Efficacy and safety of praziquantel 40 mg/kg in preschool-aged and school-aged children: A meta-analysis

Background: children carry most of the schistosomiasis burden. while school-aged children are the principal target group of preventive chemotherapy with praziquantel,limited information on efficacy and safety exists for preschool-aged children. methods: here,we conducted a meta-analysis of clinical trials of praziquantel for treating children with any form of schistosomiasis. efficacy was reported as cure rate (cr) and egg reduction rates (err); statistical corrections were applied based on methodological disparities across trials to derive the predicted geometrical mean err (perrgm). safety was reported as frequencies of adverse events. results: forty-seven comparative and non-comparative studies were identified,enrolling 15,549 children of whom 14,340 (92%) were assessed between 3 and 8 weeks post-treatment with praziquantel 40 mg/kg (the who-recommended treatment,n = 8,380,56%) or comparators (n = 5,960,44%). the median age was 10 years (range 1-19),11% (n = 1,694) were preschool-aged. the cr and perrgm with praziquantel 40 mg/kg were respectively: s. haematobium,73.6% (95% ci: 63.5-81.40,25 study arms) and 94.7% (95% ci: 92.7-96.4); s. mansoni,76.4% (95% ci: 71.5-81.0,34 arms) and 95.3% (95% ci: 94.2-96.2); s. mansoni/s. haematobium,67.6% (95% ci: 54.1-80.7,5 arms) and 93.4% (95% ci: 89.9-96.2); s. japonicum,94.7% (95% ci: 92.2-98.0) and 98.7% (95% ci: 98.3-99.2). mixed-effect multivariate analysis found no significant difference between preschool- and school-aged children for cr or perrgm in s. haematobium (p = 0.309 and p = 0.490,respectively) or s. mansoni (p = 0.982 and p = 0.895) after controlling for time of assessment,formulation,intensity of infection and detection method. praziquantel was reportedly safe at all ages,with only mild reported adverse events which cleared rapidly after treatment. conclusions: praziquantel 40 mg/kg was effective at reducing infection intensity in all schistosoma species without differences between preschool- and school-aged children. however,conclusions should be tempered because of the limited number of preschool-aged children enrolled,disparities in study procedures and limited information made available in publications,as well as the current imperfect test-of-cure. also,although reportedly well-tolerated,safety was inconsistently assessed. studies in target groups,individual-data meta-analysis and standardised methodologies are needed for more robust evidence-base. © 2017 the author(s).