Research School of Population Health, Australian National University, Canberra, Australian Capital Territory.
Department of Population Medicine, College of Medicine, Qatar University, Doha.
Clin Infect Dis. 2019 Jan 1;68(1):96-105. doi: 10.1093/cid/ciy423.
Periodic mass distribution of benzimidazole anthelminthic drugs is the key strategy to control soil-transmitted helminths (STHs) globally. However, benzimidazoles have low efficacy against Trichuris trichiura, and there are concerns about benzimidazole resistance potentially emerging in humans. Therefore, identifying alternative drug regimens is a pressing priority. We present a systematic review and network meta-analysis comparing the efficacy of 21 different anthelminthic drug regimens, including standard, novel, and combination treatments.
We searched PubMed, Medline, Embase, Web of Science, and Cochrane databases and identified studies comparing anthelminthic treatments to each other or placebo. The outcomes calculated were relative risk (RR) of cure and difference in egg reduction rates (dERR). We used an automated generalized pairwise modeling framework to generate mixed treatment effects against a common comparator, the current standard treatment (single-dose albendazole).
Our search identified 4876 studies, of which 114 were included in the meta-analysis. Results identified several drug combinations with higher efficacy than single-dose albendazole for T. trichiura, including albendazole-ivermectin (RR of cure, 3.22 [95% confidence interval {CI}, 1.84-5.63]; dERR, 0.97 [95% CI, .21-1.74]), albendazole-oxantel pamoate (RR, 5.07 [95% CI, 1.65-15.59]; dERR, 0.51 [95% CI, .50-.52]), mebendazole-ivermectin (RR, 3.37 [95% CI, 2.20-5.16]), and tribendimidine-oxantel pamoate (RR, 4.06 [95% CI, 1.30-12.64]).
There are several promising drug combinations that may enhance the impact of STH control programs on T. trichiura, without compromising efficacy against Ascaris lumbricoides and hookworm. We suggest further, large-scale trials of these drug combinations and consideration of their use in STH control programs where T. trichiura is present.
CRD42016050739.
周期性分发苯并咪唑类驱虫药物是全球控制土壤传播性蠕虫（STHs）的关键策略。然而，苯并咪唑类药物对鞭虫的疗效较低，并且人们担心人类可能会出现对苯并咪唑的耐药性。因此，确定替代药物方案是当务之急。我们提出了一项系统评价和网络荟萃分析，比较了 21 种不同驱虫药物方案的疗效，包括标准、新型和联合治疗。
我们检索了 PubMed、Medline、Embase、Web of Science 和 Cochrane 数据库，并确定了相互比较或与安慰剂比较的驱虫治疗研究。计算的结果是治愈率的相对风险（RR）和卵减少率的差异（dERR）。我们使用自动广义成对建模框架，针对共同的对照物（单剂量阿苯达唑）生成混合治疗效果。
我们的搜索确定了 4876 项研究，其中 114 项被纳入荟萃分析。结果确定了几种药物组合，它们比单剂量阿苯达唑对鞭虫更有效，包括阿苯达唑-伊维菌素（治愈率的 RR，3.22 [95%置信区间 {CI}，1.84-5.63]；dERR，0.97 [95% CI，.21-1.74]）、阿苯达唑-奥沙苯隆（RR，5.07 [95% CI，1.65-15.59]；dERR，0.51 [95% CI，.50-.52]）、甲苯咪唑-伊维菌素（RR，3.37 [95% CI，2.20-5.16]）和三苯并咪唑-奥沙苯隆（RR，4.06 [95% CI，1.30-12.64]）。
有几种有前途的药物组合可能会增强 STH 控制计划对鞭虫的影响，同时不影响对蛔虫和钩虫的疗效。我们建议对这些药物组合进行进一步的大规模试验，并考虑在存在鞭虫的 STH 控制计划中使用这些药物组合。
CRD42016050739。
