Systematic review and meta-analysis of artemisinin based therapies for the treatment and prevention of schistosomiasis.

<h4>Background</h4>Chemotherapy 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 effica...

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Autores principales:	Luis Pérez del Villar, Francisco J Burguillo, Julio López-Abán, Antonio Muro
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7b657a1aa808480385ac020317e6da92
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spelling	oai:doaj.org-article:7b657a1aa808480385ac020317e6da922021-11-18T07:04:29ZSystematic review and meta-analysis of artemisinin based therapies for the treatment and prevention of schistosomiasis.1932-620310.1371/journal.pone.0045867https://doaj.org/article/7b657a1aa808480385ac020317e6da922012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23029285/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Chemotherapy 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.<h4>Methodology/principal findings</h4>Retrieval 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.<h4>Conclusions/significance</h4>This 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.Luis Pérez del VillarFrancisco J BurguilloJulio López-AbánAntonio MuroPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 9, p e45867 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Luis Pérez del Villar Francisco J Burguillo Julio López-Abán Antonio Muro Systematic review and meta-analysis of artemisinin based therapies for the treatment and prevention of schistosomiasis.
description	<h4>Background</h4>Chemotherapy 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.<h4>Methodology/principal findings</h4>Retrieval 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.<h4>Conclusions/significance</h4>This 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.
format	article
author	Luis Pérez del Villar Francisco J Burguillo Julio López-Abán Antonio Muro
author_facet	Luis Pérez del Villar Francisco J Burguillo Julio López-Abán Antonio Muro
author_sort	Luis Pérez del Villar
title	Systematic review and meta-analysis of artemisinin based therapies for the treatment and prevention of schistosomiasis.
title_short	Systematic review and meta-analysis of artemisinin based therapies for the treatment and prevention of schistosomiasis.
title_full	Systematic review and meta-analysis of artemisinin based therapies for the treatment and prevention of schistosomiasis.
title_fullStr	Systematic review and meta-analysis of artemisinin based therapies for the treatment and prevention of schistosomiasis.
title_full_unstemmed	Systematic review and meta-analysis of artemisinin based therapies for the treatment and prevention of schistosomiasis.
title_sort	systematic review and meta-analysis of artemisinin based therapies for the treatment and prevention of schistosomiasis.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/7b657a1aa808480385ac020317e6da92
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Systematic review and meta-analysis of artemisinin based therapies for the treatment and prevention of schistosomiasis.

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