Treatment of urinary schistosomiasis: Methodological issues and research needs identified through a Cochrane systematic review

A. Danso-Appiah, P. Garner, P. L. Olliaro, J. Utzinger

Research output: Contribution to journalReview articlepeer-review

41 Citations (Scopus)

Abstract

Guidelines recommend praziquantel (PZQ) for the treatment and control of schistosomiasis, with no real alternative. Metrifonate was still widely used against Schistosoma haematobium in the 1990s, and then withdrawn. Experimental studies and clinical trials suggest that artemisinin compounds are active against S. haematobium. In a Cochrane systematic review assessing the efficacy and safety of drugs for treating urinary schistosomiasis, 24 randomized controlled trials (n=6315 individuals) met our inclusion criteria. These trials compared a variety of single agent and combination regimens with PZQ, metrifonate or artemisinin derivatives. The review confirmed that both the standard recommended doses of PZQ (single 40 mg/kg oral dose) and metrifonate (375-10 mg/kg oral doses administered fortnightly) are efficacious and safe in treating urinary schistosomiasis, but there is no study comparing these two regimens head-to-head. There is currently not enough evidence to evaluate artemisinin compounds. Most of the studies included in the Cochrane systematic review were insufficiently powered, lacked standardization in assessing and reporting outcomes, and had a number of methodological limitations. In this paper we discuss the implications of these findings with respect to public health and research methodology and propose priority research needs.

Original languageEnglish
Pages (from-to)1837-1849
Number of pages13
JournalParasitology
Volume136
Issue number13
DOIs
Publication statusPublished - Nov 2009
Externally publishedYes

Keywords

  • Schistosoma haematobium
  • artemisinin
  • meta-analysis
  • metrifonate
  • praziquantel
  • schistosomiasis
  • systematic review
  • urinary schistosomiasis

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