Intervention Review

Albendazole for lymphatic filariasis

  1. David Addiss2,
  2. Carrol L Gamble3,
  3. Paul Garner4,
  4. Hellen Gelband5,
  5. Henry OD Ejere6,
  6. Julia A Critchley1,*,
  7. International Filariasis Review Group4

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 19 OCT 2005

Assessed as up-to-date: 13 AUG 2005

DOI: 10.1002/14651858.CD003753.pub3


How to Cite

Addiss D, Gamble CL, Garner P, Gelband H, Ejere HOD, Critchley JA, International Filariasis Review Group. Albendazole for lymphatic filariasis. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003753. DOI: 10.1002/14651858.CD003753.pub3.

Author Information

  1. 1

    Newcastle University, Institute of Health and Society, Newcastle, Tyne and Wear, UK

  2. 2

    Centers for Disease Control and Prevention, Division of Parasitic Diseases, Atlanta, Georgia, USA

  3. 3

    University of Liverpool, Centre for Medical Statistics and Health Evaluation, Liverpool, UK

  4. 4

    Liverpool School of Tropical Medicine, International Health Group, Liverpool, Merseyside, UK

  5. 5

    Resources for the Future, Washington, DC, USA

  6. 6

    Metropolitan Hospital, Department of Medicine, New York, USA

*Julia A Critchley, Institute of Health and Society, Newcastle University, William Leech Building, The Medical School, Newcastle, Tyne and Wear, NE2 4HH, UK. J.A.Critchley@newcastle.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 OCT 2005

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Mass treatment with albendazole co-administered with another antifilarial drug is part of a global programme to eliminate lymphatic filariasis. We sought reliable evidence of the effects of albendazole on the disease and the parasite.

Objectives

To summarize the effects of albendazole alone or in combination with antifilarial drugs for clinical treatment and community control of lymphatic filariasis.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register (August 2005), CENTRAL (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to August 2005), EMBASE (1974 to August 2005), LILACS (1982 to August 2005), and reference lists. We also contacted researchers, the World Health Organization, and GlaxoSmithKline.

Selection criteria

Randomized and quasi-randomized controlled trials of albendazole alone or combined with another antifilarial drug for treating individuals with lymphatic filariasis, or for reducing transmission in endemic communities.

Data collection and analysis

Two authors independently assessed eligibility and trial quality, and extracted data. Authors contacted investigators for missing information or clarification.

Main results

Seven trials including 6997 participants (995 with detectable microfilariae) met the criteria. A comparison of albendazole and placebo detected no effect on microfilariae prevalence (920 participants; 3 trials); one trial (499 participants) reported significantly lower microfilariae density at six months. Albendazole performed slightly worse than ivermectin in two trials (436 participants). Compared with diethylcarbamazine (DEC), two small trials (56 participants) found little difference in microfilariae prevalence over an extended follow up. One larger trial (502 participants) found a statistically significant effect for DEC at six months, but none at three months.

Microfilariae prevalence and density were statistically significantly lower with the combination of albendazole and ivermectin compared with ivermectin alone in two of three trials (649 participants). Two trials compared albendazole plus DEC with DEC alone and found no statistically significant difference in microfilariae prevalence, though one trial favoured the combination at six months (risk ratio 0.62, 95% confidence interval 0.32 to 1.21; 491 participants). This trial also found a statistically significant reduction in microfilariae density.

Authors' conclusions

There is insufficient evidence to confirm or refute that albendazole co-administered with DEC or ivermectin is more effective than DEC or ivermectin alone in clearing microfilariae or killing adult worms. Albendazole combined with ivermectin appears to have a small effect on microfilaraemia, but this was not consistently demonstrated. The effect of albendazole against adult and larval filarial parasites, alone and in combination with other antifilarial drugs, deserves further rigorous research.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Not enough evidence on effectiveness of the drug albendazole, alone or in combination, for killing or interrupting transmission of threadlike worms that cause lymphatic filariasis

Filariasis affects about 120 million people in more than 80 countries and is spread by mosquitoes. Adult worms take up residence in lymph channels and when paired, produce larvae that circulate in the blood. The adult worms can live in the lymph system for five years or more. The infection can cause severe disability, due to massive enlargement of limbs, genitals, and breasts. On the other hand, many infected people have no symptoms, but do contribute to the perpetuation of the infection in the community. This review of trials found insufficient evidence to say whether a single dose of the drug albendazole kills the worms, or whether, if given in combination with diethylcarbamazine or ivermectin, it enhances the killing of these worms or the larvae they produce.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以Albendazole治療淋巴絲蟲病

在1項根絕淋巴絲蟲病的全球性計畫中,有1部分就是以albendazole加上另外1種共同給藥的抗絲蟲藥物來進行大規模地治療。我們尋找可信有關albendazole對於這種疾病與寄生蟲的影響的證據。

目標

對於淋巴絲蟲病在臨床上的治療與社區控制而言,要歸納出單獨使用albendazole或是將它與抗絲蟲藥物合併使用時的效應。

搜尋策略

我們搜尋Cochrane Infectious Diseases Group Specialized Register (2005年8月)、 CENTRAL (Cochrane Library Issue 3, 2005)、 MEDLINE (1966年−2005年8月)、 EMBASE (1974年−2005年8月)、 LILACS (1982年−2005年8月)、 以及參考資料清單。我們也與研究人員、World Health Organization以及GlaxoSmithKline大藥廠聯繫。

選擇標準

針對患有淋巴絲蟲病的人們或是對於降低區域性淋巴絲蟲病傳播的隨機化與半隨機對照試驗,這些試驗的內容為包括單獨使用albendazole或是將它與抗絲蟲藥物合併使用。

資料收集與分析

有2位作者獨立地評估了合格性與試驗的品質,並且擷取出資料。針對遺漏的資訊或是須要釐清的部分,作者們與研究人員們取得了聯繫。

主要結論

共有包含了6997名參與者(995名帶有可偵測到的微絲蟲)在內的7項試驗符合了收案標準。有1項albendazole與安慰劑之間的比較當中,結果是對於微絲蟲的盛行率方面沒有影響(920名參與者;3份試驗);另1項試驗(499名參與者)報告在6個月的時候微絲蟲的密度很明顯地比較低。有2份試驗(436名參與者)顯示跟 ivermectin比較起來Albendazole的表現稍微呈現劣勢。跟diethylcarbamazine(DEC)比較起來,有2項小規模的試驗(56名參與者)發現經過1段長時期的追蹤後,微絲蟲的盛行率方面有些微的差異。有1項比較大型的試驗(502名參與者)發現,在6個月的時候,DEC方面產生了某種統計學上的顯著效應,但是在3個月的時候卻沒有這樣的現象。在這3項試驗中的2項(649參與者)顯示,跟單獨使用ivermectin 比較起來,將albendazole與ivermectin合併使用的時候,微絲蟲的盛行率與密度在統計學上會明顯地比較低。有2項試驗將albendazole加上DEC與單獨使用DEC進行了比較,雖然說有1項試驗認為於6個月的時候使用合併的型式較優(相對風險為0.62,95%信賴區間0.32到1.21;491名參與者),但是這些試驗發現微絲蟲的盛行率在統計學上並沒有顯著的差異。這項試驗也發現微絲蟲的密度也達到統計學上顯著的下降。

作者結論

對於清除微絲蟲或是消滅成蟲而言,以albendazole搭配DEC或是 ivermectin來進行共同給藥時,是否會比單獨使用DEC或是ivermectin還要有效,並沒有足夠的證據能夠加以確認或是反駁。Albendazole與ivermectin合併使用時,顯然會對於微絲蟲病帶來小型的影響,但是這並沒有獲得人們一致的認同。以單獨使用albendazole及合併其他種抗絲蟲類的藥物來對抗成蟲以及幼年絲蟲的效應還需要進行後續嚴格的研究。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

就消滅這些會引發淋巴絲蟲病的絲狀蟲類或是阻斷它們的傳播來看,對於albendazole這種藥物而言,不論是單獨使用或是採取合併的型式,都沒足夠證據顯示功效。在超過80個國家當中,絲蟲病影響到了大約1億2千萬的人口,而且它會藉者蚊子來進行散布。成年的蟲體會占據淋巴管,而且一旦配對成功,就會繁殖出幼蟲,而幼蟲則會在血液當中循環。成年的蟲體可以在淋巴系統之中存活達5年之久,甚至是更久。因為各個肢體、生殖器,以及乳房等部位會發生大幅的膨脹,所以這樣的感染就可能會引發嚴重的殘疾。另一方面,很多被感染的人們並沒有出現症狀,但是卻會讓這樣的感染在該社區當中持續存在。本篇回顧發現如後: 並沒有足夠的證據可以證實是否使用單1次albendazole即可以殺死這些蟲體,或是如果將這種藥物與diethylcarbamazine 或ivermectin進行合併給藥的時候能夠增強殺蟲的效果。