Clofazimine for nontuberculous mycobacterial pulmonary disese: A discussion from a Twitter journal club @respandsleepjc #rsjc

References

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• Stanbrook M. [drstanbrook]. (2018, Aug 9). @skbrode Why would such patients be started on NTM treatment, let alone clofazimine specifically? #rsjc
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• Brode SK. [skbrode]. (2018, Aug 9). @drstanbrook #rsjc they likely had pos cultures (either sputum or bAL) previously, but the most recent ones before starting clof were neg- so couldn’t analyze them for conversion
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• Stanbrook M. [drstanbrook]. (2018, Aug 9). @skbrode Did you analyze them for relapse? Maybe these patients were already partially responding to their prior NTM regimen and would therefore be at lower risk of relapse after clofazimine? #rsjc
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• Brode SK. [skbrode]. (2018, Aug 9). @drstanbrook #Rsjc too few patients converted and not enough FU time to study relapse
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• Stanbrook M. [drstanbrook]. (2018, Aug 9). @skbrode 15% of patients started clofazimine as first-line therapy. Under what circumstances do you use clofazimine first-line? #rsjc
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• Brode SK. [skbrode]. (2018, Aug 9). @drstanbrook #rsjc- we often use it first line for M abscessus. We might use it 1st line for MAC if pt has contraindication to RIF or EMB, or very severe disease and we want more drugs
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• Adams C. [colinadamsMD]. (2018, Aug 9). When talking about the adverse outcomes, the conclusion seems to be that clofazimine is just as well tolerated as other regimens. What was it compared to? It seems like the high rate of events would speak against that… #rsjc
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• Brode SK. [skbrode]. (2018, Aug 9). @ColinAdamsMD #rsjc Wallace et al chest 2014- 71% of pts on daily therapy had regimen modification bc of AE
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• Brode SK. [skbrode]. (2018, Aug 9). @ColinAdamsMD #rsjc yes AE rate was high, but prior NTM studies have reported similar rates- unfortunately!
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• Brode SK. [skbrode]. (2018, Aug 9). @ColinAdamsMD #rsjc many prior studies only report AEs causing drug discontinuation- hard to study all minor AEs - 34% in ours is consistent with literature
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• Abhyankar P. [respandsleepjc]. (2018, Aug 9). #RSJC: What are the limitations? (2/2) •Retrospective inferior to prospective •Clofazimine is special access – more complex group w lower rates of sputum conversion • Change in clinical guidelines during the study period – resulting in potential for differing tx decisions
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• Stanbrook M. [drstanbrook]. (2018, Aug 9). @skbrode What was the specific change(s) in study guidelines that you think could have influenced your study findings? #rsjc
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• Brode SK. [skbrode]. (2018, Aug 9).@drstanbrook #rsjc- great question- not sure what we meant by this! But thrice weekly therapy was only suggested in 2007, not 1997
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• Budd L. [lbudd313]. (2018, Aug 9). @skbrode Can clofazimine be obtained at any pharmacy or need pre-established pharmacy r/ship to carry it (ex. TWH pharmacy)? #rsjc
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• Brode SK. [skbrode]. (2018, Aug 9). @lbudd3 #rsjc clof is not approved for use by health Canada - only avail thru SAP- SAP will only ship to MDs office or a hospital pharmacy associated with MD
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• Zaheen A. [drzaheen]. (2018, Aug 9). @skbrode What are the requirements for SAP coverage? Simply progression on or intolerance of 1st line medications? In my limited experience FLQs or AMK are always trialed first #rsjc
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• Stanbrook M. [drstanbrook]. (2018, Aug 9). @drazaheen @skbrode @GovCanHealth a few years back had been making it really hard to access clofazimine at all for NTM. How was that situation resolved? #rsjc
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• Brode SK. [skbrode]. (2018, Aug 9). @drstanbrook @drazaheen @GovCanHealth #rsjc some NTM docs across Canada had discussions with HC-SAP about the need and fact that disseminated mac in HiV(where 1 study had bad outcomes) is very different from ntm Pulm disease
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• Brode SK. [skbrode]. (2018, Aug 9). @drstanbrook @drazaheen @GovCanHealth #rsjc- HC-SAP has given us clear direction on what info they want in application, which was helped. They don’t have clear requirements about indication, but we generally wouldn’t ask for it for mild MAC unless drug intol/contraindication
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• Brode SK. [skbrode]. (2018, Aug 9). @lbudd3 #rsjc yes so true! We need a breakthrough drug for NTM- not there yet- clof is a useful addition but not a breakthrough.
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