Research Article: Albendazole versus Praziquantel in the Treatment of Neurocysticercosis: A Meta-analysis of Comparative Trials

Date Published: March 12, 2008

Publisher: Public Library of Science

Author(s): Dimitrios K. Matthaiou, Georgios Panos, Eleni S. Adamidi, Matthew E. Falagas, Hélène Carabin

Abstract: BackgroundNeurocysticercosis, infection of the brain with larvae of Taenia solium (pork tapeworm), is one of several forms of human cysticercosis caused by this organism. We investigated the role of albendazole and praziquantel in the treatment of patients with parenchymal neurocysticercosis by performing a meta-analysis of comparative trials of their effectiveness and safety.Methods and Principal FindingsWe performed a search in the PubMed database, Cochrane Database of Controlled Trials, and in references of relevant articles. Six studies were included in the meta-analysis. Albendazole was associated with better control of seizures than praziquantel in the pooled data analysis, when the generic inverse variance method was used to combine the incidence of seizure control in the included trials (patients without seizures/[patients×years at risk]) (156 patients in 4 studies, point effect estimate [incidence rate ratio] = 4.94, 95% confidence interval 2.45–9.98). In addition, albendazole was associated with better effectiveness than praziquantel in the total disappearance of cysts (335 patients in 6 studies, random effects model, OR = 2.30, 95% CI 1.06–5.00). There was no difference between albendazole and praziquantel in reduction of cysts, proportion of patients with adverse events, and development of intracranial hypertension due to the administered therapy.ConclusionsA critical review of the available data from comparative trials suggests that albendazole is more effective than praziquantel regarding clinically important outcomes in patients with neurocysticercosis. Nevertheless, given the relative scarcity of trials, more comparative interventional studies—especially randomized controlled trials—are required to draw a safe conclusion about the best regimen for the treatment of patients with parenchymal neurocysticercosis.

Partial Text: Neurocysticercosis is a parasitic disease caused by the larval form of Taenia solium, known as pork tapeworm, when the larvae lodge in the central nervous system (CNS). It happens when human ingests the eggs, acting as the intermediate host in the life cycle of T. solium. The eggs hatch in the intestine and the embrya penetrate the intestinal wall and are distributed via the blood, anchoring in the CNS as a larval form of the parasite [1]. With T. solium parasitosis, both self-reinfection and infection of household members are common.

Neurocysticercosis is an endemic disease in many developing countries, and it may expand to the developed world, mainly as a result of immigration. Estimations report around 50 million new cases worldwide [24]. To our knowledge, until now the guidelines for the treatment of cysticercosis are the result of a consensus by a panel of experts in the subject [25]. Specifically, for viable parenchymal cysts the recommendations are based on evidence obtained from multiple case series with or without intervention, including dramatic results in uncontrolled experiments (level II-3 recommendation, which is considered a weak category of evidence), and on opinions of respected authorities, based on clinical experience, descriptive studies, and case reports or reports of expert committees (level III recommendation). Although these recommendations support the use of antiparasitic treatment, they do not point to either albendazole nor praziquantel as the drug of choice for this type of neurocysticercosis.



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