Praziquantel
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Praziquantel: From Schistosomiasis to Plasmodium falciparum Malaria
One-Sentence Summary
Praziquantel is an anthelmintic originally used to treat parasitic worm infections such as schistosomiasis, opisthorchiasis, enterobiasis and trichinosis. The TxGNN model's top-ranked prediction is uterine corpus epithelioid leiomyosarcoma, but it has no supporting studies. The best-supported prediction in this set is Plasmodium falciparum malaria, with 2 clinical trials (neither tests praziquantel as a treatment) and 20 publications, including one placebo-controlled randomised trial. This report covers the top-ranked prediction, then discusses malaria as the best-supported alternative.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Opisthorchiasis, schistosomiasis, enterobiasis, trichinosis (from the knowledge graph; the Singapore licence text is blank) |
| Predicted New Indication | Uterine corpus epithelioid leiomyosarcoma (rank 1); best-supported alternative: Plasmodium falciparum malaria (rank 2) |
| TxGNN Prediction Score | 97.28% (rank 1); 97.22% (malaria) |
| Evidence Level | L5 (rank 1); L3 (malaria) |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 1 |
| Recommended Decision | Hold (rank 1); malaria: Hold, as a research question |
Why is This Prediction Reasonable?
Detailed mechanism-of-action data are not available in the data compiled for this report. Praziquantel is generally understood to act on schistosome calcium channels (TRPM_PZQ) and to disrupt the worm's outer surface (tegument). It is used against trematodes (flukes) and cestodes (tapeworms).
Rank 1, uterine corpus epithelioid leiomyosarcoma: No mechanistic link has been identified. Praziquantel's actions in helminths have no established counterpart in smooth muscle sarcoma. The high score is a graph-based prediction only, with no trials or literature behind it. The same applies to the other sarcoma predictions (retroperitoneal sarcoma, uterine myxoid leiomyosarcoma, anus leiomyosarcoma, small intestinal sarcoma, leiomyosarcoma, dermatofibrosarcoma protuberans).
Malaria: No direct antiplasmodial mechanism has been established. Most observations are epidemiological: schistosome co-infection alters malaria susceptibility and immune responses, so treating schistosomiasis may change malaria outcomes indirectly. A 2026 double-blind, placebo-controlled randomised trial (PMID 41159886) tested praziquantel against P. falciparum infection in asymptomatic Gabonese adults. Only the title was available, so its results need confirmation.
Other parasitic predictions: Gnathostomiasis (a nematode) and fascioliasis (a trematode) are biologically plausible targets for an antiparasitic. However, the evidence is weak. For gnathostomiasis it is anecdotal, and for fascioliasis reports indicate poor efficacy, with triclabendazole as the standard treatment.
Clinical Trial Evidence
No clinical trials are registered for the rank 1 prediction (uterine corpus epithelioid leiomyosarcoma).
For the malaria prediction:
| Trial Number | Phase | Status | Enrollment | Key Findings |
|---|---|---|---|---|
| NCT02769013 | N/A | Completed | 380 | Effect of neglected tropical disease control on P. falciparum transmission in a co-endemic area; not a test of praziquantel as an antimalarial |
| NCT00347113 | N/A | Completed | 620 | Effect of schistosome and soil-transmitted helminth infections, and of anthelmintic treatment, on malaria and anaemia in Tanzanian children; addresses co-infection, not praziquantel efficacy against malaria |
Literature Evidence
No literature is available for the rank 1 prediction. The table below shows the most relevant publications for malaria.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 41159886 | 2026 | Randomised controlled trial | J Infect Dis | Double-blind, placebo-controlled trial of praziquantel against P. falciparum infection in asymptomatic Gabonese adults; results need confirmation |
| 10531774 | 1998 | Small clinical report | JPMA | 10 patients (9 P. falciparum, 1 P. vivax) given praziquantel; 8 were cured within 4-6 days, 2 with severe disease did not respond |
| 37957702 | 2023 | RCT | Malar J | Feasibility and safety of combining helminth mass drug administration with seasonal malaria chemoprevention in Senegalese children |
| 25887977 | 2015 | Randomised intervention trial | BMC Infect Dis | Impact of anthelmintic treatment on malaria infection and anaemia in Tanzanian children |
| 38265982 | 2024 | Review | PLoS Negl Trop Dis | Scoping review of efforts to integrate malaria and schistosomiasis control |
| 21696629 | 2011 | Intervention study | BMC Int Health Hum Rights | School-based de-worming with prompt malaria treatment in Zimbabwe, 33-month follow-up |
| 25210876 | 2014 | Cohort study | PLoS Negl Trop Dis | In Mali, S. haematobium co-infection was linked to protection from febrile malaria |
| 17568947 | 2007 | Cohort/immunological | Mem Inst Oswaldo Cruz | Anti-malaria antibody responses in children exposed to both P. falciparum and S. haematobium |
| 37808169 | 2023 | Cohort/cross-sectional | J Parasitol Res | Malaria, urogenital schistosomiasis and anaemia in pregnant Ghanaian women |
| 37446846 | 2023 | Preclinical (chemistry) | Molecules | Design and testing of praziquantel analogues as potential antimalarial and anti-schistosomal agents |
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN06822P | DISTOCIDE TABLET 600 mg | Film-coated tablet (oral) | Not stated in the licence data |
Safety Considerations
- Contraindications flagged in the knowledge graph (not label text): epilepsy, liver disease, gallbladder disease, heart disease, cardiovascular disease.
- Drug interactions: 83 interactions were identified. The listed ones include:
- Major: apalutamide, phenobarbital, carbamazepine (enzyme-inducing drugs, which may lower praziquantel exposure).
- Moderate: dexamethasone, amobarbital, armodafinil, bexarotene, bosentan, brigatinib, butalbital, deferasirox, fostamatinib, and others.
- Minor: cimetidine, albendazole.
Please refer to the package insert for full warnings and contraindications.
Conclusion and Next Steps
Decision: Hold
Rationale:
- The top-ranked prediction (uterine corpus epithelioid leiomyosarcoma) is a model output only. There is no mechanism, trial or literature support, and the other sarcoma predictions are in the same position.
- Malaria has the most evidence (L3), but the registered trials are co-infection studies rather than tests of praziquantel's efficacy, so it is best treated as a research question. Praziquantel's activity against fascioliasis and gnathostomiasis is poorly supported compared with the standard treatments.
To proceed, the following is needed:
- The full design and results of the 2026 Gabon randomised trial (PMID 41159886), and independent replication.
- Mechanism of action data for praziquantel, and a plausible mechanism for any non-helminth indication.
- The Singapore package insert (warnings, contraindications and approved indications), which is needed before safety screening.
- A safety review for use in patients with epilepsy, liver disease, gallbladder disease or cardiovascular disease, and a plan for managing interactions with enzyme-inducing drugs.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.