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Kanza EM, Nyathirombo A, Larbelee JP, Opoku NO, Bakajika DK, Howard HM, Mambandu GL, Nigo MM, Wonyarossi DU, Ngave F, Kennedy KK, Kataliko K, Bolay KM, Attah SK, Olipoh G, Asare S, Mumbere M, Vaillant M, Halleux CM, Kuesel AC. Onchocerca volvulus microfilariae in the anterior chambers of the eye and ocular adverse events after a single dose of 8 mg moxidectin or 150 µg/kg ivermectin: results of a randomized double-blind Phase 3 trial in the Democratic Republic of the Congo, Ghana and Liberia. Parasit Vectors 2024; 17:137. [PMID: 38491528 PMCID: PMC10943894 DOI: 10.1186/s13071-023-06087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/07/2023] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND After ivermectin became available, diethylcarbamazine (DEC) use was discontinued because of severe adverse reactions, including ocular reactions, in individuals with high Onchocerca volvulus microfilaridermia (microfilariae/mg skin, SmfD). Assuming long-term ivermectin use led to < 5 SmfD with little or no eye involvement, DEC + ivermectin + albendazole treatment a few months after ivermectin was proposed. In 2018, the US FDA approved moxidectin for treatment of O. volvulus infection. The Phase 3 study evaluated SmfD, microfilariae in the anterior chamber (mfAC) and adverse events (AEs) in ivermectin-naïve individuals with ≥ 10 SmfD after 8 mg moxidectin (n = 978) or 150 µg/kg ivermectin (n = 494) treatment. METHODS We analyzed the data from 1463 participants with both eyes evaluated using six (0, 1-5, 6-10, 11-20, 21-40, > 40) mfAC and three pre-treatment (< 20, 20 to < 50, ≥ 50) and post-treatment (0, > 0-5, > 5) SmfD categories. A linear mixed model evaluated factors and covariates impacting mfAC levels. Ocular AEs were summarized by type and start post-treatment. Logistic models evaluated factors and covariates impacting the risk for ocular AEs. RESULTS Moxidectin and ivermectin had the same effect on mfAC levels. These increased from pre-treatment to Day 4 and Month 1 in 20% and 16% of participants, respectively. Six and 12 months post-treatment, mfAC were detected in ≈5% and ≈3% of participants, respectively. Ocular Mazzotti reactions occurred in 12.4% of moxidectin- and 10.2% of ivermectin-treated participants without difference in type or severity. The risk for ≥ 1 ocular Mazzotti reaction increased for women (OR 1.537, 95% CI 1.096-2.157) and with mfAC levels pre- and 4 days post-treatment (OR 0: > 10 mfAC 2.704, 95% CI 1.27-5.749 and 1.619, 95% CI 0.80-3.280, respectively). CONCLUSIONS The impact of SmfD and mfAC levels before and early after treatment on ocular AEs needs to be better understood before making decisions on the risk-benefit of strategies including DEC. Such decisions should take into account interindividual variability in SmfD, mfAC levels and treatment response and risks to even a small percentage of individuals.
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Affiliation(s)
- Eric M Kanza
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Nord Kivu, Democratic Republic of the Congo
- Programme National de Lutte Contre Les Maladies Tropicales Négligées À Chimio-Thérapie Préventive (PNLMTN-CTP), Kinshasa, Democratic Republic of the Congo
| | - Amos Nyathirombo
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
- Department of Ophthalmology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Jemmah P Larbelee
- Clinical Research Center, Liberia Institute for Biomedical Research, Bolahun, Liberia
- Ministry of Health, Monrovia, Liberia
| | - Nicholas O Opoku
- Onchocerciasis Chemotherapy Research Center, Hohoe, Ghana
- Department of Epidemiology and Biostatistics School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Didier K Bakajika
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
- ESPEN, African Regional Office of the World Health Organization (WHO/AFRO/ESPEN), Brazzaville, Republic of Congo
| | - Hayford M Howard
- Clinical Research Center, Liberia Institute for Biomedical Research, Bolahun, Liberia
- Ganta United Methodist Hospital, Ganta City, Nimba County, Liberia
| | - Germain L Mambandu
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
- Inspection Provinciale de La Santé de La Tshopo, Division Provinciale de La Santé de La Tshopo, Kisangani, Province de La Tshopo, Democratic Republic of the Congo
| | - Maurice M Nigo
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
- Institut Supérieur Des Techniques Médicales de Nyankunde, Bunia, Ituri, Democratic Republic of the Congo
| | - Deogratias Ucima Wonyarossi
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
| | - Françoise Ngave
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
| | - Kambale Kasonia Kennedy
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Nord Kivu, Democratic Republic of the Congo
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kambale Kataliko
- Centre de Recherche en Maladies Tropicale de L'Ituri, Hôpital Générale de Référence de Rethy, Ituri, Democratic Republic of the Congo
- Centre de Santé CECA 20 de Mabakanga, Beni, Nord Kivu, Democratic Republic of the Congo
| | - Kpehe M Bolay
- Clinical Research Center, Liberia Institute for Biomedical Research, Bolahun, Liberia
- National Public Health Institute of Liberia, Public Health & Medical Research, Monrovia, Liberia
| | - Simon K Attah
- Onchocerciasis Chemotherapy Research Center, Hohoe, Ghana
- Department of Microbiology, University of Ghana Medical School, Accra, Ghana
- Baldwin University College, Accra, Ghana
| | - George Olipoh
- Onchocerciasis Chemotherapy Research Center, Hohoe, Ghana
- National Assay Centre, Precious Minerals Marketing Company Ltd., Diamond House, Accra, Ghana
| | - Sampson Asare
- Onchocerciasis Chemotherapy Research Center, Hohoe, Ghana
- Bell Laboratories Inc, Window, WI, USA
| | - Mupenzi Mumbere
- Centre de Recherche Clinique de Butembo, Université Catholique du Graben, Site Horizon, Butembo, Nord Kivu, Democratic Republic of the Congo
- Medicines Development for Global Health (MDGH), Melbourne, Australia
| | - Michel Vaillant
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Grand Duchy of Luxembourg
| | - Christine M Halleux
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR), World Health Organization, Geneva, Switzerland
| | - Annette C Kuesel
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR), World Health Organization, Geneva, Switzerland.
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Kaur B, Blavo C, Parmar MS. Ivermectin: A Multifaceted Drug With a Potential Beyond Anti-parasitic Therapy. Cureus 2024; 16:e56025. [PMID: 38606261 PMCID: PMC11008553 DOI: 10.7759/cureus.56025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
Ivermectin was first discovered in the 1970s by Japanese microbiologist Satoshi Omura and Irish parasitologist William C. Campbell. Ivermectin has become a versatile pharmaceutical over the past 50 years. Ivermectin is a derivative of avermectin originally used to treat parasitic infections. Emerging literature has suggested that its role goes beyond this and may help treat inflammatory conditions, viral infections, and cancers. Ivermectin's anti-parasitic, anti-inflammatory, anti-viral, and anticancer effects were explored. Its traditional mechanism of action in parasitic diseases, such as scabies and malaria, rests on its ability to interfere with the glutamate-gated chloride channels in invertebrates and the lack of P-glycoprotein in many parasites. More recently, it has been discovered that the ability of ivermectin to block the nuclear factor kappa-light-chain enhancer of the activated B (NF-κB) pathway that modulates the expression and production of proinflammatory cytokines is implicated in its role as an anti-inflammatory agent to treat rosacea. Ivermectin has also been evaluated for treating infections caused by viruses, such as SARS-CoV-2 and adenoviruses, through inhibition of viral protein transportation and acting on the importin α/β1 interface. It has also been suggested that ivermectin can inhibit the proliferation of tumorigenic cells through various pathways that lead to the management of certain cancers. The review aimed to evaluate its multifaceted effects and potential clinical applications beyond its traditional use as an anthelmintic agent.
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Affiliation(s)
- Baneet Kaur
- Department of Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Cyril Blavo
- Department of Public Health, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Mayur S Parmar
- Department of Foundational Sciences, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
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Ngwewondo A, Scandale I, Specht S. Onchocerciasis drug development: from preclinical models to humans. Parasitol Res 2021; 120:3939-3964. [PMID: 34642800 PMCID: PMC8599318 DOI: 10.1007/s00436-021-07307-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
Twenty diseases are recognized as neglected tropical diseases (NTDs) by World Health Assembly resolutions, including human filarial diseases. The end of NTDs is embedded within the Sustainable Development Goals for 2030, under target 3.3. Onchocerciasis afflicts approximately 20.9 million people worldwide with > 90% of those infected residing in Africa. Control programs have made tremendous efforts in the management of onchocerciasis by mass drug administration and aerial larviciding; however, disease elimination is not yet achieved. In the new WHO roadmap, it is recognized that new drugs or drug regimens that kill or permanently sterilize adult filarial worms would significantly improve elimination timelines and accelerate the achievement of the program goal of disease elimination. Drug development is, however, handicapped by high attrition rates, and many promising molecules fail in preclinical development or in subsequent toxicological, safety and efficacy testing; thus, research and development (R&D) costs are, in aggregate, very high. Drug discovery and development for NTDs is largely driven by unmet medical needs put forward by the global health community; the area is underfunded and since no high return on investment is possible, there is no dedicated drug development pipeline for human filariasis. Repurposing existing drugs is one approach to filling the drug development pipeline for human filariasis. The high cost and slow pace of discovery and development of new drugs has led to the repurposing of “old” drugs, as this is more cost-effective and allows development timelines to be shortened. However, even if a drug is marketed for a human or veterinary indication, the safety margin and dosing regimen will need to be re-evaluated to determine the risk in humans. Drug repurposing is a promising approach to enlarging the pool of active molecules in the drug development pipeline. Another consideration when providing new treatment options is the use of combinations, which is not addressed in this review. We here summarize recent advances in the late preclinical or early clinical stage in the search for a potent macrofilaricide, including drugs against the nematode and against its endosymbiont, Wolbachia pipientis.
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Affiliation(s)
- Adela Ngwewondo
- Centre of Medical Research, Institute of Medical Research and Medicinal Plants Studies (IMPM), P.O. Box13033, Yaoundé, Cameroon
- Drugs for Neglected Diseases Initiative, Chemin Camille-Vidart 15, 1202, Geneva, Switzerland
| | - Ivan Scandale
- Drugs for Neglected Diseases Initiative, Chemin Camille-Vidart 15, 1202, Geneva, Switzerland
| | - Sabine Specht
- Drugs for Neglected Diseases Initiative, Chemin Camille-Vidart 15, 1202, Geneva, Switzerland.
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Abiose A. Onchocercal eye disease and the impact of Mectizan treatment. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2016. [DOI: 10.1080/00034983.1998.11813361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Paradigm lost: how parasite control may alter pattern and process in human helminthiases. Trends Parasitol 2012; 28:161-71. [DOI: 10.1016/j.pt.2012.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 02/07/2012] [Accepted: 02/07/2012] [Indexed: 11/22/2022]
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Abstract
Filariasis is caused by thread-like nematode worms, classified according to their presence in the vertebrate host. The cutaneous group includes Onchocerca volvulus, Loa loa and Mansonella streptocerca; the lymphatic group includes Wuchereria bancrofti, Brugia malayi and Brugia timori and the body cavity group includes Mansonella perstans and Mansonella ozzardi. Lymphatic filariasis, a mosquito-borne disease, is one of the most prevalent diseases in tropical and subtropical countries and is accompanied by a number of pathological conditions. In recent years, there has been rapid progress in filariasis research, which has provided new insights into the pathogenesis of filarial disease, diagnosis, chemotherapy, the host–parasite relationship and the genomics of the parasite. Together, these insights are assisting the identification of novel drug targets and the discovery of antifilarial agents and candidate vaccine molecules. This review discusses the antifilarial activity of various chemical entities, the merits and demerits of antifilarial drugs currently in use, their mechanisms of action, in addition to antifilarial drug targets and their validation.
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Rates of microfilarial production by Onchocerca volvulus are not cumulatively reduced by multiple ivermectin treatments. Parasitology 2008; 135:1571-81. [PMID: 18831801 DOI: 10.1017/s0031182008000425] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Regular distribution of ivermectin reduces onchocerciasis transmission and morbidity by killing, within humans, the microfilarial stage of the parasite (microfilaricidal effect). In addition, ivermectin exerts a so-called embryostatic effect by which microfilarial production by the adult female worm becomes suppressed during a number of weeks after treatment. To assess the overall effect of ivermectin on onchocerciasis transmission and evaluate the likelihood of local elimination of the infection it is important to estimate the magnitude of the anti-fertility effect over the course of a treatment programme. Estimates of the effect of repeated drug treatments on the production of microfilariae by adult Onchocerca volvulus were obtained by developing a model that was fitted to data collected from three hyperendemic communities in Guatemala, where eligible residents received ivermectin twice per year for two and a half years. The data consist of microfilarial load measurements in the skin, collected just before each six-monthly treatment during the programme. The model that is developed describes the dynamics of an individual host's expected microfilarial load over the 30-month study period. We adopt a Bayesian approach and use Markov chain Monte Carlo (McMC) techniques to fit the model to the data. Combining estimates from the three villages, average microfilarial production in the first six months post-treatment was reduced by ~64% of its pre-treatment level, regardless of values chosen for the pre-ivermectin fertility rate within plausible ranges. Increased adult worm death rate after treatment (to mimic removal of macrofilariae via nodulectomy during the programme) resulted in a smaller estimated magnitude of the embryostatic effect (rate of microfilarial production was reduced by ~58% of pre-ivermectin value). After subsequent treatments, the rate of microfilarial production appeared to be similarly decreased. The data and analyses therefore do not support the hypothesis of a cumulative effect of multiple ivermectin treatments on microfilarial production by female worms.
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Basáñez MG, Pion SDS, Boakes E, Filipe JAN, Churcher TS, Boussinesq M. Effect of single-dose ivermectin on Onchocerca volvulus: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2008; 8:310-22. [DOI: 10.1016/s1473-3099(08)70099-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Ivermectin: 25 years and still going strong. Int J Antimicrob Agents 2007; 31:91-8. [PMID: 18037274 DOI: 10.1016/j.ijantimicag.2007.08.023] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 08/20/2007] [Indexed: 11/20/2022]
Abstract
Ivermectin is a drug that many people will never have heard of. Yet thousands of villagers of all ages in communities scattered throughout the remotest parts of Africa and Latin America know its name, and some experts regard it as one of the greatest health interventions of the past 50 years. Ivermectin was brought to the commercial market place for multi-purpose use in animal health in 1981. Six years later it was registered for human use. This remarkable compound has improved the lives and productivity of billions of humans, livestock and pets around the globe, and promises to help consign to the history books two devastating and disfiguring diseases that have plagued people throughout the tropics for generations--while new uses for it are continually being found.
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Fobi G, Gardon J, Kamgno J, Aimard-Favennec L, Lafleur C, Gardon-Wendel N, Duke BOL, Boussinesq M. A randomized, double-blind, controlled trial of the effects of ivermectin at normal and high doses, given annually or three-monthly, against Onchocerca volvulus: ophthalmological results. Trans R Soc Trop Med Hyg 2005; 99:279-89. [PMID: 15708387 DOI: 10.1016/j.trstmh.2004.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2003] [Revised: 04/15/2004] [Accepted: 04/21/2004] [Indexed: 10/25/2022] Open
Abstract
A three-year randomized, controlled, double-blind trial was conducted in Cameroon to determine whether ivermectin, given at three-monthly intervals and/or at high doses (800 microg/kg), had a greater effect on adult Onchocerca volvulus than standard doses (150 microg/kg annually). As several patients complained of transitory subjective visual problems after treatment, some of them being of an unexpected type, we organized two series of detailed ophthalmological examinations to evaluate whether they were associated with ocular lesions. Analysis showed that these complaints were significantly more frequent in the two groups treated with high doses of ivermectin than in the reference group. In the ophthalmological examinations, the only differences recorded between the groups were a lower prevalence and mean number of microfilariae in the anterior chamber in the groups treated three-monthly, and, at the first examination round, a higher prevalence of early lesions of the iris in the group treated at high doses annually. These findings do not allow us to explain the cause of the transitory ocular complaints, nor why they were more frequent in the groups treated at high doses. However, one may conclude that using doses of ivermectin higher than the standard one should be considered with caution.
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Affiliation(s)
- Grace Fobi
- Service d'Ophtalmologie, Hôpital Central de Yaoundé, Yaoundé, Cameroun
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Peixoto CA. Some morphological aspects of Wuchereria bancrofti uterus after treatment with diethylcarbamazine. Micron 2005; 36:17-22. [PMID: 15582474 DOI: 10.1016/j.micron.2004.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Revised: 06/30/2004] [Accepted: 07/01/2004] [Indexed: 10/26/2022]
Abstract
Confocal and EM analyses revealed that some female Wuchereria bancrofti, obtained from volunteers that received recommended diethylcarbamazine dose regimens, showed few or no embryos. Furthermore, inside the gravid uterus of female W. bancrofti treated with DEC we observed a finely granular, electron-dense material organised as strings of pearls, approximately 70 nm in maximal length surrounding intra-uterine microfilariae and apparently secreted by the embryo. Over the eggshells a similar material was also observed, possibly secreted by the uterine wall. The surface of intra-uterine microfilariae presented a material with identical electron-density to the scattered structures observed inside the egg. Similarly, the sheath of blood microfilariae of W. bancrofti also showed electron-dense projections, with shape and size similar to that observed inside the uterus.
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Affiliation(s)
- Christina Alves Peixoto
- Departmento de Patologia e Biologia Celular e Ultraestrutura, Centro de Pesquisas Aggeu Magalhães, Laboratório de Imunopatologia Keizo Asami, Universidade Federal de Pernambuco, Recife, CEP 50670-420, Brazil.
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Tielsch JM, Beeche A. Impact of ivermectin on illness and disability associated with onchocerciasis. Trop Med Int Health 2004; 9:A45-56. [PMID: 15078278 DOI: 10.1111/j.1365-3156.2004.01213.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The Onchocerciasis Control Program (OCP), one of the most successful vertical disease control programs in the history of public health, came to an end in 2003 with devolvement of responsibilities for control program activities passed to the countries affected. Fortunately, 15 years ago the Mectizan Distribution Program (MDP) was founded to provide a complementary approach to controlling the disabling consequences of this parasitic infection. With over 250 million doses of ivermectin distributed over the past 15 years, the MDP is well on its way to both solidifying the progress made by the OCP and extending program reach well beyond the boundaries of the OCP. Through the extensive clinical testing protocols implemented in a variety of countries in Aftica, ivermectin has been proven to be a safe and highly effective treatment for onchocerciasis. Regular distribution to populations living in endemic areas has demonstrated significant reductions in blinding ocular complications, transmission, and disability caused by onchocercal skin disease. As yet undocumented, are the likely significant impact regular population dosing with ivermectin has on intestinal helminth infections, lymphatic filariasis, and human scabies infection. While there are significant barriers to continued program success, focussed attention on expanding and improving community-directed ivermectin distribution is likely to lead to further progress against this resilient infection.
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Affiliation(s)
- James M Tielsch
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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Dupouy-Camet J, Yera H, Tourte-Schaefer C. Utilisation de 1' ivermectine en médecine tropicale. Arch Pediatr 2003; 10 Suppl 5:545s-549s. [PMID: 15022779 DOI: 10.1016/s0929-693x(03)90035-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ivermectin is a major breakthrough for the treatment of onchocerciasis, strongyloidosis, scabies and cutaneous larva migrans. Combined with albendazole, ivermectin is highly efficient for treating lymphatic filariasis and intestinal worms. Ivermectin shows very few side-effects but its use in children below 5 and during pregnancy is discussed. Ivermectin tolerance could be related to mdr1 gene expression. Additional studies are needed to assess its efficiency for pediculosis.
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Affiliation(s)
- J Dupouy-Camet
- Service de parasitologie-mycologie, CHU Cochin, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
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15
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Affiliation(s)
- K Awadzi
- Onchocerciasis Chemotherapy Research Centre, Hohoe Hospital, Ghana
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Mourad AE, Wise DS, Townsend LB. Methyl imidazo[1,2-b]pyridazine-2-carbamates and related compounds as potential antifilarial agents. J Heterocycl Chem 1992. [DOI: 10.1002/jhet.5570290636] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Affiliation(s)
- G C Cook
- Department of Clinical Sciences, Hospital for Tropical Diseases, London, UK
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Van der Lelij A, Rothova A, Klaassen-Broekema N, Wilson WR, Barbe RF, Stilma JS. Decrease in adverse reactions after repeated ivermectin treatment in onchocerciasis. Doc Ophthalmol 1990; 75:215-24. [PMID: 2090395 DOI: 10.1007/bf00164834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We assessed the side-effects after multiple single-dose treatment with ivermectin (150 micrograms/kg) in onchocerciasis patients form a hyperendemic area in Sierra Leone, in order to investigate whether medical surveillance was always necessary. After initial treatment 87 onchocerciasis patients were examined for adverse reactions. Fourty-four of these 87 patients (51%) received a second dose of ivermectin 5 months later and thirty-five (40%) received a third dose one year later. The side-effects after the second and third doses were significantly diminished, when compared with the initial dose of ivermectin in the treatment of onchocerciasis (chi2 test p less than 0.005, resp. p less than 0.008). Side-effects requiring therapy were observed in 32% of patients after the first dose, in 18% after the second dose and in 11% after the third dose of ivermectin. Severe side-effects (9%) were only seen after the initial ivermectin dose. All the severe adverse reactions appeared within 48 hours. In view of our findings, it seems necessary that the first treatment with ivermectin should take place under strict medical supervision during at least two days. Five months after treatment with a single dose of ivermectin 29 out of 44 patients (66%) still had a positive skin-snip test. Seven months after the second dose 15 of 35 patients (43%) had a positive skin-snip count. Since almost half of the patients had a positive skin-snip test despite two treatments with ivermectin, it could be argued that in hyperendemic areas treatment should consist of at least two doses in the first year.
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Affiliation(s)
- A Van der Lelij
- Department of Ophthalmology, Free University Amsterdam, The Netherlands
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Townson S, Dobinson AR, Townsend J, Siemienska J, Zea-Flores G. The effects of ivermectin used in combination with other known antiparasitic drugs on adult Onchocerca gutturosa and O. volvulus in vitro. Trans R Soc Trop Med Hyg 1990; 84:411-6. [PMID: 2260177 DOI: 10.1016/0035-9203(90)90340-k] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The effects of ivermectin at a concentration of 3.13 x 10(-6) M used in combination with other antiparasitic drugs on the viability of adult Onchocerca in vitro were assessed using MTT colorimetry and worm motility levels. When ivermectin was used against male O. gutturosa over a 7 d period in combination with suramin (5 x 10(-5) M), CGP 6140 (3.13 x 10(-6) M), CGP 20376 (1.95 x 10(-7) M), mefloquine (3.13 x 10(-6) M), levamisole (3.13 x 10(-6) M), mebendazole (5 x 10(-5) M), flubendazole (5 x 10(-5) M) and albendazole (5 x 10(-5) M), there was either no increased effect or only a marginally increased effect on motility levels when compared with the use of ivermectin alone. MTT colorimetry revealed that in most cases there was a cumulative effect of the 2 drugs used in combination but not a synergistic effect. In a trial extended to 26 d it was demonstrated that the combination of ivermectin and suramin did not produce a greater inhibition of motility than ivermectin alone. Using female O. volvulus, the activity of ivermectin, CGP 6140 and the 2 drugs combined was examined. The motility of all 3 groups exposed to drug(s) was suppressed by 24 h compared with controls. MTT colorimetry performed on day 7, using the pre-weighed anterior end of each worm, illustrated that ivermectin alone produced a 43.4% inhibition of formazan formation compared with controls, CGP 6140 alone produced 50.6% inhibition, while the drug combination produced a 72% inhibition, equivalent to the heat-killed control.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Townson
- CAB International Institute of Parasitology, St Albans, Hertfordshire, UK
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Ottesen EA, Vijayasekaran V, Kumaraswami V, Perumal Pillai SV, Sadanandam A, Frederick S, Prabhakar R, Tripathy SP. A controlled trial of ivermectin and diethylcarbamazine in lymphatic filariasis. N Engl J Med 1990; 322:1113-7. [PMID: 2181312 DOI: 10.1056/nejm199004193221604] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Ivermectin is a new antifilarial drug that can be given in a single oral dose. To compare the efficacy and side effects of ivermectin with those of diethylcarbamazine, the standard antifilarial treatment, we conducted a randomized, double-blind trial in 40 South Indian men with lymphatic filariasis caused by Wuchereria bancrofti. Patients were randomly assigned to one of three treatments: a single low dose of ivermectin (mean [+/- SE], 21.3 +/- 0.7 micrograms per kilogram of body weight; n = 13) followed by placebo for 12 days; a single high dose of ivermectin (mean, 126.2 +/- 3.7 micrograms per kilogram; n = 13) followed by placebo for 12 days; or diethylcarbamazine for 13 days (6 mg per kilogram per day for 12 days preceded by 3 mg per kilogram for 1 day; n = 14). Eleven patients were initially assigned to receive placebo and after five days were reassigned to one of the three treatment groups. At day 12 there was complete clearance of microfilariae from the blood in all 26 men who took ivermectin and in 11 of the 14 men who took diethylcarbamazine. At six months the numbers of detectable microfilariae (as a percentage of the pretreatment values) were 18.3 percent after low-dose ivermectin and 19.5 percent after high-dose ivermectin, as compared with 6.0 percent after diethylcarbamazine (P less than 0.05). The side effects were confined to the first five days and were similar in the three treatment groups. We conclude that in lymphatic filariasis, the clinical response to a single dose of ivermectin compares favorably with that after the standard 12-day course of diethylcarbamazine. Given the practical advantages of single-dose administration, ivermectin should become a useful medication for the control of bancroftian filariasis.
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Affiliation(s)
- E A Ottesen
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md. 20892
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Ette EI, Thomas WO, Achumba JI. Ivermectin: a long-acting microfilaricidal agent. DICP : THE ANNALS OF PHARMACOTHERAPY 1990; 24:426-33. [PMID: 2183496 DOI: 10.1177/106002809002400417] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Ivermectin is a macrocyclic lactone (fermentation) product and actinomycete (Streptomyces avermitilis) that possesses an unusually broad spectrum of potent activity against several species of nematodes, arachnids, and insects that parasitize domestic animals. From clinical trials in humans it has been found to be microfilaricidal, killing microfilariae of Onchocerca volvulus (the parasite causing onchocerciasis), and interrupting its transmission by the black fly vector. Dermal microfilariae density in patients are reduced to near zero levels for 6-12 months after a single oral dose of ivermectin 0.15-0.2 mg/kg. Its precise mechanism of action is unknown. It has a time to maximum concentration of 2.7-4.3 h, and an elimination half-life of 28 +/- 10 h. When compared with an oral solution the tablet dosage form has a relative bioavailability of approximately 60 percent. Not much is known about its metabolism in humans, and the unchanged drug is not detected in the urine. Controlled clinical trials have shown ivermectin to be associated with milder side effects than diethylcarbamazine, the current drug of choice for onchocerciasis therapy. It does not cause the severe Mazzoti-type (anaphylactoid) reactions that are associated with diethylcarbamazine use. Ivermectin is effective, safer, and more tolerable than diethylcarbamazine. It should, therefore, replace diethylcarbamazine as the drug of choice for onchocerciasis therapy.
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23
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Dadzie KY, Remme J, Alley ES, de Sole G. Changes in ocular onchocerciasis four and twelve months after community-based treatment with ivermectin in a holoendemic onchocerciasis focus. Trans R Soc Trop Med Hyg 1990; 84:103-8. [PMID: 2345906 DOI: 10.1016/0035-9203(90)90395-u] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The impact of ivermectin mass treatment on ocular onchocerciasis was studied in a holoendemic focus of blinding onchocerciasis in Ghana. A cohort of 417 persons, 369 of whom were treated, was followed up at 4 and 12 months after treatment. The mean ocular microfilarial load in the anterior chamber of the eye and in the cornea of treated persons was reduced to less than 20% and 10% of the pretreatment levels respectively at the 4 months follow-up but had increased significantly by 12 months. Lesions of the eye at the advanced stage of development remained stable. There was significant regression of early lesions of the anterior segment of the eye, particularly iridocyclitis, after ivermectin treatment. In view of the substantial increase of ocular microfilarial loads after 12 months, 6-monthly treatment may be indicated in such highly endemic foci. However, long-term observation is needed to give a correct estimate of the full benefit to be derived from mass treatment with ivermectin.
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Affiliation(s)
- K Y Dadzie
- Onchocerciasis Control Programme in West Africa, Ouagadougou, Burkina Faso
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Abstract
Ivermectin is a recently developed macrocyclic lactone that has widespread antiparasitic activity. A series of clinical trials has shown that ivermectin is safe and effective in the treatment of human infection with Onchocerca volvulus. Although it is rapidly microfilaricidal, it does not cause a severe reaction as is seen with diethylcarbamazine treatment. The drug also temporarily interrupts production of microfilaria but has no known long-lasting effects on the adult worms. In patients with onchocerciasis, a single oral dose of ivermectin (150 micrograms/kg) repeated once a year leads to a marked reduction in skin microfilaria counts and ocular involvement. At this dose, ivermectin causes minimal side effects and appears to be sufficiently free of severe adverse reactions to be used on a mass scale. Its use promises to revolutionise the treatment of onchocerciasis.
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Affiliation(s)
- H R Taylor
- Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland 21205
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Estambale BB, Howells RE. The efficacy of 22,23-dihydroavermectin B1 (Ivermectin) acting singly or in combination with a benzodiazepine on microfilariae of Onchocerca species and Brugia pahangi (an in vitro study). ZENTRALBLATT FUR BAKTERIOLOGIE : INTERNATIONAL JOURNAL OF MEDICAL MICROBIOLOGY 1989; 271:249-55. [PMID: 2775429 DOI: 10.1016/s0934-8840(89)80080-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
An in vitro study of the antinematodal action of two groups of compounds which act on the receptor complex of the inhibitory neurotransmitter, Gamma-aminobutyric acid (GABA) in mammalian systems is described. The compounds, Ivermectin and two benzodiazepines, Diazepam and a water soluble Midazolam were tested singly or in combination against two microfilarial parasites Onchocerca lienalis (closely related to Onchocerca volvulus) and Brugia pahangi. The combination of ivermectin and diazepam at a concentration of 0.1 microgram/ml and 33 micrograms/ml respectively achieved the same effect on microfilarial motility as when ivermectin was given at 1 microgram/ml alone or diazepam at 66 micrograms/ml alone. Similarly when the combination of ivermectin at 0.1 microgram/ml and midazolam at 10 micrograms/ml was used it achieved the same effect as ivermectin at 1 microgram/ml alone or midazolam at 33 micrograms/ml alone. This showed that both benzodiazepines had a synergistic effect on the activity of ivermectin. The microfilariae of B. pahangi were insensitive to both groups of compounds at all concentrations used.
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Affiliation(s)
- B B Estambale
- Department of Medical Microbiology, College of Health Sciences, University of Nairobi, Kenya
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Newland HS, White AT, Greene BM, D'Anna SA, Keyvan-Larijani E, Aziz MA, Williams PN, Taylor HR. Effect of single-dose ivermectin therapy on human Onchocerca volvulus infection with onchocercal ocular involvement. Br J Ophthalmol 1988; 72:561-9. [PMID: 3046657 PMCID: PMC1041529 DOI: 10.1136/bjo.72.8.561] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ivermectin has shown promise as a potentially safe and effective microfilaricidal drug for the treatment of onchocerciasis. Several limited studies have shown it to have fewer side effects, especially ocular complications, than the currently available drug, diethylcarbamazine. The detailed ocular findings in 200 moderately to heavily infected Liberians who were enrolled in a safety and dose-finding study are presented. They received either 0, 100, 150, or 200 micrograms/kg of ivermectin and were followed up for 12 months. In clinical studies so far carried out ivermectin in a dose of 100, 150, or 200 micrograms/kg has not been associated with any major adverse reactions nor were there any sight-threatening effects even in the presence of severe ocular disease. Each of these doses significantly reduced the ocular microfilaria load for at least 12 months when compared with either the placebo (p less than 0.05) or pretreatment values (p less than 0.001). However, the 100 and 150 micrograms/kg doses caused fewer minor side effects than the higher dose. These results confirm that ivermectin in a single oral dose may be a safe and effective microfilaricidal drug for the treatment of onchocerciasis and that it appears to be free of major ocular side effects.
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Affiliation(s)
- H S Newland
- Ocular Onchocerciasis Research Unit, Wilmer Institute, Johns Hopkins University, Baltimore, Maryland
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Mak JW, Lam PL, Rain AN, Suresh K. Chemoprophylactic studies with ivermectin against subperiodic Brugia malayi infection in the leaf monkey, Presbytis cristata. J Helminthol 1987; 61:311-4. [PMID: 3437112 DOI: 10.1017/s0022149x00010221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Four Presbytis cristata were treated with oral ivermectin at the same time as the subcutaneous inoculation of 100 infective larvae monthly for three months. Two animals given 0.2 mg/kg monthly and two others given 0.3 mg/kg monthly as well as three control animals became patent for microfilaraemia. However, only 1% of the infective dose was recovered as adult worms from animals in the higher drug dosage group compared to 8.2% and 6.2% in the lower dosage and control groups respectively.
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Affiliation(s)
- J W Mak
- Institute for Medical Research, Jalan Pahang, Kuala Lumpur, Malaysia
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Diallo S, Aziz MA, Ndir O, Badiane S, Bah IB, Gaye O. Dose-ranging study of ivermectin in treatment of filariasis due to Wuchereria bancrofti. Lancet 1987; 1:1030. [PMID: 2883362 DOI: 10.1016/s0140-6736(87)92291-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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