Stronger Together? Evaluating the Moxidectin–Albendazole Combination for Trichuriasis Through a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Introduction: Trichuriasis, caused by Trichuris trichiura, affects approximately 513 million people globally, especially children in tropical regions with poor sanitation. Current treatments with albendazole or mebendazole has limited efficacy against Trichuris trichiura. Moxidectin, a milbemycin derivative with a favorable safety profile and longer half-life, may improve treatment outcomes when combined with albendazole. Therefore, moxidectin–albendazole combination therapy has emerged as a potential alternative for trichuriasis management.

Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. We systematically searched PubMed, Cochrane, ScienceDirect, Scopus, and other databases for randomized controlled trials up to March 2026. Eligible studies included patients with parasitologically confirmed trichuriasis receiving moxidectin–albendazole compared with albendazole monotherapy, ivermectin–albendazole, placebo, or other control. Outcomes included cure rate, egg reduction rate, and adverse events. A random-effects model was used to analyze pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI), and heterogeneity was assessed using I².

Results: Four randomized controlled trials involving 1,305 participants were included. Moxidectin–albendazole significantly improved the cure rate (RR = 2.41; 95% CI: 1.13–5.14; p = 0.02) and the egg reduction rate (MD = 25.03; 95% CI: 6.21–43.85; p = 0.009). There was no significant difference in adverse events (RR = 1.08; 95% CI: 0.78–1.50; p = 0.63). Most adverse events were mild, and the overall risk of bias was low.

Conclusion: Moxidectin–albendazole combination therapy is more effective than the control regimens in improving the cure rate and the egg reduction rate in trichuriasis without increasing adverse events. Despite high heterogeneity across studies, the findings support its potential as an alternative treatment strategy, particularly in endemic settings and mass drug administration programs. Further large-scale trials with standardized outcomes are needed.

Keywords: Albendazole, moxidectin, trichuriasis, meta-analysis