Drugs for treating urinary schistosomiasis
Editorial Group: Cochrane Infectious Diseases Group
Published Online: 16 JUL 2008
Assessed as up-to-date: 15 OCT 2007
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Danso-Appiah A, Utzinger J, Liu J, Olliaro P. Drugs for treating urinary schistosomiasis. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD000053. DOI: 10.1002/14651858.CD000053.pub2.
- Publication Status: New search for studies and content updated (conclusions changed)
- Published Online: 16 JUL 2008
Urinary schistosomiasis causes long-term ill-health. This review examines the various treatment options and newer drugs.
To evaluate antischistosomal drugs, used alone or in combination, for treating urinary schistosomiasis.
In August 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 3), MEDLINE, EMBASE, LILACS, mRCT, and reference lists of articles. We also contacted experts in schistosomiasis research.
Randomized and quasi-randomized controlled trials of praziquantel, metrifonate, artemisinin derivatives, or albendazole, alone or in combination, versus placebo, different doses, or other antischistosomal drugs for treating urinary schistosomiasis.
Data collection and analysis
One author extracted data, and assessed eligibility and methodological quality, which were cross-checked by a second person. Dichotomous outcomes were combined using risk ratio (RR), and continuous data were combined using weighted mean difference (WMD); both presented with 95% confidence intervals (CI).
Twenty-four trials (6315 participants) met the inclusion criteria. Compared with placebo, participants receiving metrifonate had fewer parasitological failures at follow up at one to three months (1 trial) and three to 12 months (3 trials). Egg reduction rate was over 90%, and no adverse events were reported (1 trial). One metrifonate dose was inferior to three doses given fortnightly (both used 10 mg/kg). Praziquantel (standard single 40 mg/kg oral dose) was more effective than placebo at reducing parasitological failure at one to three months' follow up and three to 12 months. Egg reduction rates were improved with praziquantel (over 95% versus 5.3% to 64% with placebo). Mild to moderate adverse events were recorded in two trials. A comparison of metrifonate (10 mg/kg x 3, once every 4 months for one year) with praziquantel (standard dose) showed little difference in parasitological failure. For praziquantel, there was no significant difference in effect between 20 mg/kg x 2, 30 mg/kg x 1, and 20 mg/kg x 1, and the standard dose for all outcomes. One small trial of artesunate showed no obvious benefit compared with placebo, and the artesunate-praziquantel combination was similar to praziquantel alone.
Praziquantel and metrifonate are effective treatments for urinary schistosomiasis and have few adverse events. Metrifonate requires multiple administrations and is therefore operationally less convenient in community-based control programmes. Evidence on the artemisinin derivatives is currently inconclusive, and further research is warranted on combination therapies. We suggest metrifonate be reconsidered for the WHO Model List of Essential Medicines.
Plain language summary
Drug treatments for worms in the bladder (urinary schistosomiasis)
Worms residing in blood vessels of the bladder cause a chronic disease known as urinary schistosomiasis. The disease is commonly found in African and Eastern Mediterranean countries, especially in poor, rural areas. Humans become infected when they come into contact with contaminated water. The infection occurs when small larvae shed from snails in infected waters get into the individual through the skin and develop into adult worms that travel to the blood vessels of the bladder. There they can produce a large number of eggs, and the worm can live for three to five years. It is mainly the eggs that cause the disease. The main symptoms are blood in the urine and pain when passing urine. The eggs also cause tissue damage, and the severity of disease depends upon the intensity of the infection. Sometimes the infection can lead to bladder cancer or other kidney problems, including kidney failure. There are a number of measures that have been introduced to try to reduce the risk of infection. These include health education, improving clean water supplies and sanitation, environmental control measures to reduce numbers of intermediate host snails, and drug treatments. The review looked at the efficacy of drugs to reduce the ill-health associated with these infections. The review identified 24 trials involving 6315 people. Praziquantel and metrifonate were both found to be efficacious with few adverse events, although adverse outcomes were poorly assessed. Evidence on the artemisinins was inconclusive, and further research is warranted on combination therapies.
在2007年8月，我們搜尋了Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2007, Issue 3), MEDLINE, EMBASE, LILACS, mRCT,以及參考文獻所列出的文章。我們還聯絡血吸蟲病專家。
隨機和半隨機對照試驗研究泌尿道血吸蟲病之治療以單獨或合併使用praziquantel, metrifonate, artemisinin衍生物,或albendazole，來與安慰劑、不同劑量的藥物或其他血吸蟲藥物比較。
一個作者提取數據，並評估適用性和其方法學的品質，再由第二個作者作交叉審查。使用二分類結果合併相對風險率(RR)評估，連續變數之數據則使用weighted mean difference(WMD)的方式，並且都呈現95％信賴區間(confidence intervals, CI)。
24個試驗(6315人參加研究)符合納入標準。與安慰劑組相比，研究組接受metrifonate在1～3個月(1個臨床試驗)和3個至12個月(3個臨床試驗)追蹤時較少治療失敗。蟲卵減幅超過90％，無不良事件報告(1個臨床試驗)。一劑metrifonate的效果低於雙週給三劑(均用10毫克/公斤)。在1～3個月和3至12個月追蹤時，Praziquantel(標準單一劑量口服40毫克/公斤)的效果比安慰劑能更有效減少失敗率。使用Praziquantel蟲卵減幅也大幅改善(減幅超過95％，安慰劑減幅為5.3％到64％)。輕、中度不良事件在兩個臨床試驗中曾發生過。比較metrifonate(10 mg/kg兩週三劑，每4個月一療程為期一年)與Praziquantel(標準劑量)的效果，差別不大。使用praziquantel不同劑量，在兩劑20 mg/kg,一劑30 mg/kg，一劑20 mg/kg 以及標準劑量的所有結果並無顯著差異。一個小型試驗顯示artesunate與安慰劑相比沒有明顯的好處，artesunate和praziquantel合併使用與單用praziquantel效果相同。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。