Introduction: Treatment of NTM pulmonary disease remains a challenge for the respiratory physician. It is lengthy, while drug adverse effects often lead to treatment discontinuation. Currently, great research is taking place towards new and effective drug development with a better safety and tolerability profile.

Patients and methods: We present 11 patients of Greek origin (median age of 65 years) with NTM lung disease, who were treated with Amikacin Liposomal Inhalation Suspension (ALIS) between 2020 and 2022. Nine out of 11 (82%) had MAC disease  (4 with M.intracellulare and 5 with M.avium), and the other 2 had M.abscessus disease. The majority of paients (91%) had previously received amikacin intravenously, 4 of which developed ototoxicity (hearing loss, tinnitus) and 1 of them developed additionally nephrotoxicity. Imaging studies revealed cavitary disease in 3 patients whereas the other 8 had mainly nodules and bronchiectasis. All patients presented both clinical and radiological deterioration or disease relapse after receiving standard treatment regimens. After ALIS administration, 5 patients presented radiological improvement and sputum culture conversion. The other 2 patients had radiological stability, despite sputum conversion. Treatment was discontinued in one patient due to pneumonitis, while another patient passed away due to other causes.The 2 M.abscessus patients relapsed, despite initial radiological and microbiological improvement. All patients received maximum oral treatment in combination with ALIS.

Conclusions: Addition of ALIS to standard pharmaceutical scheme for NTM lung disease has shown encouraging results, with fewer adverse effects observed.