Abstract
BackgroundChemotherapy based on repeated doses of praziquantel is still the most effective control strategy against Schistosomiasis, however artemisinin derivatives emerged as a family of compounds with schistomicide activity. The aim of the present work is to compare the efficacy of artemisinin-based therapies in the treatment and prophylaxis of human schistosomiasis. The design of this work involved a quantitative systematic review and meta-analysis.Methodology/Principal FindingsRetrieval of published studies was carried out through an electronic search of the PubMed (MEDLINE), EMBASE, Cochrane Library and CINAHL databases. This included reports comparing the therapeutic efficacy of artesunate alone, artesunate plus sulfadoxine-pyrimethamine and a combination of artemisinin derivatives plus praziquantel against praziquantel alone on different types of schistosomiasis. Moreover, studies on artesunate and artemether used as preventive drugs were also analyzed against placebo. The primary outcome measure for schistosomiasis treatment was “parasitological cure”, whereas for the prophylaxis the outcome evaluated was “infection rate”. Our results show that patients treated with artesunate alone have significantly lower cure rates than those treated with praziquantel (OR = 0.27 (95% C.I. 0.13–0.53; p<0.001)) and that the combined therapy of artesunate plus sulfadoxine-pyrimethamine is also significantly less effective than praziquantel treatment (OR = 0.14 (95% C.I. 0.02–0.92; p = 0.04)). However, the combination of an artemisinin derivatives plus praziquantel showed a higher cure rate than praziquantel monotherapy with OR = 2.07 (95% C.I. 1.27–3.36; p = 0.003). Finally, chemoprophylaxis with either artesunate (RR = 0.11 (95% C.I. 0.06–0.22; p<0.001)) or artemether (RR = 0.25 (95% C.I. 0.16–0.40; p<0.001)) was significantly better than a placebo in both cases.Conclusions/SignificanceThis meta-analysis confirms that artemisinin derivatives used in combination with praziquantel have the potential to increase the cure rates in schistosomiasis treatment, but not artesunate alone. It is also confirmed that repeated doses of artemisinin derivatives play a prophylactic role, significantly reducing the incidence of Schistosoma japonicum infections compared with placebo.
Highlights
Schistosomiasis continues to be one of the most prevalent parasitic diseases
Study Selection Reports from 261 published articles were screened for evidence of clinical trials that evaluated the efficacy of artemisinin derivatives in schistosomiasis treatment or prophylaxis
The results revealed that patients treated with artesunate alone had a significantly lower cure rate than those treated with praziquantel, both with S. haematobium, showing an PLOS ONE | www.plosone.org
Summary
Schistosomiasis continues to be one of the most prevalent parasitic diseases. An estimated 779 million people - more than 10% of the world’s population - were at risk of schistosomiasis in mid-2003 and approximately 207 million people were infected [1]. A recent systematic review has shown that schistosomiasis-related disability is underestimated [9]. The treatment of this chronic and debilitating disease relies on the use of praziquantel, a broad-spectrum schistosomicide drug that combines safety and low price [10]. Current control programmes against schistosomiasis depend on the wide-scale use of praziquantel. This drug pressure could favor the emergence of praziquantel-resistant parasites [11]. Chemotherapy based on repeated doses of praziquantel is still the most effective control strategy against Schistosomiasis, artemisinin derivatives emerged as a family of compounds with schistomicide activity. The design of this work involved a quantitative systematic review and meta-analysis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
