Moser W, et al. - This research appraised the efficacies of anthelmintic drugs against soil-transmitted helminths, with regard to cure rates and egg reduction rates. Limitations were reported in the efficacy profile of the 4 recommended drugs. Only albendazole exhibited good efficacy against hookworm infection. Nevertheless, all drugs had low efficacy against T trichiura. The decrease in efficacy of albendazole against T trichiura over the past two decades served as a matter of concern. A necessity arose for strengthening efforts to develop new drug therapies, with emphasis on drugs against T trichiura.

Methods

• The scheme of this research was a systematic review and network meta-analysis.
• Data was cumulated from the 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.
• Randomised controlled trials examining 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 were included for this study.
• The primary outcomes comprised of the cure rates gauged by network meta-analysis with mixed logistic regression models and egg reduction rates with mixed linear models.

Results

• The selected studies included 55 and 46 randomised controlled trials, in the analysis of cure rates and egg reduction rates, respectively.
• All drugs werediscovered to be highly efficacious against A lumbricoides.
• Albendazole displayed 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 reported 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 brought to light marked reductions in the 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).