TY - JOUR

T1 - Efficacy and safety of antiparasitic therapy for neurocysticercosis in rural Tanzania

T2 - a prospective cohort study

AU - Stelzle, D.

AU - Makasi, C.

AU - Schmidt, V.

AU - Trevisan, C.

AU - Van Damme, I.

AU - Ruether, C.

AU - Dorny, P.

AU - Magnussen, P.

AU - Zulu, G.

AU - Mwape, K. E.

AU - Bottieau, E.

AU - Prazeres da Costa, C.

AU - Prodjinotho, U. F.

AU - Carabin, H.

AU - Jackson, E.

AU - Fleury, A.

AU - Gabriel, S.

AU - Ngowi, B. J.

AU - Winkler, A. S.

PY - 2023

Y1 - 2023

N2 - PurposeNeurocysticercosis is common in regions endemic for Taenia solium. Active-stage neurocysticercosis can be treated with antiparasitic medication, but so far no study on efficacy and safety has been conducted in Africa.MethodsWe conducted a prospective cohort study on treatment of neurocysticercosis in Tanzania between August 2018 and January 2022. Patients were initially treated with albendazole (15 mg/kg/d) for 10 days and followed up for 6 months. Additionally in July 2021, all participants who then still had cysts were offered a combination therapy consisting of albendazole (15 mg/kg/d) and praziquantel (50 mg/kg/d). Antiparasitic treatment was accompanied by corticosteroid medication and anti-seizure medication if the patient had experienced epileptic seizures before treatment.ResultsSixty-three patients were recruited for this study, of whom 17 had a complete follow-up after albendazole monotherapy. These patients had a total of 138 cysts at baseline, of which 58 (42%) had disappeared or calcified by the end of follow-up. The median cyst reduction was 40% (interquartile range 11-63%). Frequency of epileptic seizures reduced considerably (p < 0.001). Three patients had all active cysts resolved or calcified and of the remaining 14, eight received the combination therapy which resolved 63 of 66 cysts (95%). Adverse events were infrequent and mild to moderate during both treatment cycles.ConclusionCyst resolution was unsatisfactory with albendazole monotherapy but was very high when it was followed by a combination of albendazole and praziquantel.

AB - PurposeNeurocysticercosis is common in regions endemic for Taenia solium. Active-stage neurocysticercosis can be treated with antiparasitic medication, but so far no study on efficacy and safety has been conducted in Africa.MethodsWe conducted a prospective cohort study on treatment of neurocysticercosis in Tanzania between August 2018 and January 2022. Patients were initially treated with albendazole (15 mg/kg/d) for 10 days and followed up for 6 months. Additionally in July 2021, all participants who then still had cysts were offered a combination therapy consisting of albendazole (15 mg/kg/d) and praziquantel (50 mg/kg/d). Antiparasitic treatment was accompanied by corticosteroid medication and anti-seizure medication if the patient had experienced epileptic seizures before treatment.ResultsSixty-three patients were recruited for this study, of whom 17 had a complete follow-up after albendazole monotherapy. These patients had a total of 138 cysts at baseline, of which 58 (42%) had disappeared or calcified by the end of follow-up. The median cyst reduction was 40% (interquartile range 11-63%). Frequency of epileptic seizures reduced considerably (p < 0.001). Three patients had all active cysts resolved or calcified and of the remaining 14, eight received the combination therapy which resolved 63 of 66 cysts (95%). Adverse events were infrequent and mild to moderate during both treatment cycles.ConclusionCyst resolution was unsatisfactory with albendazole monotherapy but was very high when it was followed by a combination of albendazole and praziquantel.

KW - Taenia solium

KW - Neurocysticercosis

KW - Neglected tropical diseases

KW - Antiparasitic medication

KW - Albendazole

KW - Praziquantel

KW - SUB-SAHARAN AFRICA

KW - DOUBLE-BLIND

KW - PRAZIQUANTEL

KW - ALBENDAZOLE

KW - PREVALENCE

KW - CYSTICERCOSIS

KW - MORBIDITY

KW - EPILEPSY

U2 - 10.1007/s15010-023-02021-y

DO - 10.1007/s15010-023-02021-y

M3 - Journal article

C2 - 36961623

VL - 51

SP - 1127

EP - 1139

JO - Therapies

JF - Therapies

SN - 0300-8126

ER -