The data are inadequate to assess safety and efficacy of mass chemotherapy for Taenia solium taeniasis.

A Clinton White,Seth O’Neal,Hélène Carabin,Andrea Winkler,Annette Abraham,Adriano Casulli

doi:10.1371/journal.pntd.0008294

Abstract

As members of the Pan American Health Organization (PAHO) and World Health Organization (WHO) guidelines development group on chemotherapy strategies for the control of Taenia solium taeniasis, we are very disappointed at the systematic review by Haby and colleagues. With respect to the analysis of efficacy, the authors did not account for differences in the methods used to ascertain the outcome in the studies analyzed. There are also major concerns regarding the safety analyses. Few of the included studies used carefully designed active surveillance protocols to detect epileptic seizures and/or chronic progressive headaches. These neurologic side effects, due the inadvertent killing of viable brain cysts, have been noted after mass therapy with praziquantel and albendazole. We wholeheartedly agree with the authors’ statement in their discussion that control programs applying chemotherapy using mass drug administration “need to be informed by evidence of the best drug and dose in terms of efficacy and side-effects.” Unfortunately, the flawed analysis that was published is contrary to that goal.

Highlights

All of the studies involving ABZ included in the metaanalysis relied solely on microscopy to assess treatment efficacy, [2, 3] a method that is notoriously insensitive and cannot distinguish T. solium from T. saginata
Microscopy is subject to inaccurate interpretation of the temporary cessation of egg shedding that may occur when terminal proglottids are killed but the scolex remains viable. Both limitations would result in misclassification of persistent infections as cured and would be expected to overestimate the efficacy of ABZ
[4] In some of the included studies, the outcome was assessed through coAg detection of serial stool samples, further increasing the sensitivity

Summary

Introduction

Support of the efficacy and safety of albendazole (ABZ) and praziquantel in mass drug administration. With respect to the analysis of efficacy, the authors did not account for differences in the methods used to ascertain the outcome in the studies analyzed. A critical oversight in this meta-analysis was disregarding the disparity in the sensitivity and specificity of these methods.

Results

Conclusion