Benzimidazoles in the treatment of alveolar echinococcosis: a comparative study and review of the literature

Abstract

Mebendazole and albendazole are the drugs of choice for the treatment of alveolar echinococcosis. In this open-labelled observational study we present and evaluate the outcome of long-term treatment with these drugs and present results of different treatment regimens. Thirty-five patients were started on either mebendazole or albendazole at the beginning of 1992 and followed for an average of 39 months (range 12-79 months). Treatment was classed as successful if the disease had not progressed for>1 year and if there were no side-effects necessitating a change of treatment. Lack of progression was evaluated mainly using ultrasound and computed tomography and was further substantiated by laboratory tests and clinical findings. The overall success rate was 97%. An initial regimen for cases of alveolar echinococcosis was recurrence-free in 71% of those treated with mebendazole and in 78% of those treated with albendazole. Four out of five cases with progressive disease stabilized after the therapeutic regimen was changed. Seven patients received a continuous regimen with albendazole. These patients were observed over an average of 28 months (range 13-50 months) without signs of progression or significant side-effects. This open-labelled prospective study demonstrates the high therapeutic efficacy of both mebendazole and albendazole with similar response rates in the treatment of alveolar echinococcosis. Albendazole reduced costs by >40% and is easier for patients to take, further arguing in favour of its preferred use. Albendazole in alveolar echinococcosis is only licensed for intermittent application. None the less, continuous treatment is safe and well tolerated and showed promising results when applied to patients in whom other treatment regimens had failed. It should thus be strongly considered in inoperable cases or progressive disease.

Mebendazole Induces Apoptosis via Bcl-2 Inactivation in Chemoresistant Melanoma Cells

“…Mebendazole has been extensively used to treat gastrointestinal parasitic infections in humans, and in this capacity, it has shown remarkable efficacy and safety (17,18). Furthermore, clinical data from long-term mebendazole therapy in the treatment of alveolar echinococcosis suggest that mebendazole should also exhibit minimal toxicity when used as a cancer therapy (19,20).…”

“…Mebendazole is more suited for clinical study than other benzimidazoles identified in our screen given its status as a marketed drug, its oral availability, and its favorable safety profile in long-term treatment regimens (19). In contrast, a pilot study of albendazole treatment in advanced cancer resulted in increased levels of neutropenia in treated subjects (22).…”

Structured treatment interruption in patients with alveolar echinococcosis

“…Chronic intake of benzimidazoles, however, may be complicated by serious side effects, and benzimidazoles are expensive drugs. 19 Recent case reports describe a parasitocidal effect for benzimidazoles, suggesting the possibility for definite discontinuation of the medication. 5,6,20 Thus, parameters indicating death of the parasite would allow the discrimination of a subgroup of patients in whom long-term medical treatment could be discontinued.…”

“…Eight patients with new signs of progression 18 months after discontinuation of benzimidazoles were restarted on continuous dosing of ABZ. 19 Shortly after starting ABZ, rising transaminases forced the change to MBZ in 1 case; the patient has been asymptomatic since. The other 7 patients tolerated the reinitiation of treatment well.…”

Unusual clinical course of trichinellosis with relapse

“…Such parasitostatic effect of albendazole on parasite germinating cell is also known in Echinococcus multilocularis. After cessation of albendazole treatment, the growth of larvocysts is resumed (Reuter et al, 2000). When a 10-day-administration of albendazole was completed during the first hospitalization, similar regeneration of Trichinella females parasitizing in intestine could have occurred and the production of new born larvae might continue.…”