Medical treatment of cystic echinococcosis: systematic review and meta-analysis

Abstract

Background: Cystic echinococcosis (CE) is a well-known neglected parasitic disease. However, evidence supporting the four current treatment modalities is inadequate, and treatment options remain controversial. The aim of this work is to analyse the available data to answer clinical questions regarding medical treatment of CE.

Methods: A thorough electronic search of the relevant literature without language restrictions was carried out using PubMed (Medline), Cochrane Central Register of Controlled Trials, BioMed, Database of Abstracts of Reviews of Effects, and Cochrane Plus databases up to February 1, 2017. All descriptive studies reporting an assessment of CE treatment and published in a peer-reviewed journal with available full-text were considered for a qualitative analysis. Randomized controlled trials were included in a quantitative meta-analysis. We used the standard methodological procedures established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results: We included 33 studies related to the pharmacological treatment of CE in humans. Of these, 22 studies with levels of evidence 2 to 4 were qualitatively analysed, and 11 randomized controlled trials were quantitatively analysed by meta-analysis.

Conclusions: Treatment outcomes are better when surgery or PAIR (Puncture, Aspiration, Injection of protoscolicidal agent and Reaspiration) is combined with benzimidazole drugs given pre- and/or post-operation. Albendazole chemotherapy was found to be the primary pharmacological treatment to consider in the medical management of CE. Nevertheless, combined treatment with albendazole plus praziquantel resulted in higher scolicidal and anti-cyst activity and was more likely to result in cure or improvement relative to albendazole alone.

Keywords: Albendazole; Cystic echinococcosis; Echinococcus granulosus; Mebendazole; Praziquantel.

Fig. 1

Flowchart of information through the different phases of the systematic review following the PRISMA recommendations

Fig. 2

Forest plot of comparison: intervention (albendazole plus surgery) vs control (surgery alone), outcome: Viability of scolex (Event = non-viable or dead)

Fig. 3

Forest plot of comparison: intervention (albendazole) vs control (mebendazole), outcome: Response to treatment (Event = cure/success plus improvement)

Fig. 4

Forest plot of comparison: intervention (albendazole) vs control (placebo), outcome: Response to treatment (Event = cure/success plus improvement)