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Trans R Soc Trop Med Hyg. 2019 Aug 21. pii: trz073. doi: 10.1093/trstmh/trz073. [Epub ahead of print]

A longitudinal analysis of albendazole treatment effect on neurocysticercosis cyst evolution using multistate models.

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Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, New York, New York 10027, USA.
CUNY Institute for Implementation Science in Population Health, City University of New York, 55 West 125th Street, New York, New York 10027, USA.
School of Medicine, University of Cuenca, Av 12 de Abril s/n Ciudadela Universitaria, 010201 Cuenca, Ecuador.
Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, 630 168th Street, Columbia University, New York, New York 10032, USA.
Instituto de Diagnóstico por Imágenes, Inés Salcedo 1-99, Cuenca, Ecuador.
Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, New York 10032, USA.



In neurocysticercosis, the larval form of the pork tapeworm Taenia solium appears to evolve through three phases-active, degenerative and sometimes calcification-before disappearance. The antihelmintic drug, albendazole, has been shown to hasten the resolution of active cysts in neurocysticercosis. Little is known about the time cysts take to progress through each phase, with or without treatment.


We reconfigured brain imaging data from patient level to cyst level for 117 patients in a randomized clinical trial of albendazole in which images were taken at baseline, 1, 6, 12 and 24 mo. Applying a multistate model, we modelled the hazard of a cyst evolving to subsequent cyst phases before the next imaging (vs no change). We examined the impact of albendazole treatment overall and by patient and cyst characteristics on the hazard.


Albendazole accelerated the evolution from the active to degenerative phase (HR=2.7, 95% CI 1.3 to 6.5) and from the degenerative phase to disappearance (HR=1.9, 95% CI 1.1 to 3.9). Albendazole's impact was stronger for patients who were male, did not have calcified cysts at baseline and who had multiple cysts in different locations.


This research provides a better understanding of where in the cyst trajectory albendazole has the greatest impact.


Taenia solium ; albendazole; brain; central nervous system; multistate model; neurocysticercosis


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