Albendazole-Praziquantel Dual Therapy Compared With Albendazole Monotherapy in Neurocysticercosis: A Systematic Review and Meta-Analysis of RCTs.

Background and Objectives: Neurocysticercosis is the most common parasitic infection of the CNS and remains a significant, yet often neglected, public health issue in endemic regions. High-quality evidence suggests that albendazole monotherapy leads to superior clinical outcomes compared with placebo or praziquantel. However, there is still insufficient evidence regarding the efficacy and safety of combined albendazole-praziquantel therapy. This systematic review and meta-analysis aims to compare combined antiparasitic therapy with albendazole and praziquantel with albendazole monotherapy, evaluating whether dual therapy offers superior therapeutic benefits in the management of neurocysticercosis while maintaining an acceptable safety profile. Methods: We searched MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) published until April 2024 that compared combined albendazole-praziquantel therapy with albendazole monotherapy for the treatment of neurocysticercosis. Statistical analysis was performed using Review Manager 5.4.1, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. A random-effects model was applied to all end points. The risk of bias was assessed for each study, and the certainty of evidence was evaluated using the GRADE approach. Results: Five RCTs were included, comprising a total of 320 patients, 49% of whom received combined therapy. Complete cyst resolution was significantly more frequent in patients treated with combined albendazole-praziquantel therapy compared with albendazole monotherapy (OR = 3.06; 95% CI [1.81-5.19]; p = 0.0001; I 2 = 5%; high-certainty evidence). In a subgroup analysis restricted to patients with 1-2 cysts (248 patients), no statistically significant difference in complete cyst resolution was observed (OR = 1.98; 95% CI [0.92-4.27]; p = 0.08; I 2 = 34%; very-low-certainty evidence). There was no significant difference in seizure recurrence between treatment strategies (OR = 1.28, 95% CI [0.56-2.91], p = 0.55, I 2 = 0%; moderate-certainty evidence). Similarly, the incidence of adverse effects did not differ significantly between groups (OR = 1.40, 95% CI [0.72-2.72], p = 0.30, I 2 = 0%; moderate-certainty evidence). Discussion: This systematic review and meta-analysis demonstrated a threefold increase in complete cyst resolution among patients receiving combined therapy, suggesting its superiority over albendazole monotherapy for the management of neurocysticercosis. In addition, no significant differences were observed between treatment strategies regarding seizure or adverse events.