Moxidectin as an Alternative Anthelmintic for Strongyloides stercoralis: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Strongyloidiasis, caused by Strongyloides stercoralis, is a significant health threat, especially in tropical regions. Ivermectin is the standard treatment, but concerns about resistance have spurred interest in alternatives like moxidectin, known for its favorable pharmacokinetics and potential efficacy.

METHODS: This systematic review and meta-analysis, registered with PROSPERO (CRD42024576472), evaluated randomized controlled trials on the efficacy and safety of moxidectin for Strongyloides stercoralis infections. PubMed, EBSCOHost, ProQuest, and Google Scholar were searched for relevant studies. Cure rates, mean larval reduction rates, and adverse events were analyzed, and study quality was assessed using the Cochrane Risk of Bias tool. Three trials with 1,062 participants were included in the analysis.

RESULTS: Moxidectin showed efficacy comparable to ivermectin (RR 0.98 [95% CI 0.95-1.01], I²=0%) and placebo, with cure rates meeting non-inferiority thresholds. Mean larvae reduction rates were high across studies, and adverse events were mild and infrequent, with headache as the most common. No serious AEs were reported, although the trials were underpowered to detect rare events.

CONCLUSION: Moxidectin provides a safe and effective alternative to ivermectin for treating strongyloidiasis, with advantages like a longer half-life and fixed dosing, particularly in limited-resource settings. However, further multicenter studies are necessary to validate these findings across broader populations.