Recent meta-analysis shows that efficacy of benzimidazole drugs is decreasing over time.

Recently, our partners from the Swiss Tropical and Public Health institute in Basel published a systematic review and meta-analysis on the efficacy of recommended drugs against soil-transmitted helminths (Ascaris lumbricoides, Trichuris trichiura and Hookworms). This comprehensive review summarizes the data that was presented in available publications reporting randomized control trials with a single dose regimen of albendazole, mebendazole, levamisole or pyrantel pamoate against STH.

The results of the meta-analysis show that there was still very high efficacy of all tested drugs against A. lumbricoides, with albendazole having the highest cure rate (95.7%) and egg reduction rate (98.5%). Also for hookworm infections, albendazole was the best-performing drug, with a cure rate of 79.5% and an 89.6% egg reduction rate. For Trichuris infections, both albendazole and mebendazole showed moderate cure rates (30.7% and 42.1% respectively) that were significantly higher than in individuals that were treated with a placebo. However, looking at egg reduction rates, mebendazole (66.0%) was superior to albendazole (49.9%).

Alarmingly, they also noted a distinct and significant decrease in cure rates over time for albendazole against T. trichiura and a notable reduction against hookworm. Moreover, egg reduction rates of albendazole against hookworm and both albendazole and mebendazole against T. trichiura significantly also decreased when publications were stratified by year. This observed effect could be attributable to the rise of drug resistance in these parasite populations.

The findings presented in this manuscript further underpin the urgent need to improve efforts to develop novel drugs for soil-transmitted helminths and to keep monitoring the efficacy of the few drugs that are currently available.


(Fig 3 extracted from publication by Moser et al., 2017)

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