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Structured treatment interruption in patients with alveolar echinococcosis
Stefan Reuter1, Andreas Buck, Burkhard Manfras
1Section of Infectious Diseases and Clinical Immunology, Department of Medicine III, University Hospital of Ulm, Germany.
Hepatology (Baltimore, Md.)
|February 10, 2004
Summary
Benzimidazoles suppress but rarely kill alveolar echinococcosis (AE) parasites. Positron-emission tomography (PET) reliably detects active AE lesions and relapses, guiding treatment decisions.
Area of Science:
- Medical Imaging
- Parasitology
- Infectious Diseases
Background:
- Alveolar echinococcosis (AE) treatment with benzimidazoles is lifelong due to parasitic inhibition, not eradication.
- A long-term goal is to reduce treatment duration, with some evidence suggesting benzimidazoles may be parasiticidal in select cases.
Purpose of the Study:
- To evaluate the efficacy of discontinuing benzimidazoles in patients with inactive AE lesions identified by [18F]fluoro-deoxyglucose positron-emission tomography (PET).
- To assess the reliability of PET in detecting AE activity and guiding treatment interruptions.
Main Methods:
- A 3-year prospective study involving 23 AE patients.
- Structured treatment interruption for patients with PET-negative lesions.
- Disease progression monitored by PET, ultrasound, CT, laboratory tests, and clinical exams.
Main Results:
- 15 of 23 patients had PET-negative lesions and discontinued benzimidazoles.
- After 18 months, 8 of these 15 patients showed relapse (6 on PET, 2 clinically).
- PET sensitivity for detecting active lesions was 91%; treatment reinitiation halted progression.
Conclusions:
- Benzimidazoles primarily suppress AE parasite activity, rarely leading to eradication.
- PET is a dependable tool for assessing AE metabolic activity and detecting relapses.
- Discontinuation of benzimidazoles in inoperable AE is discouraged; PET monitoring is crucial if attempted.