A systematic review of fluralaner as a treatment for ectoparasitic infections in mammalian species

Abstract

Fluralaner (Bravecto™) is a novel isoxazoline ectoparasiticide used for controlling ectoparasites of domestic mammals and is increasingly being used on wildlife. The aim of this systematic review was to evaluate the efficacy, pharmacokinetics, and safety of fluralaner on mammals given its increasing use. The search was performed in GoogleScholar and the SciFinder databases using the terms ‘fluralaner’ and ‘Bravecto™’, and was concluded on 30th August, 2024. A total of 250 references were initially saved and reduced to 121 peer-reviewed journal articles using PRISMA guidelines, based on the removal of duplicates, those published in low quality journals (ranked less than Q2), and limiting publications to clinical trials. Articles were then categorised and ranked using the level of evidence, Cochrane ‘risk of bias’ assessment tool, methodological quality, and study size. Overall, the efficacy of fluralaner has been assessed on 14 mammalian species, and pharmacokinetic investigations conducted on 15. Fluralaner was mostly effective at treating some ectoparasites on captive individuals when there was little chance of re-infection; however, it did not prevent bites from blood-sucking ectoparasites and could not prevent blood-borne pathogen transfer to host animals. Very few studies have investigated the pharmacokinetics of fluralaner, and hence were difficult to compare; however, wombats differed greatly from their eutherian counterparts in their C _max and t½ values and require further investigation. Overall, fluralaner was deemed moderately safe; however, most studies were classified as fair in terms of quality and most studies were based on small or very small sample numbers. Nineteen studies reported side effects, one of which included signs of severe neurological toxicity, with most of the articles not reporting on safety either positively or negatively. Concerns were raised regarding the extended time fluralaner was detected in faeces and subsequently environmental contamination is a concern. No longer-term impacts of the use of fluralaner have been investigated, and wider implications of the use of this ectoparasiticide have not yet been assessed.