For two decades, albendazole has been donated to a large-scale program for the treatment of lymphatic filariasis. A recent Cochrane review examined the efficacy of albendazole in the treatment of lymphatic filariasis.
Lymphatic filariasis is a common disease in tropical and subtropical regions, transmitted by mosquitoes and caused by a parasitic filariasis infection. After infection, the larvae grow into adults and mate to form microfilariae (MF). The mosquito then picks up MF while feeding on blood, and the infection can be passed on to another person.
Infection can be diagnosed by testing for circulating MF (microfilamentemia) or parasite antigens (antigenemia) or by detecting viable adult worms by ultrasonography.
The World Health Organization (WHO) recommends mass treatment of the entire population annually for at least five years. The basis of treatment is a combination of two drugs: albendazole and microfilaricidal (antifilariasis) drug diethylcarmazine (DEC) or ivermectin.
Albendazole alone is recommended for semi-annual use in areas where Roa disease is co-endemic, where DEC or ivermectin should not be used due to the risk of serious side effects.
Both ivermectin and DEC rapidly cleared MF infection and suppressed its recurrence. However, MF production will resume due to limited exposure in adults. Albendazole was considered for the treatment of lymphatic filariasis after a study showed that high doses given over several weeks led to serious side effects suggesting death of the adult worms.
An informal WHO consultation subsequently showed that albendazole has killing or sterilizing activity against adult worms. In 2000, GlaxoSmithKline began donating albendazole to projects to treat lymphatic filariasis.
Randomized clinical trials (RCTs) have examined the efficacy and safety of albendazole alone or in combination with ivermectin or DEC. Subsequently, there have been several systematic reviews of randomized controlled trials and observational data, but it is unclear whether albendazole has any benefit in lymphatic filariasis.
In light of this, a Cochrane review published in 2005 has been updated to assess the impact of albendazole on patients and communities with lymphatic filariasis.
Cochrane reviews are systematic reviews that aim to identify, evaluate, and summarize all empirical evidence that meets predetermined criteria to answer a research question. Cochrane reviews are updated as new data become available.
The Cochrane approach minimizes bias in the review process. This includes using tools to assess the risk of bias in individual trials and assess the certainty (or quality) of the evidence for each outcome.
An updated Cochrane Commentary "Albendazole alone or in combination with microfilaricidal agents in lymphatic filariasis" was published in January 2019 by the Cochrane Infectious Diseases Group and the COUNTDOWN Consortium.
Outcomes of interest include transmission potential (MF prevalence and density), adult worm infection markers (antigenemia prevalence and density, and ultrasound detection of adult worms), and measurements of adverse events.
The authors attempted to use an electronic search to find all relevant trials up to January 2018, regardless of language or publication status. Two authors independently assessed studies for inclusion, assessed risk of bias, and extracted trial data.
The review included 13 trials with a total of 8713 participants. A meta-analysis of the prevalence of parasites and side effects was performed to measure treatment effects. Prepare tables to analyze parasite density results, as poor reporting means data cannot be pooled.
The authors found that albendazole alone or in combination with microfilaricides had little to no effect on MF prevalence between two weeks and 12 months post-treatment (high-quality evidence).
They did not know whether there was an effect on mf density at 1–6 months (very low quality evidence) or at 12 months (very low quality evidence).
Albendazole alone or in combination with microfilaricides had little to no effect on the prevalence of antigenemia over 6–12 months (high-quality evidence).
The authors did not know if there was an effect on antigen density between 6 and 12 months of age (very low-quality evidence). Albendazole added to microfilaricides probably had little to no effect on the prevalence of adult worms detected by ultrasound at 12 months (low-certainty evidence).
When used alone or in combination, albendazole had little to no effect on the number of people reporting adverse events (high-quality evidence).
The review found sufficient evidence that albendazole, alone or in combination with microfilaricides, has little or no effect on complete eradication of microfilariae or adult helminths within 12 months of treatment.
Given that this drug is part of mainstream policy, and that the World Health Organization now also recommends a three-drug regimen, it is unlikely that researchers will continue to evaluate albendazole in combination with DEC or ivermectin.
However, in areas endemic for Roa, only albendazole is recommended. Therefore, understanding whether the drug works in these communities remains a top research priority.
Large filariatic insecticides with short-term application schedules can have a major impact on filariasis eradication programs. One of these drugs is currently in preclinical development and was published in a recent BugBitten blog.
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