predictors of mortality in Mycobacterium avium complex pulmonary disease. PLoS One 21(5): e0350106. https://doi.org/10.1371/journal.pone.0350106
Editor: Fumihiro Yamaguchi, Showa University Fujigaoka Hospital, JAPAN
Received: February 4, 2026; Accepted: May 10, 2026; Published: May 27, 2026
Copyright: © 2026 Hong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Data cannot be shared publicly because of ethical restrictions to protect participant privacy. The data contain sensitive information including patient clinical records. Data are available from the Institutional Review Board of Severance Hospital, Yonsei University Health System (contact via irb@yuhs.ac or +82-2-2228-0430~4) for researchers who meet the criteria for access to confidential data.
Funding: National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (RS-2024-00341299). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Abbreviation: AFB, Acid-fast bacillus; ADRs, Adverse drug reactions; aOR, Adjusted odds ratio; BMI, Body mass index; CI, Confidence interval; CTCAE, Common Terminology Criteria for Adverse Events; ETI, Early treatment interruption; LFTU, Lost to follow-up; MAC-PD, Mycobacterium avium complex pulmonary disease; NTM-PD, Nontuberculous mycobacterium pulmonary disease; PNI, Prognostic Nutritional Index; TB, Tuberculosis
