Efficacy and tolerability of linezolid as an adjunctive treatment for nontuberculous mycobacterial infections in patients with adult-onset immunodeficiency syndrome: a prospective cohort study.

Linezolid may show some efficacy in treating nontuberculous mycobacterial diseases, but the high rate of adverse events and treatment discontinuation warrants caution.

Summary and findings

This study evaluated the efficacy and tolerability of a nine-month oral linezolid regimen in 40 adults with nontuberculous mycobacterial diseases and anti-interferon gamma autoantibodies. The study reported treatment failure and relapse rates, as well as adverse events during the treatment period. Notably, 25% of participants discontinued treatment early due to adverse events.

Abstract

Background Patients with nontuberculous mycobacterial (NTM) diseases associated with anti-interferon gamma autoantibodies (anti-IFN-γ auto-Abs) often experience recurrences, despite prolonged treatment, which requires intravenous anti-mycobacterial therapy. Linezolid (LZD) shows a potential as an adjunct treatment, but there is limited data on its long-term efficacy and safety. Methods We conducted a prospective study from December 2017 to April 2022, to evaluate the efficacy of a nine-month oral LZD regimen in reducing NTM treatment failure, defined as relapse and the need for intravenous anti-mycobacterial therapy for suspected uncontrolled NTM or death as well as to determine its tolerability. Results Among 40 adults (≥18 years) with NTM diseases and anti-IFN-γ auto-Abs treated with linezolid, 10 (25%) discontinued treatment early due to adverse events (AEs), including one death from suspected uncontrolled diseases at month seven. Of the 30 patients who completed the nine-month course, only five maintained their initial dose. The remaining 25 required dose modification: four temporarily paused treatment due to AEs, nine reduced to a half dose due to AEs, and 12 reduced their dose because of stable disease. By month nine, the cumulative incidence rates of relapse and treatment failure were 22.5 and 15.0%, respectively; consequently, 77.5% and 85.0% of patients remained free from the relapse and treatment failure. Overall, 24 patients (60%) reported a total of 31 AEs, with anemia and peripheral neuropathy being the most frequent. Conclusion Our findings suggest that linezolid could be a valuable adjunct treatment for nontuberculous mycobacteria diseases in patients with anti-interferon gamma autoantibodies. However, close monitoring for adverse events is essential.

Key findings

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Limitations

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