OBJECTIVES: We searched the Cochrane
Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, the WHO ICTRP, and ClinicalTrials.gov, up to 21 October 2020.
SELECTION CRITERIA: Two review authors independently screened the title and abstract of all articles identified by the search. We obtained full-text articles to confirm the eligibility of all studies that passed screening. One review author extracted data, which a second review author checked. Two review authors assessed the risk of bias of each trial and performed GRADE assessments. In cases of disagreement at consensus discussion stage between review authors, we consulted a third review author. We calculated risk ratios (RR) for dichotomous variables, with 95% confidence intervals (CIs) for pooled data from studies with similar interventions and outcomes.
MAIN RESULTS: We included 16 studies in the review. Only two studies investigated
praziquantel and did not report data in a format that could contribute to meta-analysis. Most results in this review are therefore applicable to
albendazole versus placebo or no
anthelmintic. The aggregate analysis across all participants with
neurocysticercosis did not demonstrate a difference between groups in seizure recurrence, but heterogeneity was marked (RR 0.94, 95% CI 0.78 to 1.14; 10 trials, 1054 participants; I2 = 67%; low-certainty evidence). When stratified by participants with a single
cyst or multiple
cysts, pooled analysis suggests that
albendazole probably improves seizure recurrence for participants with a single
cyst (RR 0.61, 95% CI 0.4 to 0.91; 5 trials, 396 participants; moderate-certainty evidence). All studies contributing to this analysis recruited participants with non-viable, intraparenchymal
cysts only, and most participants were children. We are uncertain whether or not
albendazole reduces seizure recurrence in participants with multiple
cysts, as the certainty of the evidence is very low, although the direction of effect is towards
albendazole causing harm (RR 2.05, 95% CI 1.28 to 3.31; 2 trials, 321 participants; very low-certainty evidence). This analysis included a large study containing a highly heterogeneous population that received an assessment of unclear risk for multiple 'Risk of bias' domains. Regarding radiological outcomes,
albendazole probably slightly improves the complete radiological clearance of lesions (RR 1.22, 95% CI 1.07 to 1.39; 13 trials, 1324 participants; moderate-certainty evidence) and the evolution of
cysts (RR 1.27, 95% CI 1.10 to 1.47; 6 trials, 434 participants; moderate-certainty evidence). More adverse events appeared to be observed in participants treated with either
albendazole or
praziquantel compared to those receiving placebo or no
anthelmintic. The most commonly reported side effects were
headache,
abdominal pain, and
nausea/
vomiting.
AUTHORS' CONCLUSIONS: For participants with a single
cyst, there was less seizure recurrence in the
albendazole group compared to the placebo/no
anthelmintic group. The studies contributing to this evidence only recruited participants with a non-viable intraparenchymal
cyst. We are uncertain whether
albendazole reduces seizure recurrence for participants with multiple
cysts. We also found that
albendazole probably increases radiological clearance and evolution of lesions. There were very few studies reporting
praziquantel outcomes, and these findings apply to
albendazole only.