Objective:

This systematic review and meta-analysis aims to compare the combined antiparasitic therapy of albendazole and praziquantel with albendazole monotherapy, to assess whether it provides superior therapeutic benefits in the management of patients with neurocysticercosis, while preserving an adequate safety profile.

Background:

Neurocysticercosis, the most common parasitic infection of the central nervous system, is a neglected tropical disease, and remains a significant public health issue in endemic regions. There is good quality evidence that suggests the antihelmintic monotherapy with albendazole shows superior clinical outcomes when compared with placebo or praziquantel. However, to date, there is no sufficient evidence regarding the efficacy and safety of the albendazole-praziquantel combination therapy.

Design/Methods:

We searched Medline, Embase and Cochrane for randomized controlled trials (RCTs) comparing the albendazole-praziquantel combined therapy with albendazole monotherapy in the treatment of neurocysticercosis. Statistical analysis was performed using R, with odds ratios (OR) reported with 95% confidence intervals (CI). A random-effects model was applied to all endpoints.

Results:

5 RCTs were included, with a total of 320 patients, of whom 49% received combined therapy. There was a significant increase in complete cyst resolution in patients treated with the albendazole-praziquantel combined therapy when compared to albendazole monotherapy (OR= 3.06; 95% CI [1.81, 5.19]; p= 0.0001; I²= 5%). There was no significant difference in seizure recurrence between treatment strategies (OR= 1.28, 95% CI [0.56, 2.91], p= 0.55, I²= 0%). Similarly, the incidence of adverse effects did not differ significantly between both groups (OR= 1.40, 95% CI [0.72, 2.72], p= 0.30, I²= 0%).

Conclusions: