Mebendazole 100mg/5ml oral suspension

Loiasis, a filarial vector-borne disease, is common in rural West and Central Africa. Benzimidazole derivatives albendazole and mebendazole are recommended as alternative treatments due to their perceived safety in hypermicrofilaremic patients. There is growing evidence that benzimidazoles might also lead to Loa loa-associated encephalopathy. In this systematic review we analyzed all available evidence of benzimidazole-associated encephalopathy. Literature was systematically searched in PubMed, Google Scholar, and WHO-VigiBase®, including conference abstracts and consultation of experts. Six potential cases of benzimidazole-associated encephalopathy, including 2 fatalities, were identified among microfilaremic loiasis patients. Due to the limited global use of prolonged benzimidazole regimens for loiasis, the number of encephalopathy cases identified raises significant safety concerns, challenging the rationale of their use. Further research on mechanisms and safer alternative regimens is urgently needed.

Abstract licence: CC BY

AimMebendazole (MBZ), a benzimidazole anthelmintic with established clinical use, has emerged as a repurposing candidate for primary brain tumours due to its multimodal anticancer actions and central nervous system penetrance. This systematic review synthesizes preclinical and clinical evidence evaluating MBZ's efficacy, mechanisms of action and translational relevance.MethodsThis systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology. Systematic searches were performed in PubMed, EMBASE, SCOPUS and Web of Science using predefined eligibility criteria. A total of 22 studies were included (17 preclinical and five clinical/population).ResultsPreclinical work across glioblastoma, diffuse midline glioma, medulloblastoma and meningioma demonstrates consistent tumour growth suppression and survival extension via microtubule depolymerization, kinase inhibition, angiogenesis blockade, Hedgehog pathway interference, apoptosis/pyroptosis induction and impairment of DNA repair. MBZ also potentiates standard therapies, enhancing the effects of alkylators, radiotherapy and autophagy inhibitors. Efficacy was influenced by formulation, with polymorph C demonstrating superior brain penetration and tolerability. Additional delivery strategies, including efflux inhibition, intranasal microemulsions and nanosuspensions, further improved exposure. Clinically, MBZ was generally tolerable at high oral doses in early-phase studies, but evidence of efficacy remained modest, inconsistent and inconclusive.ConclusionMBZ shows broad preclinical anticancer activity and acceptable tolerability in early human studies, but current clinical evidence does not demonstrate meaningful efficacy in brain tumour patients. Further well-designed comparative trials with clear formulation reporting and integrated pharmacokinetic and biomarker analyses are needed.

Abstract licence: CC BY-NC