Albendazole and Corticosteroids for the Treatment of Solitary Cysticercus Granuloma: A Network Meta-analysis

Abstract

BackgroundSolitary cysticercus granuloma (SCG) is the commonest form of neurocysticercosis in the Indian subcontinent and in travelers. Several different treatment options exist for SCG. We conducted a Bayesian network meta-analysis of randomized clinical trials (RCTs) to identify the best treatment option to prevent seizure recurrence and promote lesion resolution for patients with SCG.Methods and Principal FindingsPubMed, EMBASE and the Cochrane Library databases (up to June 1, 2015) were searched for RCTs that compared any anthelmintics or corticosteroids, alone or in combination, with placebo or head to head and reported on seizure recurrence and lesion resolution in patients with SCG. A total of 14 RCTs (1277 patients) were included in the quantitative analysis focusing on four different treatment options. A Bayesian network model computing odds ratios (OR) with 95% credible intervals (CrI) and probability of being best (Pbest) was used to compare all interventions simultaneously. Albendazole and corticosteroids combination therapy was the only regimen that significantly decreased the risk of seizure recurrence compared with conservative treatment (OR 0.32, 95% CrI 0.10–0.93, Pbest 73.3%). Albendazole and corticosteroids alone or in combination were all efficacious in hastening granuloma resolution, but the combined therapy remained the best option based on probability analysis (OR 3.05, 95% CrI 1.24–7.95, Pbest 53.9%). The superiority of the combination therapy changed little in RCTs with different follow-up durations and in sensitivity analyses. The limitations of this study include high risk of bias and short follow-up duration in most studies.ConclusionsDual therapy of albendazole and corticosteroids was the most efficacious regimen that could prevent seizure recurrence and promote lesion resolution in a follow-up period of around one year. It should be recommended for the management of SCG until more high-quality evidence is available.

Predictors of Lesion Calcification in Patients with Solitary Cysticercus Granuloma and New-Onset Seizures

“…None of regimens showed a better effect on reducing the risk of residual calcification. 23 The use of computed tomography in our study might be contested. At one end, where it is an excellent modality to demonstrate calcification unequivocally, it may not be very sensitive in demonstrating perilesional edema.…”

Screening, diagnosis and management of human cysticercosis and Taenia solium taeniasis: technical recommendations by the COHEMI project study group

“…A meta‐analysis showed clinical (increased rate of seizure‐free period) and radiological benefit in treating solitary cysticercus granuloma with antiparasitic drugs (ABZ in majority of the cases) . Another meta‐analysis found that the association of ABZ and corticosteroids is the most efficacious regimen and that it could prevent seizure recurrence and promote lesion resolution in a follow‐up period of around 1 year .…”

Prevalence, Response to Cysticidal Therapy, and Risk Factors for Persistent Seizure in Indian Children with Neurocysticercosis

“…Calcification in NCC is a common long-term outcome with observed rates of calcification in pediatric NCC varying widely from 6.2% to as high as 60% [24]. Interestingly, cysticidal therapy was found to have no significant effect in the calcification of solitary parenchymal NCC [25, 26]. A retrospective analysis of solitary parenchymal NCC from India [24] reported that the risk of breakthrough seizures was significantly higher in calcified lesions on follow-up scan when compared to normal scans or persisting lesions.…”