Etanercept to Control Inflammation in the Treatment of Complicated Neurocysticercosis

Theodore E. Nash, Jean Anne M. Ware, Christina M. Coyle, Siddhartha Mahanty

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Manifestations of neurocysticercosis (NCC) are primarily due to host inflammatory responses directed at drug-damaged or naturally degenerating metacestodes (cysts) of the tapeworm Taenia solium. Prolonged high-dose corticosteroids are frequently required to control this inflammation in complicated disease, often causing severe side effects. Studies evaluating alternatives to corticosteroids are lacking. Here, we describe the clinical course of NCC in 16 patients prescribed etanercept (ETN), a tumor necrosis factor-alpha inhibitor to control inflammation resulting from anthelmintic treatment. Twelve patients with extraparenchymal NCC were administered ETN with corticosteroids (11/12, 91.7%) and/or methotrexate (9/12, 75.0%). The median age of the subgroup with extraparenchymal NCC was 40 years (range 26-57 years) and 66.7% were male. They were administered ETN for a median period of 311 days (range 31-461 days) and then followed for a median of 3.4 years (range 0.3-6.6 years). Among nine assessable patients, all improved clinically after starting ETN and one deteriorated transiently. Of the remaining three, one was lost to follow-up and two patients have improved but had not completed their assigned course. Four additional persons with recurrent perilesional edema (PE) episodes were given ETN for a median of 400.5 days (range 366-854 days) and followed post-ETN for a median of 1.7 years (range 0.2-2.4 years). All PE patients improved and two successfully tapered corticosteroids. Etanercept administration was associated with clinical improvement, stable disease, absence of recurrence, and lack of serious side effects. Etanercept appears to contribute to the control of inflammation and facilitate corticosteroid taper.

Original languageEnglish (US)
Pages (from-to)609-616
Number of pages8
JournalThe American journal of tropical medicine and hygiene
Volume100
Issue number3
DOIs
StatePublished - Mar 1 2019

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Neurocysticercosis
Inflammation
Adrenal Cortex Hormones
Therapeutics
Edema
Taenia solium
Cestoda
Anthelmintics
Etanercept
Lost to Follow-Up
Methotrexate
Cysts
Tumor Necrosis Factor-alpha
Recurrence

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases
  • Virology

Cite this

Etanercept to Control Inflammation in the Treatment of Complicated Neurocysticercosis. / Nash, Theodore E.; Ware, Jean Anne M.; Coyle, Christina M.; Mahanty, Siddhartha.

In: The American journal of tropical medicine and hygiene, Vol. 100, No. 3, 01.03.2019, p. 609-616.

Research output: Contribution to journalArticle

Nash, Theodore E. ; Ware, Jean Anne M. ; Coyle, Christina M. ; Mahanty, Siddhartha. / Etanercept to Control Inflammation in the Treatment of Complicated Neurocysticercosis. In: The American journal of tropical medicine and hygiene. 2019 ; Vol. 100, No. 3. pp. 609-616.
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