Infection. 2026 May 8. doi: 10.1007/s15010-026-02807-w. Online ahead of print.
ABSTRACT
BACKGROUND: Praziquantel (PZQ) is the mainstay treatment for schistosomiasis, but its efficacy against juvenile schistosomes is limited, which can lead to treatment failure and reinfection. Artemisinin derivatives (ARTs) exhibit potent activity against juvenile worms, offering a complementary mechanism. However, the potential risk of accelerating artemisinin resistance, particularly in schistosomiasis-malaria co-endemic regions, warrants consideration when evaluating ART-based regimens. To find a more optimal regimen for the treatment of schistosomiasis, this meta-analysis evaluated the effectiveness of ARTs and PZQ in combination or as a single agent for the treatment of schistosomiasis.
PURPOSE: To evaluate the efficacy and safety of PZQ combined with ARTs compared with praziquantel alone for the treatment of schistosomiasis through a meta-analysis of randomized controlled trials.
METHODS: Randomized controlled trials (RCTs) of artemisinin derivatives in combination with praziquantel in the treatment of schistosomiasis were selected from computerized searches of PubMed, Embase, Cochrane Library, and Web of Science, up to November 2025. The inclusion criteria were randomized controlled trials involving participants diagnosed with Schistosoma mansoni, S. haematobium, or S. japonicum, who were treated with PZQ combined with ARTs or PZQ alone, and reporting on efficacy and safety outcomes. The primary outcome indicator was cure rate (CR), and secondary outcome indicators were egg count reduction rate and number of adverse events. The meta-analysis was performed using a random-effects model. Subgroup analyses were conducted to explore the impact of different types of schistosomes.
RESULTS: A total of eight studies, involving 1595 patients with schistosomiasis, explored the cure rate of PZQ combined with ARTs and PZQ alone. The pooled result showed that PZQ combined with ARTs had a significantly higher cure rate than PZQ alone (RR 1.12; 95% CI 1.01-1.24; P = 0.02). The corresponding subgroup analysis results showed that the CR of patients with S. mansoni treated with PZQ combined with ARTs was still higher than that of patients treated with PZQ alone (RR 1.16; 95% CI 1.01-1.34; P = 0.03). However, there was no statistically significant difference between PZQ combined with ARTs and PZQ for S. haematobium (RR 1.11; 95% CI 0.99-1.23; P = 0.06) or S. japonicum (RR 1.02; 95% CI 0.95-1.09; P = 0.60) in subgroup analyses. In addition, our study also found that there was no significant difference in egg count reduction between the PZQ-ARTs and PZQ-alone groups, either for S. mansoni (MD – 4.54, 95% CI – 17.67 to 8.58; P = 0.50) or for S. haematobium (MD – 13.74; 95% CI – 55.64 to 28.15; P = 0.52). Furthermore, the combination therapy was associated with a higher incidence of adverse events compared with PZQ alone (RR 1.41; 95% CI 1.01 to 1.96; P = 0.04).
CONCLUSIONS: The combination of PZQ and ARTs can significantly improve the CR for S. mansoni, but not for other schistosome species, at the cost of a higher incidence of adverse events, which were however manageable.
PMID:42101772 | DOI:10.1007/s15010-026-02807-w
