Triclabendazole in the treatment of human fascioliasis: a review

Abstract

Fascioliasis occurs on all inhabited continents. It is caused by Fasciola hepatica and Fasciola gigantica, trematode parasites with complex life cycles, and primarily affects domestic livestock. Humans become infected after ingestion of contaminated food (typically wild aquatic vegetables) or water. Fascioliasis may be difficult to diagnose as many symptoms are non-specific (e.g. fever, abdominal pain and anorexia). Treatment options are limited, with older effective therapies such as emetine and bithionol no longer used due to safety issues and unavailability, and most common anthelminthics having poor efficacy. Clinical trials conducted over a 25-year period, together with numerous case reports, demonstrated that triclabendazole has high efficacy in the treatment of human fascioliasis in adults and children and in all stages and forms of infection. Triclabendazole was approved for human use in Egypt in 1997 and in France in 2002 and a donation program for the treatment of fascioliasis in endemic countries was subsequently established by the manufacturer and administered by the World Health Organization. Here the published data on triclabendazole in the treatment of human fascioliasis are reviewed, with a focus on more recent data, in light of the 2019 US Food and Drug Administration approval of the drug for use in human infections.

<p>Human Fascioliasis: Current Epidemiological Status and Strategies for Diagnosis, Treatment, and Control</p>

“…Triclabendazole resistance is a significant problem in some European, Latin American and African countries that may increase the economic burden of fascioliasis. 26 In Germany, the breakdown of the median annual costs associated with fascioliasis in each farm included treatment of cattle (USD 100), decreased efficiency of calf production (USD 2100), and decreased milk production (USD 735). 27 In developing countries, the burden of fascioliasis in livestock is less well studied.…”

Equines as reservoirs of human fascioliasis: transmission capacity, epidemiology and pathogenicity inFasciola hepatica-infected mules

“…For the treatment of fascioliasis in mules, drugs successfully used in horses may be applied. Triclabendazole continues to be the drug of choice because it is the only one efficient against both migrating fluke juveniles and fluke adults in the bile ducts, for both animals and humans (Gandhi et al ., 2019). Triclabendazole is widely used for equines nowadays (Dorchies, 2010).…”

Triclabendazole for the treatment of human fascioliasis and the threat of treatment failures

“…For instance, Keiser et al Egypt, Chile and Iran, the cure rates were dose-dependent, the higher the dose the higher the cure rate. Cure rates were the highest (above 95.5%) for the 20 mg/kg dose, followed by cure rates of 88% in the 10mg/kg dose and 50% in the 5 mg/kg dose [59]. There have not been clinical trials of TCBZ using more than 20mg/kg but in clinical practice, 30-60mg/kg divided in several days and weeks have been well tolerated in chronic fascioliasis cases and they have achieved cure (negative stool examination up to 90 days post treatment) in two thirds of the patients who failed standard-of-care regimens without evidence of re-infection (Terashima unpublished data).…”

“…More than 500 people in several countries around the world received the veterinary form of TCBZ between 1986 and 2002 with no or minimal adverse events [53][54][55][56][57][58]. Later, in the 1990s, the WHO started the development of TCBZ for human use [59]. The main use of TCBZ during the last 2 decades has been by the WHO in order to treat and control fascioliasis.…”