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Cited by 350Parasites and Host InteractionsParasitic Diseases Research and TreatmentHelminth infection and control

Efficacy of recommended drugs against soil transmitted helminths: systematic review and network meta-analysis

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Moser, Wendelin, Schindler, Christian, Keiser, Jennifer·2017·BMJ
DOI 10.1136/bmj.j4307PMC PMC5611648
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Abstract

Objective To evaluate efficacies of anthelmintic drugs against soil transmitted helminths in terms of cure rates and egg reduction rates. Design Systematic review and network meta-analysis. Data Sources PubMed, ISI Web of Science, Embase, ScienceDirect, the Cochrane Central Register of Clinical Trials, and the World Health Organization library database from 1960 until 31 December 2016. Study selection Randomised controlled trials evaluating the efficacy of a single dose regimen of albendazole, mebendazole, levamisole, and pyrantel pamoate against Ascaris lumbricoides, hookworm (Necator americanus and Ancylostoma duodenale) and Trichuris trichiura. The primary outcomes included cure rates analysed by network meta-analysis with mixed logistic regression models and egg reduction rates with mixed linear models. Results 55 and 46 randomised controlled trials were included in the analysis of cure rates and egg reduction rates, respectively. All drugs were highly efficacious against A lumbricoides. Albendazole showed the highest efficacy against hookworm infections with a cure rate of 79.5% (95% confidence interval 71.5% to 85.6%) and an egg reduction rate of 89.6% (81.9% to 97.3%). All drugs had low efficacy against T trichiura, with mebendazole showing the highest cure rate of 42.1% (25.9% to 60.2%) and egg reduction rate of 66.0% (54.6% to 77.3%). Estimates for the years 1995 and 2015 showed significant reductions in efficacy of albendazole against T trichiura: by 2015 the egg reduction rates fell from 72.6% (53.7% to 91.5%) to 43.4% (23.5% to 63.3%; P=0.049) and the cure rates fell from 38.6% (26.2% to 52.7%) to 16.4 (7.7% to 31.3%; P=0.027). Conclusions All four currently recommended drugs show limitations in their efficacy profile. While only albendazole showed good efficacy against hookworm infection, all drugs had low efficacy against T trichiura. The decrease in efficacy of albendazole against T trichiura over the past two decades is of concern. The findings indicate the need for strengthening efforts to develop new drug treatments, with a particular focus on drugs against T trichiura.

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  • Ascaris lumbricoides is the most highly susceptible parasite species to albendazole and mebendazole among intestinal nematodes infecting humans.

    “Among various species of intestinal nematodes infecting humans, Ascaris lumbricoides is the most highly susceptible parasite species to albendazole and mebendazole [1,8–10,42–44] (Table 1).”

    From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [43]

    The Discussion (Summary of key findings) says albendazole and mebendazole are highly effective against A. lumbricoides, while reporting lower efficacy against hookworm or T. trichiura. The paper compares soil-transmitted helminths, however, not all intestinal nematodes infecting humans, so it does not establish the broader superlative. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • The therapeutic efficacy of mebendazole against A. lumbricoides seems unchanged until recently (2017), reported 96.2% CR and 98.0% ERR.

    “The therapeutic efficacy of mebendazole against A. lumbricoides seems unchanged until recently (2017); it was reported to be 96.2% in CR and 98.0% in ERR [43].”

    From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [43]

    Table 1 and the Results section on A. lumbricoides report a 96.2% cure rate and 98.0% egg reduction rate for mebendazole. The copy does not establish that its efficacy remained unchanged through 2017; the Methods describe trend estimates for 1995 and 2015, not a 2017 measurement. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The therapeutic efficacy of albendazole against A. lumbricoides seems unchanged until recently (2017), reported 95.7-96.5% CR and 98.5-99.7% ERR.

    “The therapeutic efficacy of albendazole against A. lumbricoides seems unchanged until recently (2017); it was reported to be 95.7–96.5% in CR and 98.5–99.7% in ERR [42,43].”

    From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [43]

    The Results section, “Drug efficacy against A lumbricoides” (page not provided), reports albendazole estimates of 95.7% for cure rate and 98.5% for egg reduction rate. It does not report the claimed upper endpoints of 96.5% and 99.7%, and the passages found do not establish that efficacy against A. lumbricoides remained unchanged through 2017. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Moser et al. considered the temporal decrease of albendazole efficacy against T. trichiura to be in part due to an emergence of drug resistance.

    “Moser et al. [42,43] put an emphasis on a temporal decrease of ERR which was 72.6% in 1995 and 43.4% in 2015 and considered this temporal decrease of albendazole efficacy against T. trichiura to be in part due to an emergence of drug resistance.”

    From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [43]

    The Results section reports that albendazole egg reduction rates against T. trichiura fell from 72.6% in 1995 to 43.4% in 2015. In Discussion > Clinical implications, the authors say the decline might be attributable to drug resistance, but they also say resistance in humans has not yet been shown and other factors might have contributed. The claim overstates their tentative explanation as a causal attribution. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Mebendazole 500 mg single dose for T. trichiura showed lower efficacies recently: 27.9% CR and 66.0% ERR in 2012, 42.1% CR and 66.0% ERR in 2017, and 44.4% CR and 80.7% ERR in 2017.

    “Recently, however, the 500 mg single dose regimen showed lower efficacies, 27.9% CR and 66.0% ERR in 2012 [44] (Table 1), 42.1% CR and 66.0% ERR in 2017 [43], and 44.4% CR and 80.7% ERR in 2017 [42].”

    From Albendazole and Mebendazole as Anti-Parasitic and Anti-Cancer Agents: an Update (2021) · cites this paper as [43]

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Cited by

Sorted by citations

Authors
Moser, W., Schindler, C., & Keiser, J.
Affiliations
Swiss Tropical and Public Health Institute (CH)
Corresponding author
Keiser, Jennifer
ORCID
Venue
BMJ
Publisher
BMJ
Published
2017-09-25
Volume
358
Pages
j4307
ISSN
  • 1756-1833 (ISSN-L)
  • 0959-8138
DOI
10.1136/bmj.j4307
PMC
PMC5611648
OpenAlex
W2759758131
Cited by
350
References
8
Citations by year
2026: 11 · 2025: 29 · 2024: 51 · 2023: 49 · 2022: 55 · 2021: 43 · 2020: 42 · 2019: 32 · 2018: 31 · 2017: 2 · 2012: 1
FWCI
4.07
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • edoc (University of Basel) (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Science Foundation
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (320030_14930/1, 320030_14930, No 320030_14930, 320030)
Topics
  • Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
  • Health Sciences › Medicine › Infectious Diseases › Parasitic Diseases Research and Treatment
  • Health Sciences › Veterinary › Small Animals › Helminth infection and control
Keywords
soil-transmitted helminths, anthelmintic efficacy, albendazole, mebendazole, levamisole, pyrantel pamoate, Ascaris lumbricoides, hookworm, Trichuris trichiura, cure rate, egg reduction rate, anthelmintic resistance, single-dose therapy, deworming programs
MeSH terms
Network Meta-Analysis, Animals, Anthelmintics, Female, Helminthiasis, Helminths, Humans, Male, Soil, Randomized Controlled Trials as Topic, Treatment Outcome

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