Zhao Bing-Cheng, Jiang Hong-Ye, Ma Wei-Ying, Jin Da-Di, Li Hao-Miao, Lu Hai, Nakajima Hideaki, Huang Tong-Yi, Sun Kai-Yu, Chen Shu-Ling, Chen Ke-Bing
Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
PLoS Negl Trop Dis. 2016 Feb 5;10(2):e0004418. doi: 10.1371/journal.pntd.0004418. eCollection 2016 Feb.
Solitary 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.
PubMed, 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.
Dual 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.
孤立性囊尾蚴肉芽肿（SCG）是印度次大陆及旅行者中最常见的神经囊尾蚴病形式。对于SCG存在几种不同的治疗选择。我们进行了一项随机临床试验（RCT）的贝叶斯网络荟萃分析，以确定预防癫痫复发和促进SCG患者病变消退的最佳治疗选择。
检索了PubMed、EMBASE和Cochrane图书馆数据库（截至2015年6月1日），以查找比较任何驱虫药或皮质类固醇单独或联合使用与安慰剂或直接对比，并报告SCG患者癫痫复发和病变消退情况的RCT。共有14项RCT（1277例患者）纳入了针对四种不同治疗选择的定量分析。使用计算比值比（OR）及95%可信区间（CrI）和最佳概率（Pbest）的贝叶斯网络模型同时比较所有干预措施。与保守治疗相比，阿苯达唑和皮质类固醇联合治疗是唯一能显著降低癫痫复发风险的方案（OR 0.32，95% CrI 0.10 - 0.93，Pbest 73.3%）。阿苯达唑和皮质类固醇单独或联合使用在加速肉芽肿消退方面均有效，但基于概率分析，联合治疗仍是最佳选择（OR 3.05，95% CrI 1.24 - 7.95，Pbest 53.9%）。在不同随访时长的RCT和敏感性分析中，联合治疗的优越性变化不大。本研究局限性包括大多数研究存在高偏倚风险和随访时间短。
阿苯达唑和皮质类固醇联合治疗是最有效的方案，可在约一年的随访期内预防癫痫复发并促进病变消退。在有更多高质量证据之前，应推荐用于SCG的治疗。
