Albendazole and Corticosteroids for the Treatment of Solitary Cysticercus Granuloma: A Network Meta-analysis

BackgroundSolitary cysticercus granuloma (SCG) is the commonest form of neurocysticercosis in the Indian subcontinent and in travelers. Several different treatment options exist for SCG. We conducted a Bayesian network meta-analysis of randomized clinical trials (RCTs) to identify the best treatment option to prevent seizure recurrence and promote lesion resolution for patients with SCG.Methods and Principal FindingsPubMed, EMBASE and the Cochrane Library databases (up to June 1, 2015) were searched for RCTs that compared any anthelmintics or corticosteroids, alone or in combination, with placebo or head to head and reported on seizure recurrence and lesion resolution in patients with SCG. A total of 14 RCTs (1277 patients) were included in the quantitative analysis focusing on four different treatment options. A Bayesian network model computing odds ratios (OR) with 95% credible intervals (CrI) and probability of being best (Pbest) was used to compare all interventions simultaneously. Albendazole and corticosteroids combination therapy was the only regimen that significantly decreased the risk of seizure recurrence compared with conservative treatment (OR 0.32, 95% CrI 0.10–0.93, Pbest 73.3%). Albendazole and corticosteroids alone or in combination were all efficacious in hastening granuloma resolution, but the combined therapy remained the best option based on probability analysis (OR 3.05, 95% CrI 1.24–7.95, Pbest 53.9%). The superiority of the combination therapy changed little in RCTs with different follow-up durations and in sensitivity analyses. The limitations of this study include high risk of bias and short follow-up duration in most studies.ConclusionsDual therapy of albendazole and corticosteroids was the most efficacious regimen that could prevent seizure recurrence and promote lesion resolution in a follow-up period of around one year. It should be recommended for the management of SCG until more high-quality evidence is available.背景 孤立性囊尾蚴肉芽肿（Solitary cysticercus granuloma, SCG）是印度次大陆及旅行者群体中最常见的神经囊尾蚴病类型。针对SCG存在多种不同的治疗方案。本研究针对随机对照试验（randomized clinical trial, RCT）开展贝叶斯网络荟萃分析，旨在筛选出可预防癫痫复发、促进病灶消退的最优SCG治疗方案。 研究方法与主要结果 检索PubMed、EMBASE及Cochrane Library数据库（截至2015年6月1日）中相关随机对照试验，纳入对比任意单一或联合使用的抗蠕虫药、糖皮质激素与安慰剂，或不同干预措施头对头比较，且报告了SCG患者癫痫复发与病灶转归情况的研究。最终共纳入14项随机对照试验，涉及1277名受试者，聚焦于4种不同的治疗方案。本研究采用贝叶斯网络模型，计算比值比（odds ratio, OR）及95%可信区间（credible interval, CrI），同时计算各干预措施成为最优方案的概率（Pbest），以实现所有干预措施的同步比较。与保守治疗相比，仅阿苯达唑联合糖皮质激素治疗可显著降低癫痫复发风险（OR=0.32，95%CrI：0.10~0.93，Pbest=73.3%）。单独使用阿苯达唑、单独使用糖皮质激素，或二者联合应用，均能加快肉芽肿病灶的消退，但基于概率分析结果，联合治疗仍为最优方案（OR=3.05，95%CrI：1.24~7.95，Pbest=53.9%）。在不同随访时长的随机对照试验及敏感性分析中，联合治疗的优势均未发生明显变化。本研究的局限性包括多数研究存在较高偏倚风险，且随访时长普遍较短。 结论 在为期约1年的随访周期内，阿苯达唑与糖皮质激素的联合治疗是预防癫痫复发、促进病灶消退的最优方案。在获得更多高质量证据之前，该方案应作为SCG临床管理的推荐方案。