Effectiveness of the Antiparasitic Combination of Albendazole and Praziquantel As Compared With Albendazole Monotherapy in the Treatment of Neurocysticercosis in Children: A Systematic Review and Meta-Analysis.

ABSTRACT

Neurocysticercosis, caused by the tapeworm Taenia solium, is a neglected tropical illness that affects millions of people worldwide. The disease leads to seizures and epilepsy as the larvae invade the nervous system. Treatment with albendazole and praziquantel is common, but the comparative effectiveness of combination therapy versus monotherapy is unclear. This study evaluated the effectiveness of albendazole and praziquantel combination therapy versus albendazole monotherapy for lesion resolution in pediatric neurocysticercosis. The study aimed to assess the effectiveness of the antiparasitic combination of albendazole and praziquantel as compared with albendazole monotherapy in the treatment of neurocysticercosis in children. This study is based on a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Randomized controlled trials on pediatric patients receiving the mentioned therapies were included. The risk-of-bias tool for randomized trials assessed the study quality once data extraction and analysis were completed. This study included randomized research in neurocysticercosis pediatric patients diagnosed with neuroimaging outcomes, using albendazole and praziquantel combination therapy or albendazole monotherapy. We searched articles between September 30 and December 1, 2023. All terms followed the Medical Subject Headings (MeSH) browser, and 13 articles were found. The data was quantitatively analyzed using RevMan 5.4.1 (The Nordic Cochrane Center, The Cochrane Collaboration, Copenhagen, Denmark). We applied the relative risk (RR) for the intervention and control groups before and after treatment, obtained from prior studies on lesion result resolution. The statistical method was Mantel-Haenszel. The model analysis we used was a fixed effect model (FEM) for heterogeneity (I2) < 50% and a random effect model (REM) for I2 ≥ 50%. The impact was measured using the risk difference (RD) by study and the overall 95% confidence interval (CI). The meta-analysis indicated that combination therapy was more effective in achieving complete lesion resolution after both three months (pooled RD = 0.18, 95% CI = 0.03-0.33, p= 0.02, I2 =0%) and six months (pooled RD = 0.24, 95% CI = 0.09-0.40, p = 0.002, I2 =0%) of therapy. However, calcification outcomes were also more significant in the combination therapy group. The study demonstrates that the albendazole and praziquantel combination therapy is superior in lesion resolution in pediatric neurocysticercosis. Clinical caution is advised to prevent calcification during treatment.