Treatment response of cystic echinococcosis to benzimidazoles: a systematic review.
Treatment response of cystic echinococcosis to benzimidazoles: a systematic review.
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囊性棘球菌对苯咪唑的治疗反应：系统评价。
DOI：
10.1371/journal.pntd.0000524
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发表时间：
2009-09-29
影响因子：
3.8
通讯作者：
Junghanss T
中科院分区：
文献类型：
--
作者：
Stojkovic M;Zwahlen M;Teggi A;Vutova K;Cretu CM;Virdone R;Nicolaidou P;Cobanoglu N;Junghanss T
在过去的 30 年里，苯并咪唑类药物越来越多地用于治疗囊性包虫病 (CE)。然而，苯并咪唑类药物的功效仍不清楚。我们系统地检索了 MEDLINE、EMBASE、SIGLE 和 CCTR，以识别有关苯并咪唑治疗结果的研究。 23 份报告中的方法存在很大异质性，无法对已发表的结果进行荟萃分析。我们联系了专家中心以提供患者的个人数据。我们对定义为不活动（根据基于超声的世界卫生组织 [WHO] 分类方案的 CE4 或 CE5）或消失的囊肿反应进行了生存分析。我们收集了来自 6 个中心（5 个国家）的 711 名治疗患者的数据，这些患者有 1,308 个囊肿。分析仅限于 1,159 个肝脏和腹膜囊肿。总体而言，开始苯并咪唑治疗后 1-2 年，50%-75% 的活性 C1 包囊被归类为不活动/消失，而 CE2 和 CE3 包囊的这一比例为 30%-55%。进一步分析与囊肿大小有关的失活/消失率，50%–60% 的 <6 cm 囊肿在 1–2 年后对治疗有反应，而 25%–50% 的囊肿 > 6 cm 对治疗有反应。然而，25% 的囊肿在最初缓解后 1.5 至 2 年内恢复到活动状态，并且观察到多次复发；第二次和第三次治疗后，60%的囊肿在2年内复发。我们估计治疗开始后 2 年，40% 的囊肿仍然活跃或再次活跃。过去，苯并咪唑类药物的总体功效被夸大了。迫切需要一项实用的随机对照试验，将标准化苯并咪唑疗法在反应性囊肿阶段与其他治疗方式进行比较。囊性包虫病（CE）是一种世界范围内发生的寄生虫感染，由狗传播给人类。感染后会出现囊肿，主要出现在肝脏和肺部。基于超声的囊肿分为活动期、过渡期和非活动期，为治疗和随访开辟了新的场所。目前使用四种治疗方式：（1）手术，（2）经皮绝育技术，（3）苯并咪唑化疗，以及（4）观察并等待不活跃的囊肿。然而，这四种方式的证据不足，为患者确定个体化治疗方案仍存在争议。苯并咪唑类药物治疗始于 20 世纪 70 年代。然而，重要的问题仍未得到解答，例如按囊肿类型和治疗持续时间分层的疗效。因此，我们启动了 EchinoMEDREV，这是一项合作项目，旨在收集接受苯并咪唑治疗的患者的个体患者数据，并使用跨治疗中心的通用分析策略来分析开始苯并咪唑治疗后的囊肿结果。我们发现苯并咪唑的功效过去被夸大了。此外，尚未考虑自然囊肿腐烂。迫切需要随机对照试验的证据来确定苯并咪唑的真正疗效。我们的分析将有助于根据当前可用的最佳证据设计苯并咪唑试验组。
Over the past 30 years, benzimidazoles have increasingly been used to treat cystic echinococcosis (CE). The efficacy of benzimidazoles, however, remains unclear. We systematically searched MEDLINE, EMBASE, SIGLE, and CCTR to identify studies on benzimidazole treatment outcome. A large heterogeneity of methods in 23 reports precluded a meta-analysis of published results. Specialist centres were contacted to provide individual patient data. We conducted survival analyses for cyst response defined as inactive (CE4 or CE5 by the ultrasound-based World Health Organisation [WHO] classification scheme) or as disappeared. We collected data from 711 treated patients with 1,308 cysts from six centres (five countries). Analysis was restricted to 1,159 liver and peritoneal cysts. Overall, 1–2 y after initiation of benzimidazole treatment 50%–75% of active C1 cysts were classified as inactive/disappeared compared to 30%–55% of CE2 and CE3 cysts. Further in analyzing the rate of inactivation/disappearance with regard to cyst size, 50%–60% of cysts <6 cm responded to treatment after 1–2 y compared to 25%–50% of cysts >6 cm. However, 25% of cysts reverted to active status within 1.5 to 2 y after having initially responded and multiple relapses were observed; after the second and third treatment 60% of cysts relapsed within 2 y. We estimated that 2 y after treatment initiation 40% of cysts are still active or become active again. The overall efficacy of benzimidazoles has been overstated in the past. There is an urgent need for a pragmatic randomised controlled trial that compares standardized benzimidazole therapy on responsive cyst stages with the other treatment modalities. Cystic echinococcosis (CE) is a parasitic infection of worldwide occurrence transmitted to humans by dogs. After infection cysts develop, mainly in the liver and lung. Ultrasound-based staging of cysts into active, transitional, and inactive has opened new venues for treatment and follow-up. Currently four treatment modalities are in use: (1) surgery, (2) percutaneous sterilization techniques, (3) chemotherapy with benzimidazoles, and (4) watch and wait for inactive cysts. However, evidence is insufficient for these four modalities, and determining individual treatment options for patients remains controversial. Medical treatment with benzimidazoles started in the 1970s. Important questions remain unanswered, however, such as efficacy stratified by cyst type and the duration of treatment. We therefore initiated EchinoMEDREV, a collaborative effort to collect individual patient data from patients treated with benzimidazoles and to analyze cyst outcome after initiation of benzimidazole therapy using a common analytical strategy across treatment centres. We found that the efficacy of benzimidazoles has been overstated in the past. Additionally, natural cyst decay has not been taken into account. Evidence from randomized controlled trials is urgently needed to determine the true efficacy of benzimidazoles. Our analysis will help to design benzimidazole trial arms on the basis of the currently available best evidence.
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DOI：
10.1080/00034983.1990.11812496
发表时间：
1990-10-01
影响因子：
--
作者：
DEROSA, F;TEGGI, A
通讯作者：
TEGGI, A
影响因子：
168.9
作者：
GILGRANDE, LA;RODRIGUEZCAABEIRO, F;DALRE, R
通讯作者：
DALRE, R
影响因子：
2.7
作者：
Perdomo, R;Alvarez, C;Yarzabal, L
通讯作者：
Yarzabal, L
影响因子：
11.8
作者：
Franchi, C;Di Vico, B;Teggi, A
通讯作者：
Teggi, A
DOI：
10.1080/00034983.1992.11812631
发表时间：
1992-02-01
影响因子：
--
作者：
TODOROV, T;VUTOVA, K;NEDELKOV, G
通讯作者：
NEDELKOV, G