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. 2017 Sep 25;358:j4307.
doi: 10.1136/bmj.j4307.

Efficacy of Recommended Drugs Against Soil Transmitted Helminths: Systematic Review and Network Meta-Analysis

Free PMC article

Efficacy of Recommended Drugs Against Soil Transmitted Helminths: Systematic Review and Network Meta-Analysis

Wendelin Moser et al. BMJ. .
Free PMC article


Objective To evaluate efficacies of anthelmintic drugs against soil transmitted helminths in terms of cure rates and egg reduction rates.Design Systematic review and network meta-analysis.Data Sources PubMed, ISI Web of Science, Embase, ScienceDirect, the Cochrane Central Register of Clinical Trials, and the World Health Organization library database from 1960 until 31 December 2016.Study selection Randomised controlled trials evaluating the efficacy of a single dose regimen of albendazole, mebendazole, levamisole, and pyrantel pamoate against Ascaris lumbricoides, hookworm (Necator americanus and Ancylostoma duodenale) and Trichuris trichiura. The primary outcomes included cure rates analysed by network meta-analysis with mixed logistic regression models and egg reduction rates with mixed linear models.Results 55 and 46 randomised controlled trials were included in the analysis of cure rates and egg reduction rates, respectively. All drugs were highly efficacious against A lumbricoides Albendazole showed the highest efficacy against hookworm infections with a cure rate of 79.5% (95% confidence interval 71.5% to 85.6%) and an egg reduction rate of 89.6% (81.9% to 97.3%). All drugs had low efficacy against T trichiura, with mebendazole showing the highest cure rate of 42.1% (25.9% to 60.2%) and egg reduction rate of 66.0% (54.6% to 77.3%). Estimates for the years 1995 and 2015 showed significant reductions in efficacy of albendazole against T trichiura: by 2015 the egg reduction rates fell from 72.6% (53.7% to 91.5%) to 43.4% (23.5% to 63.3%; P=0.049) and the cure rates fell from 38.6% (26.2% to 52.7%) to 16.4 (7.7% to 31.3%; P=0.027).Conclusions All four currently recommended drugs show limitations in their efficacy profile. While only albendazole showed good efficacy against hookworm infection, all drugs had low efficacy against T trichiura The decrease in efficacy of albendazole against T trichiura over the past two decades is of concern. The findings indicate the need for strengthening efforts to develop new drug treatments, with a particular focus on drugs against T trichiura.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: this work was founded by the Swiss National Science Foundation; all other authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work.


Fig 1 Flowchart and network showing procedure for identification of relevant publications. Circular nodes show each treatment with circle size indicating amount of respective evidence and numbers in brackets indicating number of pooled studies with only one eligible treatment arm. Weight of line and number on line indicate number of direct treatment comparisons within same study
Fig 2 Drug comparison based on network meta-analysis. Odds ratios for one to one comparisons of cure rates and difference for one to one comparisons of egg reduction rates are based on network meta-analysis for each drug and infection (*P<0.05, **P<0.01, ***P<0.001)
Fig 3 Egg reduction rates for albendazole, mebendazole, levamisole, and pyrantel pamoate. Median, third quarter (white bar), second quarter (shaded bar), and individual study specific rates (solid circles) for each drug against A lumbricoides, hookworm, and T trichiura. Negative values of rates were set to zero in this figure

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