Department of Medical Parasitology and Infection Biology, Swiss Tropical Institute, Basel, Switzerland.
Clin Infect Dis. 2010 May 1;50(9):1205-13. doi: 10.1086/651682.
Morbidity control of schistosomiasis relies on a single drug, praziquantel. The antimalarial drug mefloquine possesses interesting antischistosomal properties, yet no clinical studies have been performed.
We conducted a randomized, exploratory open-label trial to assess the efficacy and safety of mefloquine (25 mg/kg), artesunate (3 doses of 4 mg/kg), mefloquine-artesunate (3 doses of 100 mg artesunate plus 250 mg mefloquine), and praziquantel (40 mg/kg) against Schistosoma haematobium. The effects on Schistosoma mansoni, malaria parasitemia, soil-transmitted helminths, and intestinal protozoa were also determined.
A total of 83 S. haematobium-infected schoolchildren were included in the study. Cure rates of mefloquine, artesunate, mefloquine-artesunate, and praziquantel against S. haematobium at day 26 after treatment were 21%, 25%, 61%, and 88%, respectively. Both mefloquine-artesunate and praziquantel resulted in egg reduction rates >95%. Significantly lower egg reduction rates were seen in the artesunate (85%) and mefloquine groups (74%). In children coinfected with S. mansoni, praziquantel and mefloquine-artesunate, but not mefloquine and artesunate alone, resulted in high cure rates and egg reduction rates. Mefloquine, artesunate, and mefloquine-artesunate completely cured infections due to Plasmodium falciparum. No effects were found against soil-transmitted helminths and intestinal protozoa. Abdominal pain was the most frequent adverse event, with a higher incidence among children treated with mefloquine (89%), mefloquine-artesunate (83%), and artesunate (60%) than among children treated with praziquantel (46%).
The high efficacy of mefloquine-artesunate against S. haematobium warrants further investigation. Individuals coinfected with Plasmodium and Schistosoma who were treated with a mefloquine-artesunate combination against malaria might have a dual benefit: clearance of malaria parasitemia and reduction of schistosomiasis-related morbidity.
Current Controlled Trials identifier: ISRCTN06498763.
血吸虫病的发病率控制依赖于一种药物，即吡喹酮。抗疟药甲氟喹具有有趣的抗血吸虫病特性，但尚未进行临床研究。
我们进行了一项随机、探索性、开放标签试验，以评估甲氟喹（25mg/kg）、青蒿琥酯（3 剂 4mg/kg）、青蒿琥酯-甲氟喹（3 剂 100mg 青蒿琥酯加 250mg 甲氟喹）和吡喹酮（40mg/kg）对埃及血吸虫的疗效和安全性。还确定了它们对曼氏血吸虫、疟疾寄生虫血症、土壤传播性蠕虫和肠道原生动物的影响。
共有 83 名埃及血吸虫感染的学龄儿童纳入研究。治疗后 26 天，甲氟喹、青蒿琥酯、青蒿琥酯-甲氟喹和吡喹酮对埃及血吸虫的治愈率分别为 21%、25%、61%和 88%。青蒿琥酯-甲氟喹和吡喹酮均导致虫卵减少率>95%。青蒿琥酯（85%）和甲氟喹组（74%）的虫卵减少率显著较低。在同时感染曼氏血吸虫的儿童中，只有吡喹酮和青蒿琥酯-甲氟喹，而不是甲氟喹和青蒿琥酯，导致高治愈率和虫卵减少率。甲氟喹、青蒿琥酯和青蒿琥酯-甲氟喹完全治愈了恶性疟原虫感染。对土壤传播性蠕虫和肠道原生动物没有影响。腹痛是最常见的不良事件，接受甲氟喹（89%）、青蒿琥酯-甲氟喹（83%）和青蒿琥酯（60%）治疗的儿童比接受吡喹酮（46%）治疗的儿童发生率更高。
青蒿琥酯-甲氟喹对埃及血吸虫的高疗效值得进一步研究。同时感染疟原虫和血吸虫的个体，如果用青蒿琥酯-甲氟喹治疗疟疾，可能会双重获益：清除疟疾寄生虫血症和减少血吸虫病相关发病率。
当前对照试验标识符：ISRCTN06498763。
