The Impact of Short-Term,Intensive Antifolate Treatment (with Pyrimethamine and Sulfadoxine) and Antibiotics Followed by Long-Term,Secondary Antifolate Prophylaxis on the Rate of Toxoplasmic Retinochoroiditis Recurrence |
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| Authors: | Piotr K Borkowski Joanna Brydak-Godowska Wojciech Basiak Karolina ?witaj Hanna ?arnowska-Prymek Maria Olszyńska-Krowicka Piotr Kajfasz Daniel Rabczenko |
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| Institution: | 1Former Department of Zoonoses and Tropical Diseases, Medical University of Warsaw, Poland, present Department of Infectious, Tropical Diseases and Hepatology, Medical University of Warsaw, Poland;2Department of Ophthalmology, Medical University of Warsaw, Poland;3Department-Centre for Monitoring and Analyses of Population Health Status, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland;Ohio State University, UNITED STATES |
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| Abstract: | PurposeTo assess the impact of intensive antifolate treatment, followed by secondary antifolate prophylaxis (A-SP) on the recurrence rate of toxoplasmic retinochoroiditis (TRC). To investigate whether there are any other factors potentially predisposing for recurrence.ResultsWhen secondary antifolate prophylaxis (A-SP) was instituted immediately after the treatment for TRC, the probability of 3-year recurrence–free survival after the first course of A-SP was 90.9%. A recurrence was most likely approximately 3.5 years after the first treatment. A univariate Cox regression model demonstrated that a risk for recurrence was 2.82 times higher (p = 0.02) in patients with retinal scars. In the multivariate analysis, the risk for recurrence was 2.41 higher (p = 0.06). In patients with haemorrhagic lesions the risk for recurrence was lower, aRR = 0.17 (approaching borderline statistical significance p = 0.08).ConclusionsWith the institution of A-SP of immediately after the intensive treatment for TRC, i.e. when a reactivation was most likely, there was no recurrence during A-SP. Following A-SP the recurrence rates were low and recurrence-free periods tended to be longer. The treatment regimen employed had a beneficial effect on the recurrence interval as it reduced and delayed the highest probability of recurrence. |
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