Albendazole alone or in combination with microfilaricidal drugs for lymphatic filariasis

UPDATE

Cara Macfarlane1 , Shyam Budhathoki2, Samuel Johnson1, Marty Richardson1, Paul Garner1

1. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
2. School of Public Health & Community Medicine, B P Koirala Institute of Health Sciences, Dharan, Nepal

Macfarlane  CL, Budhathoki  SS, Johnson  S, Richardson  M, Garner  P. Albendazole alone or in combination with microfilaricidal drugs for lymphatic filariasis. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD003753. DOI: 10.1002/14651858.CD003753.pub4

Access the full text article here: DOI:10.1002/14651858.CD003753.pub4

In this Cochrane Review, Cochrane researchers examined the effects of using albendazole alone and albendazole added to antifilarial drugs to treat infected people and people who live in areas with lymphatic filariasis. After searching for relevant trials up to January 2018, we included 13 randomized controlled trials (RCTs), including one cluster‐RCT, with a total of 8713 participants.

Lymphatic filariasis

Lymphatic filariasis, a disease common in tropical and subtropical areas, is spread by mosquitoes and caused by infection with parasitic filarial worms. After a person is infected from a mosquito bite, the worms grow into adults and mate to produce microfilariae (mf). The mf circulate in the blood so they can be collected by mosquitoes, and the infection can be spread to another person. Infection can be diagnosed by checking for the presence of circulating mf (microfilaraemia) or parasite antigens (antigenaemia), or by ultrasound imaging to detect live adult worms.

The World Health Organization (WHO) recommends mass treatment of entire populations once a year for many years. Treatment is a two‐drug combination of albendazole and a microfilaricidal (antifilarial) drug, either diethycarbamazine (DEC) or ivermectin. Albendazole alone is recommended for people when DEC or ivermectin can not be used.

What the research says

Albendazole alone or added to a microfilaricidal drug makes little or no difference to mf prevalence over two weeks to 12 months after treatment (high‐certainty evidence), but we do not know if albendazole alone or in combination reduces mf density between one to six months (very low‐certainty evidence) or at 12 months (very low‐certainty evidence).

Treatment with albendazole alone or added to a microfilaricidal drug makes little or no difference to antigenaemia prevalence between six to 12 months (high‐certainty evidence). We do not know if albendazole alone or in combination reduces antigen density over six to 12 months (very low‐certainty evidence). Albendazole added to a microfilaricidal drug may make little or no difference to adult worm prevalence detected by ultrasound at 12 months (low‐certainty evidence).

When given alone or added to a microfilaricidal drug, albendazole makes little or no difference to the number of people reporting an adverse event (high‐certainty evidence).