AJMC Post Conference Perspectives: Advances in MAC Pulmonary Disease From ATS 2026

Better risk stratification, more tolerable regimens, and outcome measures beyond culture conversion top the list of unmet needs Dr. Losier identifies for MAC and NTM pulmonary disease heading into ATS 2026.

New multi-center registry data confirm MAC as the dominant cause of NTM pulmonary disease, while culture conversion with standard therapy still fails in nearly half of patients.

The ENCORE trial challenges the practice of reserving inhaled amikacin liposome therapy for refractory disease, showing improved culture conversion when it is introduced earlier in newly diagnosed, non-cavitary MAC.

An all-oral, bedaquiline-containing regimen offers a potential salvage option for refractory MAC, reducing reliance on aminoglycoside therapy while requiring continued QT monitoring.

Early data on inhaled clofazimine suggest the drug can reach the lung at meaningful concentrations with far less systemic exposure than oral therapy, though efficacy evidence remains preliminary.

Culture conversion alone cannot capture what patients experience during MAC treatment, and new patient-reported outcome data argue for a more multidimensional definition of treatment success.