Efficacy of Different Drugs in Treating Urinary Schistosomiasis: Systematic Review and Network Meta-analysis

Background: Praziquantel is the current pillar for morbidity control of schistosomiasis. Artesunate and its derivatives, widely used for malaria treatment, also display antischistosomal activities. This review compares the efficacy of three drugs, namely praziquantel (PZQ), artesunate, and metrifonate in urinary schistosomiasis. Methods: Databases were searched for articles comparing the effectiveness of any of the three drugs to other medications or controls in urinary schistosomiasis in children aged 18 or less. Stata software was opted to generate the network meta-analysis. Efficacy (Cure rate and egg reduction rate) was the main outcome measure. Pairwise and network meta-analysis were used to report Odds Ratios (ORs) with either 95% confidence interval (CI) for direct comparisons or 95% credible intervals (CrI) for indirect comparisons. Results: The SUCRA plot for cure rate revealed that PZQ (SUCRA= 40.4%) was the fourth effective drug after albendazole 400mg (SUCRA= 71.5), metrifonate 5 mg (SUCRA= 62.2%), and metrifonate 10 mg (SUCRA= 59.7). PZQ was only superior to metrifonate 7.5 mg. ORs were PZQ 40 mg (OR 0.48; 95% CI -3.55 to 4.51; p-value 0.816), artesunate 6 mg (OR 0.06; 95% CI -5.67 to 5.79; p-value 0.983), metrifonate 5 mg (OR -1.65; 95% CI -7.52 to 4.21; p-value 0.581), metrifonate 10 mg (OR -1.76; 95% CI -8.86 to 5.34; p-value 0.628), and metrifonate 7.5 mg (OR -2.40; 95% CI -9.78 to 4.98; p-value 0.524). A similar plot for egg reduction rate showed an exclusive superiority of PZQ 40 mg (SUCRA= 94.4%), followed by metrifonate 10mg (SUCRA= 82.3%) and niridazole 25mg plus metrifonate 10mg (SUCRA= 48.6%). Conclusions: Our network analysis revealed that PZQ 40 mg was the most efficient drug in reducing egg count, whereas albendazole 400mg showed the highest cure rates.