Drivers of the variability in albendazole pharmacokinetics and their consequences for anti-helminthic treatment: a systematic review and meta-analysis

Albendazole (a benzimidazole) is an anti-parasitic medication used in a wide array of both clinical and programmatic contexts to treat (neuro-)cysticercosis, echinococcosis, infection with soil-transmitted helminths, lymphatic filariasis and loiasis, amongst others. The drug is characterised by extensive pharmacokinetic variability, with this variation likely to have important consequences for treatment success both at the individual and population level.

In order to better characterise the determinants of this variation, researchers carried out a systematic review to identify references containing information on the pharmacokinetics (PK) of albendazole following a single oral dose of the drug. These results were then integrated into a mathematical modelling framework in order to infer key PK parameters, including the maximum concentration reached (CMax), the area under the curve (AUC, reflecting total drug exposure), the bioavailability of albendazole and the half-life of its pharmacologically-active metabolite, albendazole sulfoxide. Using a regression-based approach, we related the values of these parameters to characteristics of the populations receiving treatment. Specifically, researchers assessed, on albendazole PK parameters, the effect of age, weight, sex, dosage, infection and co-infection status, whether patients had received a fatty meal prior to treatment and co- administration of other drugs.