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Table 4 Main therapeutic findings and conclusions of randomized controlled trials included in the quantitative analysis (meta-analysis)

From: Medical treatment of cystic echinococcosis: systematic review and meta-analysis

Author/s. Year(Ref.no.) Cyst location Mean cyst size(cm) Treatmenta Endpoint Main quantitative findings*
Bildik N, et al....... 2007 [33] Liver Non-registered information G-I: ABZ (10 mg/kg/day 1 month before surgery)
G-II: ABZ (10 mg/kg/day 2 months before surgery)
G-III: ABZ (10 mg/kg/day 3 months before surgery)
G-IV (control gr.): surgery (no preoperative therapy)
Viability of the scoleces   Intact Dead
G-I
G-II
G-III
G-IV
10
7
2
17
11
14
19
4
Cobo F, et al. 1998 [9] Liver Non-registered information G-I: ABZ (10 mg/kg/day 1 month before surgery)
G-II: ABZ (20 mg/kg/day 1 months before surgery)
G-III: ABZ (10 mg/kg/day) + PZQ (25 mg/kg/day 1 month before surgery)
Protoscolex viability. ABZ sulphoxide levels in serum and cyst fluid Protoscoleces viability
G-III and G-I
G-III and G-II
p = 0.004
p = 0.030
ABZ sulphoxide levels
G-III and G-I
G-III and G-II
p = 0.016
p = 0.034
Davis A, et al. 1986 [34] Liver, lung, other organs Non-registered information MBZ (13 to 136.4 mg/kg/day)
FBZ (37.5 to 54.5 mg/kg/day)
ABZ (9.8 to 15.4 mg/kg/day)
Results:
-success
-partial success
-improvement
-no success
MBZ FBZ ABZ
8 (9.4)
4 (4.7)
40 (47.1)
33 (38.8)
1
-
-
5
5 (16.7)
4 (13.3)
14 (46.7)
7 (23.3)
Davis A, et al. 1989 [35] Liver, lung, other organs Non-registered information ABZ (10 mg/kg/day 1 month)
MBZ (1.5 to 4.5 g/kg/day, children half of the adult dose)
Results:
-success
-favourable effect
-no success
Follow-up ABZ MBZ
< 12 months:
-success
-favourable effect
-no success
no evaluation
> 12 months:
-success
-favourable effect
-no success
21 (100)
-
13 (62)
5 (24)
3 (14)
46 (100)
18 (39)
18 (39)
10 (22)
23 (100)
-
6 (26)
13 (57)
4 (17)
22 (100)
3 (14)
14 (64)
5 (23)
Franchi C, et al. 1999 [36] Liver, abdomen, lung Non-registered information G-I: MBZ (50 mg/kg/day)
G-II: ABZ (10–12 mg/kg/day)
Both drugs in continuous 3- to 6-months cycles
Chest radiographic, ultrasonography, morphological changes and sonographic classification by Caremani et al Cysts G-I G-II
Treated
Evaluated
Changed
Further deg.
Relapse
289
271
152
34
37
640
611
502
110
134
Gil-Grande LA, et al. 1993 [37] Liver or abdominal G-A: 10.4 ± 4.1
G-B: 8.9 ± 4.3
G-C: 10.5 ± 5.1
G-A: ABZ (10 mg/kg/day 1 month before surgery)
G-B: ABZ (10 mg/kg/day 3 months before surgery)
G-C (control group): surgery (no ABZ treatment)
Protoscolex and cyst viability (patients/mice). Echographic changes p-value
Viability of protoscolices 0.041
Intraperitoneal inoculation 0.167
Membrane disruption < 0.001
Echographic changes 0.038
Keshmiri M, et al. 1999 [38] Lung E.gr: cm3 ± SD,
29.6 ± 50.5All
27.1 ± 45.8Treat.
C.gr: cm3 ± SD,
18.3 ± 49.5All
25.1 ± 63.3Treat.
Experimental group: ABZ (10–15 mg/kg/day 6 months)
Control group: placebo
Radiological or ultrasonic findings. Response to treatment was classified:
-Cured
-Improved
-No change
-Worsened
(Caremani et al)
  ABZ Placebo
No. cysts
Worse
No change
124
9 (7)
32 (26)
26
10 (39)
13 (50)
Decreased
> 25% (p < 0.001)
> 50% (p < 0.001)
> 75% (p = 0.067)
Disappeared (p = 0.075)
83 (67)
60 (48)
36 (29)
16 (13)
3 (12)
1 (4)
1 (4)
0 (0)
Keshmiri M, et al. 2001 [39] Lung, abdomen (including liver) E.gr: cm3 ± SD,
Lung, 29.6 ± 50.5All
27.1 ± 45.8Treat.
Abdomen (liver),
198.1 ± 403.7All
212.7 ± 426.2Treat.
C.gr: cm3 ± SD,
Lung,
18.3 ± 49.5All
25.1 ± 63.3Treat.
Abdomen (liver),
74.0 ± 130.8All
91.9 ± 155.4Treat.
Experimental group: ABZ (400 mg twice a day, in 3 cycles of 6 weeks with 2 weeks between cycles)
Control group: placebo
Volume. Ultrasonography and Computed tomography changes: 7 types, T1-T7.
Response to treatment was classified:
-Cured
-Improved
-No change
-Worsened
(Caremani et al)
  ABZ Placebo
No. cysts
Worse (p < 0.001)
No change
Improved (p < 0.001)
Cure (p = 0.081)
172
15 (8.7)
23 (13.4)
117 (68)
17 (9.9)
31
11 (35.5)
16 (51.6)
4 (12.9)
0 (0.0)
Khuroo MS, et al. 1993 [40] Liver cm / cm3, mean ± SD
At entry into the study vs the end of study
PD,
9.2 ± 4.4 vs 5.1 ± 3.9
686 ± 651 vs 297 ± 515
ALB-PD,
10.8 ± 3.0 vs 4.8 ± 3.4
835 ± 528 vs 260 ± 389
ALB,
8.8 ± 4.5 vs 8.0 ± 5.0
642 ± 717 vs 606 ± 741
G-I: PD
G-II: ABZ (10 mg.kg-1.day-1 for 8 weeks) plus PD
G-III: ABZ alone
At entry into the study vs the end of study:
-Clinical response
-Cyst size
-Cyst echopattern
-Hydatid serology
-Complications
  p-value
Clinical response < 0.001
  < 0.005
Cyst diameter
Cyst volume
Cyst echopattern
Hydatid serology
< 0.05
< 0.01
< 0.01
NS
Mohamed AE, et al. 1998 [8] 1st, Liver(18), lung(1), multiple cyst(3).
2nd, Liver(13), lung(2), others:pelvis, mediastinum, kidney, spinal(4)
Non-registered information 1st, ABZ (400 mg twice day four weeks/two-week drug free period)
2nd, ABZ (400 mg twice a day) + PZQ (50 mg/kg)
Ultrasound and computed tomography changes, magnetic resonance, hydatid serology and chest-X-ray.
Complete cure rates
  ABZ ABZ + PZQ
No. patients 22 19
Disappearance 8 (36.4) 9 (47.4)
Liver   7/13
Lung   2/2
Reduction 5 (22.7) 9 (47.4)
Liver   5/13
Others   4/4
No change 2 (9.1) 1 (5.2)
Increase 0 0
Shams-UI-Bari, et al. 2011 [41] Liver Non-registered information Group A: surgery.
Group B: ABZ (10 mg/kg/day 12 weeks) + surgery + ABZ (10 mg/kg/day 12 weeks)
Viability, motility of the scolices and their ability to exclude 5% eosin, under immediate microscopy.
Recurrence.
  G-A G-B
Type I
Type II
Type III
Type IV
Viable
Non-viable, p < 0.01
Recurrence, p < 0.05
12 (33.3)
10 (27.2)
8 (22.2)
6 (16.6)
36 (100)
0 (0)
6 (16.6)
11 (30.5)
11 (30.5)
10 (27.7)
4 (11.1)
2 (5.5)
34 (94.5)
0 (0)
  1. *Statistical significance level of 5% (p < 0.05)
  2. aABZ Albendazole, PZQ Praziquantel, MBZ Mebendazol, FBZ Flubendazole