Cysticidal efficacy of combined treatment with praziquantel and albendazole for parenchymal brain cysticercosis

Hector H. Garcia, Andres G. Lescano, Isidro Gonzales, Javier A. Bustos, E. Javier Pretell, John Horton, Herbert Saavedra, Armando E. Gonzalez, Robert H. Gilman

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Background. The efficacy of current antiparasitic treatment for cerebral Taenia solium cysticercosis with either albendazole (ABZ) or praziquantel (PZQ) is suboptimal. A recent study demonstrated that combining these 2 antiparasitic drugs improves antiparasitic efficacy. We present here the parasiticidal efficacy data obtained during a previous phase II pharmacokinetic study that compared combined ABZ plus PZQ with ABZ alone. Methods. The study was a randomized, double-blinded, placebo-controlled phase II evaluation of the pharmacokinetics of ABZ (15 mg/k/d, for 10 days) and PZQ (50 mg/k/d, for 10 days) in intraparenchymal brain cysticercosis. Patients received the usual concomitant medications, including an antiepileptic drug (phenytoin or carbamazepine), dexamethasone, and ranitidine. Randomization was stratified by antiepileptic drug. Patients underwent safety laboratory evaluations at days 4, 7, and 11, as well as magnetic resonance (MR) imaging at 6 months to assess parasiticidal efficacy. Results. Thirty-two patients were included, 16 in each arm. All of them completed antiparasitic treatment and underwent follow-up brain MR imaging. Cysticidal efficacy was strikingly higher in the combined ABZ-plus-PZQ group than in the ABZ-alone group (proportion of cysts resolved, 78 of 82 [95%] vs 23 of 77 [30%] [relative risk {RR}, 3.18; 95% confidence interval {CI}, 2.08-4.88; P <. 001]; patients with complete cyst clearance, 12 of 16 [75%] vs 4 of 16 [25%] [RR, 3.00; 95% CI, 1.23-7.34; P =. 005]). Conclusions. The combination of ABZ plus PZQ is more effective in destroying viable brain cysticercosis cysts than ABZ alone.

Original languageEnglish
Pages (from-to)1375-1379
Number of pages5
JournalClinical Infectious Diseases
Volume62
Issue number11
DOIs
StatePublished - 1 Jun 2016

Bibliographical note

Funding Information:
This study was funded by the National Institute of Neurological Diseases and Stroke, NIH (grant R01 054805), Fogarty International Center, NIH (training grants TW001140 for the training of study team members and 2D43 TW00739 to A. G. L.), and Wellcome Trust (International Senior Research Fellowship in Public Health and Tropical Medicine to H. H. G.).

Publisher Copyright:
© 2016 The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

Keywords

  • Peru
  • Taenia solium
  • albendazole
  • neurocysticercosis
  • praziquantel

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