Institute of Immunology and Infection Research, Centre for Immunity, Infection & Evolution, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, United Kingdom.
Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
PLoS Negl Trop Dis. 2021 Mar 17;15(3):e0009189. doi: 10.1371/journal.pntd.0009189. eCollection 2021 Mar.
The antihelminthic drug praziquantel has been used as the drug of choice for treating schistosome infection for more than 40 years. Although some epidemiological studies have reported low praziquantel efficacy in cure rate (CR) and/or egg reduction rate (ERR), there is no consistent robust evidence of the development of schistosome resistance to praziquantel (PZQ). There is need to determine factors that lead to variable treatment CR and/or ERR. Therefore, we conducted a systematic review and meta-analysis to review CR and ERR as well as identify their predictors.
METHODOLOGY/PRINCIPAL FINDINGS: In this systematic review and meta-analysis, a literature review was conducted using Biosis Citation Index, Data Citation Index, MEDLINE, and Web of Science Core Collection all of which were provided through Web of Science. Alongside these, EMBASE, and CAB abstracts were searched to identify relevant articles. Random effect meta-regression models were used to identify the factors that influence CR and/or ERR by considering differences in host characteristics and drug dose. In total, 12,127 potential articles were screened and 146 eligible articles (published from 1979 to 2020) were identified and included for the meta-analysis. We found that there has been no significant reduction in CR or ERR over the study period. The results showed more variability in CR, compared with ERR which was more consistent and remained high. The results showed a positive effect of "PZQ treatment dose" with the current recommended dose of 40 mg/kg body weight achieving 57% to 88% CR depending on schistosome species, age of participants, and number of parasitological samples used for diagnosis, and ERR of 95%.
CONCLUSIONS/SIGNIFICANCE: Based on a review of over 40 years of research there is no evidence to support concerns about schistosomes developing resistance to PZQ. These results indicate that PZQ remains effective in treating schistosomiasis.
抗蠕虫药物吡喹酮已被用作治疗血吸虫感染 40 多年的首选药物。尽管一些流行病学研究报告称，治愈率（CR）和/或卵减少率（ERR）较低，但没有一致的有力证据表明血吸虫对吡喹酮（PZQ）产生耐药性。需要确定导致治疗 CR 和/或 ERR 变化的因素。因此，我们进行了系统评价和荟萃分析，以回顾 CR 和 ERR，并确定其预测因素。
方法/主要发现：在这项系统评价和荟萃分析中，通过 Web of Science 提供的 Biosis Citation Index、Data Citation Index、MEDLINE 和 Web of Science Core Collection 进行了文献综述。此外，还搜索了 EMBASE 和 CAB 摘要，以确定相关文章。使用随机效应荟萃回归模型，通过考虑宿主特征和药物剂量的差异，确定影响 CR 和/或 ERR 的因素。总共筛选了 12127 篇潜在文章，确定了 146 篇符合条件的文章（发表于 1979 年至 2020 年）进行荟萃分析。我们发现，在研究期间，CR 或 ERR 并没有显著降低。结果表明，CR 的变异性更大，而 ERR 更一致且保持较高水平。结果表明，“PZQ 治疗剂量”具有积极影响，目前推荐的 40mg/kg 体重剂量可根据血吸虫种类、参与者年龄以及用于诊断的寄生虫样本数量，实现 57%至 88%的 CR 和 95%的 ERR。
结论/意义：基于对 40 多年研究的回顾，没有证据支持血吸虫对 PZQ 产生耐药性的担忧。这些结果表明，PZQ 仍然是治疗血吸虫病的有效药物。
