Frontiers in pharmacology · 2026
Empirical therapy for hepatic lesions in suspected clonorchiasis: a comparative efficacy analysis of Albendazole and Praziquantel.
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Cao Ya-Zhao, Guo Peng-Zhen, Zhang Yu-Feng, Li Wen-Yu, Shen Qi-Fa, Li Zhi-Hui, Lei Zi-Ying, Chen Jun-Feng, Zhang Jing
Аннотация
BACKGROUND: Clonorchiasis frequently presents as intrahepatic space-occupying lesions, posing a diagnostic challenge due to the low sensitivity of fecal examination. While Praziquantel is the standard first-line therapy, Albendazole is often used empirically in suspected cases. However, the comparative efficacy of these two agents across different levels of diagnostic certainty (confirmed vs. suspected) remains poorly defined.
METHODS: This retrospective cohort study included 151 patients with clonorchiasis-related hepatic lesions treated at our institution between January 2018 and December 2025. Patients were categorized into a Praziquantel group (n = 78) and an Albendazole group (n = 73). The primary outcome was clinical cure within 90 days, defined as symptom resolution, lesion reduction ≥50%, and normalization of eosinophil counts. Multivariable logistic regression and Generalized Estimating Equations (GEE) were employed to evaluate the interaction between treatment regimens and diagnostic certainty.
RESULTS: The overall clinical cure rate was higher in the Praziquantel group (76.9%, 60/78) than in the Albendazole group (67.1%, 49/73), though the difference was not statistically significant (χ 2 = 1.804, P = 0.179). Stratified analysis revealed that Praziquantel was significantly more effective in confirmed cases (90.0% vs. 62.5%, P = 0.047), whereas no significant difference was observed in suspected cases (68.8% vs. 68.4%, P = 0.971). The "Drug/times Diagnosis" interaction test showed marginal significance (P = 0.064). After adjusting for confounders, Albendazole showed similar clinical outcomes to Praziquantel (Adjusted OR = 0.665, 95% CI: 0.298-1.482, P = 0.318). GEE analysis confirmed a significant "Drug × Time" interaction (P < 0.001), indicating distinct kinetic patterns of recovery, with Praziquantel demonstrating a superior cure advantage over time. Age was identified as an independent predictor of clinical cure (P = 0.017).
CONCLUSION: The efficacy of Albendazole in treating clonorchiasis-related hepatic lesions is modulated by diagnostic certainty. While Praziquantel remains the superior choice for confirmed cases, Albendazole demonstrates comparable clinical efficacy in stool-negative suspected cases. These findings indicate that Albendazole demonstrates similar lesion resolution to Praziquantel in stool-negative suspected cases. However, given the retrospective design, these results should be interpreted as hypothesis-generating, necessitating prospective trials for confirmation.
METHODS: This retrospective cohort study included 151 patients with clonorchiasis-related hepatic lesions treated at our institution between January 2018 and December 2025. Patients were categorized into a Praziquantel group (n = 78) and an Albendazole group (n = 73). The primary outcome was clinical cure within 90 days, defined as symptom resolution, lesion reduction ≥50%, and normalization of eosinophil counts. Multivariable logistic regression and Generalized Estimating Equations (GEE) were employed to evaluate the interaction between treatment regimens and diagnostic certainty.
RESULTS: The overall clinical cure rate was higher in the Praziquantel group (76.9%, 60/78) than in the Albendazole group (67.1%, 49/73), though the difference was not statistically significant (χ 2 = 1.804, P = 0.179). Stratified analysis revealed that Praziquantel was significantly more effective in confirmed cases (90.0% vs. 62.5%, P = 0.047), whereas no significant difference was observed in suspected cases (68.8% vs. 68.4%, P = 0.971). The "Drug/times Diagnosis" interaction test showed marginal significance (P = 0.064). After adjusting for confounders, Albendazole showed similar clinical outcomes to Praziquantel (Adjusted OR = 0.665, 95% CI: 0.298-1.482, P = 0.318). GEE analysis confirmed a significant "Drug × Time" interaction (P < 0.001), indicating distinct kinetic patterns of recovery, with Praziquantel demonstrating a superior cure advantage over time. Age was identified as an independent predictor of clinical cure (P = 0.017).
CONCLUSION: The efficacy of Albendazole in treating clonorchiasis-related hepatic lesions is modulated by diagnostic certainty. While Praziquantel remains the superior choice for confirmed cases, Albendazole demonstrates comparable clinical efficacy in stool-negative suspected cases. These findings indicate that Albendazole demonstrates similar lesion resolution to Praziquantel in stool-negative suspected cases. However, given the retrospective design, these results should be interpreted as hypothesis-generating, necessitating prospective trials for confirmation.