Emodepside is a better treatment than albendazole for T. trichiura and hookworm infections

1. In this randomized controlled trial, emodepside had higher efficacy in treating Trichuris trichiura infections than albendazole and placebo.

2. A higher dose of emodepside was required for those with hookworm infections compared to those with T. trichiura infections.

Evidence Rating Level: 1 (Excellent)

Study Rundown: T. trichiura and hookworm are intestinal helminths that are transmitted through soil to humans and disproportionately impact individuals in remote regions. Currently, available anthelmintic drugs have unclear efficacy comparatively for different species of helminths. This study examines the efficacy of emodepside as a treatment for T. trichiura and hookworm. The predicted cure rate using emodepside at a 15mg dose was 92% and slightly higher with greater doses. Emodepside was seen to have greater efficacy against T. trichiura than albendazole and placebo. There was a predicted dose-dependent response of the geometric mean egg-reduction rate. The emodepside groups had significantly higher observed geometric mean egg-reduction rates than the albendazole group. The efficacy of emodepside 15mg dose against hookworm was similar to the cure rate of albendazole. However, a greater dose at 30 mg of emodepside had a predicated cure rate for hookworm at 92%. Emodepside at doses of 20 mg and greater were efficacious against coinfection with Ascaris lumbricoides. Side effects endorsed by patients on emodepside include headache, dizziness, and blurred vision in a dose-dependent relationship. Participants in the albendazole and placebo groups experienced fewer adverse events. The major limitations of the current study were the small sample size impacting generalizability and the lack of objective measures for symptom measurement.

Click to read the study in NEJM

Relevant Reading: Hookworm infection

In-Depth [randomized controlled trial]: This dose-ranging, randomized, placebo-controlled trial was conducted across five regions on Pemba Island, Tanzania. The present study assessed the efficacy of emodepside in curing infections with T. trichiura and hookworm. This study also evaluated egg-reduction rates, safety, and side effects of emodepside. Adults aged 18 to 45 years with T. trichiura or hookworm eggs detected on at least two of four Kato-Katz thick smears and with at least 48 eggs per gram of stool were eligible for the study. Participants were randomized for the following treatments: 5, 10, 15, 20, 25, or 30mg of emodepside, 400 mg of albendazole, or placebo. A total of 442 persons met the eligibility criteria, with 266 assigned to the T. trichiura trial and 176 assigned to the hookworm trial. The 5mg emodepside dose showed a predicted cure rate of 85% (95% Confidence Interval [CI], 69 to 93). This was associated with a predicted cure rate of 92% (95% CI, 86 to 96) with the 15mg dose. Emodepside at the 5 mg dose had greater efficacy against T. trichiura than albendazole (observed cure rate, 83% vs. 17%) and placebo (observed cure rate, 10%). Further, the egg reduction rate of the 5mg emodepside group was 99.6% (95% CI, 49.4 to 100.0) and 99.9% (95% CI, 83.4 to 100.0) in the 15mg group. All of the emodepside groups had a significantly greater egg reduction rate than the albendazole group at 76% (95% CI, 53.9 to 88.0). Emodepside was efficacious at doses of 20 mg or higher for coinfection against A. lumbricoides. The most common side effects of emodepside were blurred vision, photophobia, and headache. In summary, emodepside was an effective treatment for T. trichiura and hookworm in this study.

Image: PD

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