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Antiparasitic monotherapy recommended as treatment option for select cases of cystic echinococcosis
The World Health Organization (WHO) has published a new evidence-based guideline on the management options available for the treatment of cystic echinococcosis. The purpose of the guideline is to provide guidance on the choice of treatment so that patients can be offered appropriate, affordable, and equitable treatment in the context of available infrastructure and expertise to ensure safety and avoid unnecessary invasive interventions.
The WHO recommends treatment according to the stage and size of cysts. Treatment with albendazole (an antiparasitic agent) monotherapy is suggested for stage CE1, CE2, CE3a, and CE3b uncomplicated hepatic cysts that are less than 5 cm in size. For larger uncomplicated hepatic cysts, percutaneous, or surgical treatment is recommended depending on the cyst type, size, and response to initial treatment. Percutaneous and surgical treatments are often combined with albendazole. Praziquantel, given in combination with albendazole, is recommended after these procedures when cyst spillage is suspected or confirmed. Due to a lack of available data, these recommendations are based on very low-certainty evidence or expert consensus.
Inactive cysts (types CE4 and CE5) are typically treated with a ‘watch and wait’ approach. Complicated hepatic cysts and pulmonary cysts are usually managed with surgery. However, a 6-month course of albendazole monotherapy may be considered in patients with small pulmonary cysts. However, it is uncertain whether albendazole alone can effectively treat these cysts.
Cystic echinococcosis represents a substantial disease burden in rural and pastoral communities in lower- and upper-middle-income countries. It is considered a significant problem in South America, North Africa, Eastern and Mediterranean Europe, the Russian Federation, the Middle East, Central Asia, and China.
European guidance lowers the bar for starting antiviral therapy in chronic HBV
The European Association for the Study of the Liver (EASL) has published its updated clinical practice guideline on the management of hepatitis B virus (HBV) infection. Recommendations for when to start antiviral therapy have been updated to make sure patients who may benefit from antiviral therapy are not left untreated.
All individuals who are hepatitis B surface antigen (HBsAg)-positive with chronic HBV infection and advanced fibrosis or cirrhosis are now candidates for antiviral therapy, provided they have detectable HBV DNA, regardless of serum alanine aminotransferase (ALT) level or level of viraemia.
Individuals who do not have advanced fibrosis or cirrhosis are still candidates for antiviral therapy if their HBV DNA level is ≥2000 IU/mL and they have one of the following:
- ALT level greater than the upper limit of normal (ULN)
- Fibrosis
- Risk factors for hepatocellular carcinoma (HCC)
- Extrahepatic manifestations
- Immunosuppression
- Risk for HBV transmission
Individuals with persistent HBV DNA level <2000 IU/mL, persistently normal ALT level, and no signs of fibrosis do not usually require immediate antiviral therapy as these people have a low risk of disease progression and transmission.
In clinical practice, there has been a shift away from basing treatment decisions on the phase of chronic infection towards treatment indications being based on HBV DNA level. The EASL acknowledges this shift in its updated guideline, and presents a more simplified and pragmatic treatment approach that avoids categorising patients according to traditional disease phases or Hepatitis B e antigen (HBeAg) status. The guideline also emphasises the importance of consulting an expert when considering stopping antiviral therapy.
This change in practice has been prompted by recent evidence that shows long-term suppression of HBV DNA level is associated with a reduced risk of liver inflammation and fibrosis, thereby preventing disease progression and the development of cirrhosis and HCC, leading to increased survival.
Other major international guidelines currently vary in their recommendations on when to start antiviral therapy. For example, US guidelines still recommend initiating treatment based on the phase of chronic infection. However, these guidelines are currently in the process of being updated. The World Health Organization (WHO) supports the initiation of antiviral therapy in all individuals with a HBV DNA level ≥2000 IU/mL and ALT level above the ULN. The WHO also recommends treatment in all individuals with significant fibrosis, regardless of HBV DNA level.
Approximately 254 million people were living with chronic HBV infection in 2022, globally, with an estimated 1.1 million HBV-related deaths, mostly from cirrhosis and hepatocellular carcinoma.
FDA approves novel antipsychotic lumateperone as a new adjunctive treatment for depression
The US Food and Drug Administration (FDA) has approved lumateperone, a drug originally developed to treat psychosis, as an adjunctive treatment for major depressive disorder.
Lumateperone is an atypical antipsychotic with a distinctive mechanism of action. It is a serotonin 5-HT2A receptor antagonist and a partial agonist at central dopamine D2 receptors. Already approved for schizophrenia and depressive episodes associated with bipolar disorder, lumateperone gained approval in November 2025 as an adjunctive therapy to antidepressants for major depressive disorder in adults who experience only partial response to standard antidepressants.
The decision was underpinned by two positive phase 3 randomised controlled trials, demonstrating that lumateperone, when added to an oral antidepressant, significantly reduced depressive symptoms compared with placebo. Participants tolerated the treatment well over six weeks, with somnolence, dry mouth, diarrhoea, and dizziness the most frequently reported adverse effects. Importantly, rates of metabolic disturbance, extrapyramidal symptoms, and prolactin elevation, often problematic with other antipsychotic augmentation strategies, remained low. An accompanying open-label extension study suggests this favourable tolerability profile may persist over 6 months.
Lumateperone’s unique mechanism of action and safety profile may make it a valuable option in the future for select patients with depression, particularly those with a partial response to antidepressants, or for whom there are concerns about tolerability with other augmentation treatments. However, longer-term and real-world data are lacking, and head-to-head trials with established augmentation drugs are still needed. Additionally, availability in the US is limited by cost. Lumateperone is not currently approved in Europe.
AMT-130 gene therapy slows disease progression in patients with Huntington’s disease
AMT-130, a gene therapy which uses RNA interference to lower levels of mHTT (mutant huntingtin) protein, has shown promising results in one phase 1/2 study. Based on information from press releases, initial topline results from the European arm of the study indicate that the therapy has the potential to slow disease progression, giving hope to patients with Huntington’s disease. The study met its primary endpoint, with a statistically significant 75% slowing of disease progression with high-dose AMT-130 compared with control at 36 months, as measured using the composite Unified Huntington’s Disease Rating Scale. A secondary endpoint was also met, with high-dose AMT-130 showing a statistically significant 60% slowing of disease progression as measured by Total Functional Capacity. Favourable trends were also found across additional clinical measures of motor and cognitive function, mean cerebrospinal fluid neurofilament light protein (NfL) levels reduced below baseline at 36 months, and the therapy was well tolerated with a manageable safety profile.
A single dose of the drug is expected to last a lifetime. The US Food and Drug Administration (FDA) has previously granted AMT-130 breakthrough therapy designation and regenerative medicine advanced therapy designation, programmes designed to accelerate the development and review of new drugs. It is anticipated that a biologics license application will be submitted to the FDA in 2026 requesting accelerated approval of the drug. AMT-130 currently also has orphan drug designation in Europe.
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Prostate cancer: explore our topic
Prostate cancer is the second most common cancer and the fifth leading cause of cancer mortality in men worldwide. This topic will help you to learn how to:
- Diagnose the condition confidently
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- Share information with patients
- Advise patients about PSA testing
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One in three adults suffer from multiple chronic conditions and most patients in the acute setting have more than one medical condition.
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