Ivermectin-albendazole combination versus ivermectin or albendazole alone in soil transmitted helminthiasis: An...

Soil-transmitted helminth (STH) infections caused by Trichuris trichiura, Ascaris lumbricoides, and hookworms continue to exhibit a significant prevalence in low and middle-income countries. Monotherapy with albendazole or ivermectin demonstrates limited effectiveness against these, prompting the exploration of combinations of benzimidazoles and macrocyclic lactones as potential alternatives.

We conducted an updated systematic review and meta-analysis of randomized controlled trials (RCTs) published from March 2023 to May 2025, comparing ivermectin-albendazole (IVM+ALB) with albendazole or ivermectin monotherapy. Eligible studies included participants with confirmed STH infection and reported cure rates (CR), egg reduction rates (ERR), or adverse events. Literature searches were performed on PubMed, Embase, the Cochrane Library, and Google Scholar. Data were analyzed using a random-effects model in RevMan 5.4 to calculate pooled risks ratios (RRs) with 95 % confidence intervals (CIs). Subgroup analysis was performed and risk of bias was assessed with the Risk of Bias 2 (RoB 2) tool.

Twelve RCTs with 5720 participants were included. Combination therapy significantly improved CR for T. trichiura compared with albendazole alone (RR: 2.70; 95 % CI: 1.91-3.82; P < 0.00001), with ERR exceeding 90 % versus ∼62 % for albendazole. In contrast, CRs for A. lumbricoides and hookworm were similar between treatment arms, with both regimens achieving ERRs above 95 %. Head-to-head comparisons also showed IVM+ALB superior to ivermectin monotherapy for T. trichiura (RR: 1.81; 95 % CI: 1.46-2.25; P < 0.00001; I²=24 %). Safety outcomes, including abdominal pain, headache, fever, diarrhea, nausea, vomiting, and allergic reactions, were comparable across groups, with no significant increase in adverse events.

This meta-analysis provides robust evidence that IVM+ALB substantially improves treatment efficacy for T. trichiura while maintaining an acceptable safety profile. For A. lumbricoides and hookworm, albendazole monotherapy remains highly effective. These findings support the integration of benzimidazole-macrocyclic lactone combinations into preventive chemotherapy programs to advance global helminth control targets for 2030.