Abstract Details

Title Efficacy Analysis of Therapeutic Regimens for Neurocysticercosis: Insights from a Network Meta-Analysis

Topic Infectious Disease

Presentation(s) C11 - Central Nervous System Space-occupying Lesions (11:18 AM-11:25 AM)
P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 094

Background

Neurocysticercosis (NCC) is a leading cause of parasitic central nervous system infections globally. Current treatment options involve the use of antihelminthic agents such as albendazole (ABZ), and praziquantel (PZQ), alongside anti-epileptic drugs (AED), Prednisolone (PRED), Dexamethasone (DXM) and their combinations.

Objective

To assess the relative efficacy of drug therapies for neurocysticercosis.

Design/Methods

A systematic search of PubMed/MEDLINE, Cochrane, EMBASE, Scopus, and ClinicalTrials.gov up to 12/12/2023 focused on RCTs for neurocysticercosis treatments. Primary outcomes included cyst resolution odds and seizure recurrence, analyzed using a frequentist approach in R. Treatment regimens were categorized as short(s) (≤ 7 days) or longer(l) (≥ 7 days).

Results

The network meta-analysis for complete cyst resolution included data from 32 trials, 1500 patients, and 47 pairwise comparisons across 19 treatments. AED served as the reference node. Network heterogeneity, I^2 was 53% (23.7%-71.1%), and a random-effects model was used. The most effective combination was ABZ(s) + PZQ(s) + PRED + AED (OR: 17.57, 2.58-119.93). Other significant combinations included ABZ(l) + PZQ(l) + AED (OR: 13.19, 2.39-72.68) and ABZ(s) + PRED + AED (OR: 8.82, 2.63-29.56). In a subgroup analysis of trials on solitary cysticercus granuloma (SCG), the regimen ABZ(s) + PZQ(s) + PRED + AED showed the highest efficacy (OR: 15.65, 1.69-144.76), followed by ABZ(s) + PRED + AED (OR: 7.85, 1.64-37.60) and ABZ(l) + PRED + AED (OR: 6.45, 1.91-21.80). For seizure recurrence/persistence, data from 18 trials, 26 pairwise comparisons, and 1664 patients were analyzed. The I^2 was 36.9% (0.0%; 68.1%), and the common effects model was used. The regimen ABZ(s) + DXM + AED showed a reduced risk of seizure recurrence (OR: 0.24, 0.08-0.71).

Conclusions A shorter regimen-based combination of antihelminthics, alongside prednisolone and anti-epileptics is the most efficacious for achieving complete cyst resolution in NCC. Additionally, Albendazole(s) combined with Dexamethasone and AED significantly reduced the risk of seizure recurrence.

Authors/Disclosures
Suhrud Panchawagh, MBBS PRESENTER	Dr. Panchawagh has nothing to disclose.
Vinay Suresh	Mr. Suresh has nothing to disclose.
Muneeb Ahmad Muneer (Allama Iqbal Medical College)	Mr. Muneer has nothing to disclose.
Samit Sen (Bangalore Medical College and Research Institute)	Mr. Sen has nothing to disclose.
Binish Javed	Miss Javed has nothing to disclose.
Tirth Dave	Mr. Dave has nothing to disclose.
Malavika Jayan (Bangalore Medical College and Research Institute)	Miss Jayan has nothing to disclose.
Vivek Sanker, MBBS	Dr. Sanker has nothing to disclose.
Shiva Gupta	No disclosure on file
Hardeep Malhotra, MD	Dr. Malhotra has nothing to disclose.
Ravindra K. Garg, MD (Department of Neurology,King George Medical University, Lucknow)	Dr. Garg has received intellectual property interests from a discovery or technology relating to health care. Dr. Garg has received intellectual property interests from a discovery or technology relating to health care. Dr. Garg has received publishing royalties from a publication relating to health care.