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用吡喹酮控制血吸虫病:在没有可行替代方案的情况下还能持续多久?

Controlling schistosomiasis with praziquantel: How much longer without a viable alternative?

作者信息

Bergquist Robert, Utzinger Jürg, Keiser Jennifer

机构信息

Ingerod, Brastad, Sweden.

Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.

出版信息

Infect Dis Poverty. 2017 Mar 28;6(1):74. doi: 10.1186/s40249-017-0286-2.

Abstract

The current approach of morbidity control of schistosomiasis, a helminth disease of poverty with considerable public health and socioeconomic impact, is based on preventive chemotherapy with praziquantel. There is a pressing need for new drugs against this disease whose control entirely depends on this single drug that has been widely used over the past 40 years. We argue that a broader anthelminthic approach supplementing praziquantel with new antischistosomals targeting different parasite development stages would not only increase efficacy but also reduce the risk for drug resistance. Repositioning drugs already approved for other diseases provides a shortcut to clinical trials, as it is expected that such drugs rapidly pass the regulatory authorities. The antischistosomal properties of antimalarial drugs (e.g., semisynthetic artemisinins, synthetic trioxolanes, trioxaquines and mefloquine) and of drugs being developed or registered for other purposes (e.g., moxidectin and miltefosin), administered alone or in combination with praziquantel, have been tested in the laboratory and clinical trials. Another avenue to follow is the continued search for new antischistosomal properties in plants. Here, we summarise recent progress made in schistosomiasis chemotherapy, placing particular emphasis on repositioning of existing drugs against schistosomiasis.

摘要

血吸虫病是一种对公共卫生和社会经济有重大影响的贫困相关蠕虫病,当前对其发病率的控制方法是基于使用吡喹酮进行预防性化疗。对于这种疾病,迫切需要新的药物,因为其控制完全依赖于这种在过去40年中广泛使用的单一药物。我们认为,采用更广泛的驱虫方法,用针对不同寄生虫发育阶段的新型抗血吸虫药物补充吡喹酮,不仅会提高疗效,还会降低耐药风险。重新定位已被批准用于其他疾病的药物为临床试验提供了一条捷径,因为预计此类药物能迅速通过监管部门审批。抗疟药物(如半合成青蒿素、合成三氧烷、三氧喹和甲氟喹)以及正在开发或已注册用于其他目的的药物(如莫昔克丁和米替福新)单独或与吡喹酮联合使用时的抗血吸虫特性,已在实验室和临床试验中进行了测试。另一条途径是继续在植物中寻找新的抗血吸虫特性。在此,我们总结了血吸虫病化疗方面的最新进展,特别强调了现有药物重新定位用于治疗血吸虫病的情况。

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