Efficacy of China-made praziquantel for treatment of Schistosomiasis haematobium in Africa: A randomized controlled trial

Xin-Yao Wang, Jian He, Saleh Juma, Fatma Kabole, Jia-Gang Guo, Jian-Rong Dai, Wei Li, Kun Yang, Xin-Yao Wang, Jian He, Saleh Juma, Fatma Kabole, Jia-Gang Guo, Jian-Rong Dai, Wei Li, Kun Yang

Abstract

Background: In the roadmap on the neglected tropical diseases (NTD) the World Health Organization (WHO) aims at attaining at least 75% coverage of preventive chemotherapy in pre-school and school-age children by 2020. A randomized controlled trial was used to compare the effectiveness of praziquantel in treating Schistosoma haematobium in Africa using two different sources for the drug, Merck Limited Partnership (KgaA), Germany and Nanjing Pharmaceutical Factory (NPF), China.

Methods: More than 6,000 participants testing positive for S. haematobium infection were enrolled from three villages (shehias) situated in the northern, middle and southern part of Pemba Island, Zanzibar. Applying criteria of inclusion and exclusion, resulted in a study population of 152 people (84 males, 68 females). A randomized controlled trial was conducted assigning participants to either praziquantel from NPF or Merck KGaA. After one month, the cure rate of S. haematobium and adverse events were compared to evaluate effectiveness. The ratio of male to female, the ratio of light/high infection intensity, and the average value of age were calculated between the two drug manufacturers. Chi-squared test and T-test were used for consistency analysis.

Results: Out of the total of 73 cases receiving praziquantel from NPF, the cure rate achieved was 97.3% (73/75), while the 74 cases receiving the drug from Merck KgaA reached a similar cure rate (96.1% or 74/77). There was no significant difference between the two outcomes (χ2 = 0.003, P = 0.956). Among the 75 patients treat, only one (a 16-years old female student), who had received the drug made in China had slight adverse reactions manifested as dizziness, headache and abdominal pain.

Conclusion: The efficacy of China-made praziquantel does not differ significantly from praziquantel made by Merck KGaA in Germany.

Trial registration: ClinicalTrials.gov, NCT03133832.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram.
Fig 1. Flow diagram.

References

    1. Collins C, Xu J, Tang S. Schistosomiasis control and the health system in P.R.China. Infect Dis Poverty. 2012. November 1; 1(1): 1–8. 10.1186/2049-9957-1-8
    1. Van DAM GJ, Xu J, Bergquist R, De Dood CJ, Utzinger J, Qin ZQ, et al. An ultra-sensitive assay targeting the circulating anodic antigen for the diagnosis of Schistosoma japonicum in a low-endemic area, People's Republic of China. Acta Tropica. 2015. January; 141(Pt B): 190–7. 10.1016/j.actatropica.2014.08.004
    1. Barsoum RS, Esmat G, El-baz T. Human schistosomiasis: clinical perspective: review. J Adv Res. 2013. September; 4(5): 433–44. 10.1016/j.jare.2013.01.005
    1. Lewis FA, Tucker MS. Schistosomiasis. Adv Exp Med Biol. 2014. May 21; 766(6): 47–75. 10.1007/978-1-4939-0915-5_3
    1. Abdel-Wahab MF, Yosery A, Narooz S, Esmat G, el Hak S, Nasif S, et al. Is Schistosoma mansoni replacing Schistosoma haematobium in Fayoum?. Am J Trop Med Hyg. 1993. December; 49(6): 697–700. 10.4269/ajtmh.1993.49.697
    1. Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends. Eur Urol. 2017. January; 71(1): 96–108. 10.1016/j.eururo.2016.06.010
    1. Khurana S, Dubey M L, Malla N. Association of parasitic infections and cancers. Indian J Med Microbiol. 2005. April; 23(2): 74–9. 10.4103/0255-0857.16044
    1. El-Fakahany AF, Abdalla KF, El-Hady HM, Abd el-Aziz SM, Afifi LM. The effect of praziquantel treatment on the liver functions, worm burden, and granuloma size using two drug regimen in murine Schistosoma mansoni infection. J Egypt Soc Parasitol. 1993. December; 23(3): 877–86.
    1. Fakahany AFE, Fetouh K, Hadi HE, Aziz SAE, Afifi L. Effect of praziquantel treatment on the liver functions, worm burden, and granuloma size using murine Schistosoma mansoni infection. J Egypt Soc Parasitol. 1993. December; 23(3): 877–86.
    1. Mansoury ST. Effect of two trematodicidal drugs on the morphology and tegumentary ultrastructure of Schistosoma mansoni. J Egypt Soc Parasitol. 1997. April; 27(1): 233–41.
    1. Markoski MM, Trindade ES, Cabrera G, Laschuk A, Galanti N, Zaha A, et al. Praziquantel and albendazole damaging action on in vitro developing Mesocestoides corti (Platyhelminthes: Cestoda). Parasitol int. 2006. March; 55(1): 51–61. 10.1016/j.parint.2005.09.005
    1. Cioli D, Pica-Mattoccia L. Praziquantel. Parasitol Res. 2003. June; 90(1): S3–S9. 10.1007/s00436-002-0751-z
    1. Bobyreva NS, Korneeva YA, Degteva GN. Analysis of parasitological situation in nenets autonomous district. Gigiena i Sanitariya. 2006. March; 55(1): 51–61. 10.1016/j.parint.2005.09.005
    1. Xu LL, Jiang B, Duan JH, et al. Efficacy and Safety of Praziquantel, Tribendimidine and Mebendazole in Patients with Co-infection of Clonorchis sinensis and Other Helminths. PLoS Negl Trop Dis. 2014. August 14; 8(8): e3046 10.1371/journal.pntd.0003046
    1. WHO | Schistosomiasis [Internet]. WHO; [cited 2018 Mar]. Available from:
    1. Hotez PJ, Fenwick A. Schistosomiasis in Africa: An Emerging Tragedy in Our New Global Health Decade. PLoS Negl Trop Dis. 2009. September 29; 3(9): e485 10.1371/journal.pntd.0000485
    1. Knopp S, Person B, Ame SM, Ali SM, Muhsin J, Juma S, et al. Praziquantel coverage in schools and communities targeted for the elimination of urogenital schistosomiasis in Zanzibar: a cross-sectional survey. Parasit Vectors. 2016. January 4; 9(1): 5 10.1186/s13071-015-1244-0
    1. Molyneux DH, Savioli L, Engels D. Neglected tropical diseases: progress towards addressing the chronic pandemic. Lancet. 2017. January 21; 389(10066): 312–25. 10.1016/S0140-6736(16)30171-4
    1. Wu ZW, Bu KM, Liu QL, Li WZ, Peng XS, Zhuo SJ, et al. Study on the effect of praziquantel chemotherapy to reduce the prevalence and spread of schistosomiasis in Dongting lake. Chin J Schisto Control. 1993; (6): 325–9. 10.16250/j.32.1374.1993.06.002
    1. Shan LV | China-Africa Collaboration in Schistosomiasis Control [Internet]. [cited 11 May 2017]. Available from:
    1. MICHUZI MI | Ministry of health Zanzibar signs mou with China to implement a programme to elimanate schistosomiasis in Geneva [Internet]. [cited 2014 May 24]. Available from:
    1. WHO | WHO signs Memorandum of Understanding with China and Zanzibar for collaboration on schistosomiasis elimination in Zanzibar [Internet]. [cited 2014 May 21].
    1. Xu J, Bergquist R, Qian YJ, Wang Q, Yu Q, Peeling R, et al. China-Africa and China-Asia Collaboration on Schistosomiasis Control: A SWOT Analysis. Adv Parasitol. 2016; 92: 435–66. 10.1016/bs.apar.2016.02.005 Epub 2016 Apr 7
    1. Zanzibar | Revolutionary Government of Zanzibar [Internet]. [cited 2018 Jun 2]. Available from: .
    1. Goatly KD, Jordan P. Schistosomiasis in Zanzibar and Pemba. East Afr Med J. 1965. January; 42: 1–9.
    1. Knopp S, Person B, Ame SM, et al. Elimination of schistosomiasis transmission in Zanzibar: baseline findings before the onset of a randomized intervention trial. PLoS Negl Trop Dis. 2013. October 17; 7(10): e2474 10.1371/journal.pntd.0002474
    1. Garcia HH, Gonzales I, Lescano AG, Bustos JA, Zimic M, Escalante D, et al. Efficacy of combined antiparasitic therapy with praziquantel and albendazole for neurocysticercosis: a double-blind, randomised controlled trial. Lancet Infect Dis. 2014. August; 14(8): 687–95. 10.1016/S1473-3099(14)70779-0
    1. King CH, Wiper DW 3rd, De Stigter KV, Peters PA, Koech D, Ouma JH, et al. Dose-finding study for praziquantel therapy of Schistosoma haematobium in Coast Province, Kenya. Am J Trop Med Hyg. 1989. May;40(5):507–13. 10.4269/ajtmh.1989.40.507
    1. Mohamed-Ali Q, Doehring-Schwerdtfeger E, Abdel-Rahim IM, Schlake J, Kardorff R, Franke D, et al. Ultrasonographical investigation of periportal fibrosis in children with Schistosoma mansoni infection: reversibility of morbidity seven months after treatment with praziquantel. Am J Trop Med Hyg. 1991. April;44(4):444–51. 10.4269/ajtmh.1991.44.444
    1. Sacko M, Magnussen P, Traoré M, Landouré A, Doucouré A, Reimert CM, et al. The effect of single dose versus two doses of praziquantel on Schistosoma haematobium infection and pathology among school-aged children in Mali. Parasitology. 2009. November; 136(13): 1851–7. 10.1017/S0031182008000486
    1. Lu YQ, Feng GS. Common sample size estimation methods in medical research. Chronic Pathematology J. 2016. May; 17(4): 359–361. 10.16440/j.cnki.1674-8166.2016.04.001
    1. WHO Expert Committee. Prevention and control of schistosomiasis and soil-transmitted helminthiasis: report of a WHO expert committee. World Health Organ Tech Rep Ser. 2002; 912:1–57.
    1. Xu J, Guo JG, Wu XH, Zeng XJ, Yang WP, Yang GB, et al. Efficacy and adverse effects of film coated praziquantel for treatment of schistosomiasis japonica. Chin J Prev Med. 2009. August; 43(8): 718–22. 10.3760/cma.j.issn.0253-9624.2009.08.017
    1. Guo JG. The history and status of comprehensive management of schistosomiasis in China. Chin J Prev Med. 2006; 40(4): 225–8.
    1. Xu ZY. Diagnosis and treatment of common parasitic diseases in China (6) summary of domestic praziquantel treatment of worms. Chin J Med. 1988; (11).
    1. Colley DG, Bustinduy AL, Secor WE, King CH. Human schistosomiasis. Lancet. 2014. June 28; 383(9936): 2253–64. 10.1016/S0140-6736(13)61949-2
    1. Olds GR, Olveda R, Wu G, Wiest P, McGarvey S, Aligui G, et al. Immunity and morbidity in schistosomiasis japonicum infection. Am J Trop Med Hyg. 1996. November; 55(5 Suppl): 121–6. 10.4269/ajtmh.1996.55.121
    1. Webbe G, James C. A comparison of the susceptibility to praziquantel of Schistosoma haematobium, S. japonicum, S. mansoni, S. intercalatum and S. mattheei in hamsters. Z Parasitenkd. 1977. July 21; 52(2): 169–77.
    1. Fenwick A. New initiatives against Africa's worms. Trans R Soc Trop Med Hyg. 2006. March; 100(3): 200–7. 10.1016/j.trstmh.2005.03.014
    1. Institute of Medicine (US) Forum on Microbial Threats. The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies. Washington (DC): National Academies Press (US), 2011.
    1. Frye JE | International drug price indicator guide[Internet]. VA: Management Sciences for Health; [cited 2002 Jan]. Available from:
    1. Kusel J, Hagan P. Praziquantel—its use, cost and possible development of resistance. Parasitol Today. 1999. September; 15(9): 352–4. 10.1016/S0169-4758(99)01510-0 .
    1. Reich MR, Govindaraj R, Dumbaugh K, Yang B, Brinkmann A, El-Saharty S. International strategies for tropical disease treatments: Experiences with praziquantel. Harvard Initiative for Global Health—HIGH. 1998:1–116.
    1. XIAO SH. Development of antischistosomal drugs in China, with particular consideration to praziquantel and the artemisinins. Acta Tropica. 2005. Nov-Dec; 96(2): 153–67. 10.1016/j.actatropica.2005.07.010
    1. Chen MG. Use of praziquantel for clinical treatment and morbidity control of schistosomiasis japonica in China: a review of 30 years’ experience. Acta Trop. 2005. Nov-Dec; 96(2–3): 168–76. 10.1016/j.actatropica.2005.07.011
    1. Stelma FF, Talla I, Sow S, Kong A, Niang M, Polman K, et al. Efficacy and side effects of praziquantel in an epidemic focus of Schistosoma mansoni. Am J Trop Med Hyg. 1995. August; 53(2): 167–70. 10.4269/ajtmh.1995.53.167
    1. Midzi N, Sangweme D, Zinyowera S, Mapingure MP, Brouwer KC, Kumar N, et al. Efficacy and side effects of praziquantel treatment against Schistosoma haematobium infection among primary school children in Zimbabwe. Transa R Soc Trop Med Hyg. 2008. August; 102(8): 759–66. 10.1016/j.trstmh.2008.03.010
    1. Chen W, Wen LY. The side-effects of praziquantel against schistosomiasis japonica. Int J Med Parasit Dis. 2007. July; 34(4): 44–6. 10.3760/cma.j.issn.1673-4122.2007.04.011
    1. Julien RM. A primer of drug action: a concise, nontechnical guide to the actions, uses, and side effects of psychoactive drugs: Freeman. Holt Paperbacks. 2013.
    1. Lu Y, Xu M. Experimental observation of transdermal delivery of different dosage forms of praziquantel. Chin J Schisto Control. 1998; (4): 202 10.16250/j.32.1374.1998.04.004
    1. Wu WX, Qiu YZ. The Clinical analysis of schistosomiasis in Egypt treating with praziquantel: 1508 cases. Chin J Schisto Control. 1990; (2): 61–2. 10.16250/j.32.1374.1990.02.020

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