Background Periodic mass distribution of benzimidazole anthelminthic drugs is the key strategy to control soil-transmitted helminths (STHs) globally. However, benzimidazoles have low efficacy against Trichuris trichiura, and there are concerns about benzimidazole resistance potentially emerging in humans. Therefore, identifying alternative drug regimens is a pressing priority. We present a systematic review and network meta-analysis comparing the efficacy of 21 different anthelminthic drug regimens, including standard, novel, and combination treatments. Methods We searched PubMed, Medline, Embase, Web of Science, and Cochrane databases and identified studies comparing anthelminthic treatments to each other or placebo. The outcomes calculated were relative risk (RR) of cure and difference in egg reduction rates (dERR). We used an automated generalized pairwise modeling framework to generate mixed treatment effects against a common comparator, the current standard treatment (single-dose albendazole). Results Our search identified 4876 studies, of which 114 were included in the meta-analysis. Results identified several drug combinations with higher efficacy than single-dose albendazole for T. trichiura, including albendazole-ivermectin (RR of cure, 3.22 [95% confidence interval {CI}, 1.84-5.63]; dERR, 0.97 [95% CI, .21-1.74]), albendazole-oxantel pamoate (RR, 5.07 [95% CI, 1.65-15.59]; dERR, 0.51 [95% CI, .50-.52]), mebendazole-ivermectin (RR, 3.37 [95% CI, 2.20-5.16]), and tribendimidine-oxantel pamoate (RR, 4.06 [95% CI, 1.30-12.64]). Conclusions There are several promising drug combinations that may enhance the impact of STH control programs on T. trichiura, without compromising efficacy against Ascaris lumbricoides and hookworm. We suggest further, large-scale trials of these drug combinations and consideration of their use in STH control programs where T. trichiura is present. International Prospective Register of Systematic Reviews Registration CRD42016050739.

中文翻译：

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驱虫药和药物组合对土壤传播的蠕虫的功效：系统评价和网络荟萃分析。

背景苯并咪唑驱虫药的周期性质量分布是控制全球土壤传播蠕虫（STH）的关键策略。然而，苯并咪唑类抗Trichuris trichiura的功效较低，并且人们担心苯并咪唑类抗性可能会在人类中出现。因此，确定替代药物方案是当务之急。我们提供了系统的综述和网络荟萃分析，比较了21种不同的驱虫药方案（包括标准疗法，新颖疗法和联合疗法）的疗效。方法我们搜索了PubMed，Medline，Embase，Web of Science和Cochrane数据库，并确定了将驱虫药彼此之间或安慰剂之间进行比较的研究。计算出的结果是治愈的相对风险（RR）和减蛋率（dERR）的差异。我们使用自动化的成对建模框架来针对通用比较器（当前的标准治疗）（单剂量阿苯达唑）产生混合治疗效果。结果我们的搜索结果确定了4876项研究，其中114项纳入荟萃分析。结果确定了几种药物组合，其对曲毛癣菌的疗效高于单剂量阿苯达唑，包括阿苯达唑-伊维菌素（治愈率，3.22 [95％置信区间{CI}，1.84-5.63]； dERR，0.97 [95％CI， .21-1.74]），阿苯达唑-黄曲霉酸酯（RR，5.07 [95％CI，1.65-15.59]; dERR，0.51 [95％CI，.50-.52]），甲苯咪唑-伊维菌素（RR，3.37 [95] ％CI，2.20-5.16]）和三苯二酰亚胺-黄嘌呤棕榈酸酯（RR，4.06 [95％CI，1.30-12.64]）。结论有几种有希望的药物组合可能会增强STH控制程序对Trichiura T.trichiura的影响，而不会损害针对A虫和钩虫的功效。我们建议对这些药物组合进行进一步的大规模试验，并考虑将其用于存在Trichiura的STH控制程序中。系统评价注册国际前瞻性注册CRD42016050739。