title: Systematic review and meta-analysis of artemisinin based therapies for the treatment and prevention of schistosomiasis.
abstract: BACKGROUND
  Chemotherapy based on repeated doses of praziquantel is still the most effective control strategy against Schistosomiasis, however artemisinin derivatives emerged as a family of compounds with schistomicide activity. The aim of the present work is to compare the efficacy of artemisinin-based therapies in the treatment and prophylaxis of human schistosomiasis. The design of this work involved a quantitative systematic review and meta-analysis.
  
  
  RESULTS
  Retrieval of published studies was carried out through an electronic search of the PubMed (MEDLINE), EMBASE, Cochrane Library and CINAHL databases. This included reports comparing the therapeutic efficacy of artesunate alone, artesunate plus sulfadoxine-pyrimethamine and a combination of artemisinin derivatives plus praziquantel against praziquantel alone on different types of schistosomiasis. Moreover, studies on artesunate and artemether used as preventive drugs were also analyzed against placebo. The primary outcome measure for schistosomiasis treatment was "parasitological cure", whereas for the prophylaxis the outcome evaluated was "infection rate". Our results show that patients treated with artesunate alone have significantly lower cure rates than those treated with praziquantel (OR = 0.27 (95% C.I. 0.13-0.53; p<0.001)) and that the combined therapy of artesunate plus sulfadoxine-pyrimethamine is also significantly less effective than praziquantel treatment (OR = 0.14 (95% C.I. 0.02-0.92; p = 0.04)). However, the combination of an artemisinin derivatives plus praziquantel showed a higher cure rate than praziquantel monotherapy with OR = 2.07 (95% C.I. 1.27-3.36; p = 0.003). Finally, chemoprophylaxis with either artesunate (RR = 0.11 (95% C.I. 0.06-0.22; p<0.001)) or artemether (RR = 0.25 (95% C.I. 0.16-0.40; p<0.001)) was significantly better than a placebo in both cases.
  
  
  CONCLUSIONS
  This meta-analysis confirms that artemisinin derivatives used in combination with praziquantel have the potential to increase the cure rates in schistosomiasis treatment, but not artesunate alone. It is also confirmed that repeated doses of artemisinin derivatives play a prophylactic role, significantly reducing the incidence of Schistosoma japonicum infections compared with placebo.
authors.affiliation: Laboratorio de Inmunología y Parasitología Molecular, IBSAL-CIETUS, Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain. luispmoro@usal.es
authors.forename: Luis
authors.initials: L
authors.lastname: Pérez del Villar
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Burguillo
authors.forename: Julio
authors.initials: J
authors.lastname: López-Abán
authors.forename: Antonio
authors.initials: A
authors.lastname: Muro
mesh_terms: D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D037621:Artemisinins / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D006801:Humans; D011223:Praziquantel / Q000627:therapeutic use; D011739:Pyrimethamine / Q000627:therapeutic use; D012552:Schistosomiasis / Q000188:drug therapy* / Q000517:prevention & control*; D013413:Sulfadoxine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000981:Antiprotozoal Agents; D037621:Artemisinins; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D011223:Praziquantel; D013413:Sulfadoxine; C031327:artemisinin; D011739:Pyrimethamine