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

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.

Dual Drug Delivery Using Lactic Acid Conjugated SLN for Effective Management of Neurocysticercosis

“…(5,6). Treatment of NCC must be tailored to deliver anthelminthics like Albendazole (ALB) and corticosteroids like Prednisolone (PRD) leading to synergistic pharmacologic manifestations (7). ALB kills the cysts and parasites in the brain and PRD alleviates inflammation caused by the dead parasites (8,9).…”

In Vitro Analysis of Albendazole Sulfoxide Enantiomers Shows that (+)-( R )-Albendazole Sulfoxide Is the Active Enantiomer against Taenia solium

“…Albendazole is frequently preferred to praziquantel because it is more widely available, has a lower cost, and normally requires shorter courses of treatment (and hence represents lower hospitalization-associated expenses) for higher efficacy (2,(5)(6)(7).…”

Management of Neurocysticercosis

“…The third meta-analysis included four randomized trials and ten observational studies for evaluating the effi cacy of albendazole in children with parenchymal brain enhancing lesions, showing reduction in the relative risk of seizure recurrence in treated patients (Mazumdar et al 2007 ). A fourth meta-analysis compared the effi cacy of albendazole versus that of praziquantel in six trials and found that albendazole is more effective than praziquantel for reducing the number of recurrent seizures, but the effi cacy of both drugs for destroying cystic lesions is rather similar, with some trials favoring albendazole while others favoring praziquantel (Matthaiou et al 2008 ). The fi fth meta-analysis-published as part of the Cochrane library-showed that the use of albendazole reduces the number of cystic lesions and the chance of seizure recurrence; this meta-analysis combined series of patients with viable cysts and with enhancing lesion, so the compound result is diffi cult to interpret (Abba et al 2010 ).…”