P8 A systematic literature review and meta-analysis of patient risk factors for non-tuberculous mycobacterial pulmonary disease (NTM-PD). (11th November 2022) - Loebinger, MR
Abstract : Introduction and Objectives: Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is associated with reduced lung function and increased morbidity. NTM-PD is often diagnosed when the disease has become established, making it difficult to treat. Understanding risk factors for NTM-PD can prompt testing and initiation of early, effective treatment. Results from a systematic literature review (SLR) and meta-analysis of the identified risk factors are reported. Methods: Electronic searches on Medline and EMBASE were performed in July 2021 to identify publications (2011–2021) reporting attributable risk factors for NTM-PD. Systematic screening of 7, 246 citations against agreed inclusion and exclusion criteria identified 99 publications for inclusion in the SLR and were subjected to full data extraction. Of these, 24 publications contained data on attributed risk factors that could be included in the meta-analysis. Patient demographics, NTM species, symptoms identified, risk factors and co-morbidities were recorded, and results were analysed. Due to high heterogeneity in the data, random effect modelling was used for meta-analysis which was performed using R based meta package. Results: Underlying lung disease was associated with NTM-PD, notably non-cystic fibrosis bronchiectasis, chronic obstructive pulmonary disease, asthma, and a history of tuberculosis ( table 1 ). Use of inhaled corticosteroids and immunosuppressive drugs, specifically anti-tumour necrosis factor alpha, were also positively associated as was infection with P. aeruginosa . Low body mass index was positively associated with risk of NTM-PD and cardiovascular disease was marginally associated. In this analysis lung function (FEV1) as well as macrolide use were not statistically significantly associated with NTM-PD. Conclusion: These data explore a comprehensive range of factors predisposing patients to NTM-PD, including underlying lung „disease, specific medications, and other disease processes. These meta-analysis data are limited by a paucity of published data regarding attributable risk factors for NTM-PD and a high degree of heterogeneity across studies compared. Similarly, some studies are performed in defined patient groups which may not be reflective of data in a more general population. Understanding risk factors, as explored in this meta-analysis, may identify patients for NTM testing and further treatment if appropriate. Please refer to page A213 for declarations of interest related to this abstract.