Albendazole alone or in combination with microfilaricidal drugs for lymphatic filariasis

Abstract

Background The Global Programme to Eliminate Lymphatic Filariasis recommends mass treatment of albendazole co‐administered with the microfilaricidal (antifilarial) drugs diethylcarbamazine (DEC) or ivermectin; and recommends albendazole alone in areas where loiasis is endemic. Objectives To assess the effects of albendazole alone, and the effects of adding albendazole to DEC or ivermectin, in people and communities with lymphatic filariasis. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), Embase (OVID), LILACS (BIREME), and reference lists of included trials. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify ongoing trials. We performed all searches up to 15 January 2018. Selection criteria We included randomized controlled trials (RCTs) and cluster‐RCTs that compared albendazole to placebo or no placebo, or compared albendazole combined with a microfilaricidal drug to a microfilaricidal drug alone, given to people known to have lymphatic filariasis or communities where lymphatic filariasis was known to be endemic. We sought data on measures of transmission potential (microfilariae (mf) prevalence and density); markers of adult worm infection (antigenaemia prevalence and density, and adult worm prevalence detected by ultrasound); and data on clinical disease and adverse events. Data collection and analysis At least two review authors independently assessed the trials, evaluated the risks of bias, and extracted data. The main analysis examined albendazole overall, whether given alone or added to a microfilaricidal drug. We used data collected from all randomized individuals at time of longest follow‐up (up to 12 months) for meta‐analysis of outcomes. We evaluated mf density data up to six months and at 12 months follow‐up to ensure that we did not miss any subtle temporal effects. We conducted additional analyses for different follow‐up periods and whether trials reported on individuals known to be infected or both infected and uninfected. We analysed dichotomous data using the risk ratio (RR) with a 95% confidence interval (CI). We could not meta‐analyse data on parasite density outcomes and we summarized them in tables. Where data were missing, we contacted trial authors. We used GRADE to assess the certainty of evidence. Main results We included 13 trials (12 individually‐randomized and one small cluster‐randomized trial) with 8713 participants in total. No trials evaluated population‐level effects of albendazole in mass drug administration programmes. Seven trials enrolled people with a variety of inclusion criteria related to filarial infection, and six trials enrolled individuals from endemic areas. Outcomes were reported as end or change values. Mf and anti...

Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update

“…Gyapong et al [ 202 ] encouraged the use of albendazole in combination with ivermectin where onchocerciasis is co-endemic, and albendazole and DEC elsewhere. Nevertheless, it was suggested by Tisch et al [ 203 ] that adding albendazole to DEC would provide less reduction in microfilarial prevalence and density than adding ivermectin to DEC. Addiss et al [ 190 ], Critchley et al [ 204 ], and Macfarlane et al [ 205 ] were of opinion that not enough evidence had been gathered on the effectiveness of albendazole, alone or in combination with other drugs, for killing or interrupting transmission of filarial worms (adults and microfilariae) up to 12 months after treatment, and further well-controlled studies should be done. Although albendazole will not treat symptoms in people already affected by filariasis [ 205 ], it is of considerable importance to see that a significant proportion of children with W. bancrofti infection in India had their lymphatic pathology reversed when given the combination of albendazole and DEC annually or semiannually for 2 years [ 206 ].…”

Advances in Antiwolbachial Drug Discovery for Treatment of Parasitic Filarial Worm Infections

“…The neurological severe adverse events (SAEs) can cause loss of consciousness, can be fatal and are associated with high titers of L. loa microfilariae in the blood (>30,000 microfilariae/mL). Therefore, treatments for onchocerciasis in L. loa co-endemic areas are not recommended and in the case of LF, albendazole monotherapy may be applied (Table 3); however, the overall antifilarial effectiveness (microfilariae prevalence measured over 2 weeks to 12 months after treatment) of albendazole has been questioned [35], and other approaches are being investigated. For example, the Test and Not Treat (TnT) method, enabled by development of a mobile phone microscope, advocates for identification of patients who should not receive microfilaricidal treatment due to high burdens of circulating L. loa microfilariae and the associated risk of developing SAEs.…”

EBM verdict: should albendazole be used for treating lymphatic filariasis? No

“…In a recent Cochrane review,6 Macfarlane and colleagues examined the effectiveness of albendazole for treatment of lymphatic filariasis. They searched five scientific databases and two clinical trial registries to identify randomised controlled trials (RCT) and cluster RCTs that compared albendazole to placebo, or compared albendazole with a microfilaricidal drug (ie, DEC or ivermectin) versus a microfilaricidal drug alone.…”