Efficacy and safety of albendazole and praziquantel combination therapy for neurocysticercosis: A systematic review and meta-analysis

Abstract

Albendazole and praziquantel, together with corticosteroids, are used in the treatment of active, symptomatic neurocysticercosis (NCC), either as mono- or combination therapy. Although monotherapy with either drug has been well-established, data on combination therapy are scare, including only a handful of studies with low patient numbers. Therefore, the aim of this meta-analysis was to determine the efficacy and safety of albendazole and praziquantel combination in the treatment of patients with active, symptomatic NCC. Randomized controlled trials examining combination therapy versus monotherapy in the treatment of people with active, symptomatic NCC were selected using the PRISMA framework from four databases (PubMed, Scopus, LILACS, Embase) up to May 2, 2023. Studies were included when they reported on cyst resolution in people with active, symptomatic NCC receiving albendazole and praziquantel combination therapy, along with the safety profiles. The quality of the study was assessed using the Risk of Bias tool version 2.0 and pooled data were meta-analyzed using fixed effects. A total of 1,466 papers were retrieved and screened, whereby only five studies were included (n=291 patients). The meta-analysis revealed that the albendazole and praziquantel combination was more effective in cyst resolution as compared to albendazole alone (n=255; odds ratio (OR): 3.29; 95% confidence interval (CI): 1.96–5.22; p<0.00001). No statistical difference was found between the albendazole and praziquantel combination and albendazole alone groups in terms of adverse events (n=255; risk ratio (RR): 1.42; 95%CI: 0.82–2.46; p<0.22). The study highlights that combination therapy of albendazole and praziquantel is more effective than albendazole monotherapy regarding cyst resolution in people with active, symptomatic NCC. Adverse events did not seem to be associated with combination therapy; however, number of patients was small. Therefore large and multicenter randomized clinical trials would need to be performed to draw a final conclusion on the side effect profile.