Efficacy of oral ivermectin paste against mucosal stages of cyathostomes

Comparison of the host response to larvicidal and nonlarvicidal treatment of naturally acquired cyathostomin infections in horses

AIMS

This study aimed to collect information on local and systemic inflammatory responses, and goblet cell-associated components, following anthelmintic treatment with moxidectin and ivermectin in horses naturally infected with cyathostomin parasites.

METHODS AND RESULTS

36 horses aged 2-5 years of age were randomly allocated to three groups. Group 1 received ivermectin/praziquantel (0.2mg/kg), Group 2 received moxidectin/praziquantel (0.4mg/kg), and Group 3 were untreated controls. Tissue samples from the Cecum, Dorsal and Ventral Colons were used for histopathological evaluation and preserved for RNA isolation and gene expression analysis. Whole blood was collected weekly for gene expression analysis as well. The control group had significantly higher inflammation associated with higher larval scores. The treatment groups displayed no differences in larval counts and inflammatory cell populations (p>0.05). Mucosal larval counts were positively correlated with goblet cell hyperplasia scores (p=0.047). The moxidectin treated group had a significantly lower expression of IFN- γ (p<0.05).

CONCLUSION

The data suggest that removal of cyathostomins reduced the proinflammatory response associated with cyathostomin infections. Proinflammatory reactions associated with anthelmintic treatment were minimal, but lowest for moxidectin-treated horses. Results suggested that cecum, ventral and dorsal colons responded differently to cyathostomin larvae, which may have implications in the disease process.

Moxidectin: a review of chemistry, pharmacokinetics and use in horses

This article reviews the current knowledge of the use of moxidectin (MOX) in horses, including its mode of action, pharmacokinetic and pharmacodynamic properties, efficacy, safety and resistance profile.Moxidectin is a second generation macrocyclic lactone (ML) with potent endectocide activity. It is used for parasite control in horses in an oral gel formulation. The principal mode of action of MOX and of other MLs is binding to gamma-aminobutyric (GABA) and glutamate-gated chloride channels. Moxidectin is different from other MLs in that it is a poor substrate for P-glycoproteins (P-gps) and therefore less susceptible to elimination from parasite cells through this mechanism. Due to its unique physicochemical and pharmacokinetic characteristics, MOX provides broad distribution into tissues, long half-life, significant residual antiparasitic activity, and high efficacy against encysted cyathostomin larvae. These characteristics allow for high efficacy and longer treatment interval against all important nematodes, when compared to other equine anthelmintics. A combination of MOX with praziquantel provides expanded spectrum of activity by adding activity against cestodes. Appropriate use of MOX allows for the development of strategic anthelmintic programmes that are different from those with conventional anthelmintics. Fewer treatments are required over a period of time, and therefore impose less frequent selection pressure for resistance.

Treatment and follow-up of clinical cyathostominosis in horses

The results of the treatment with moxidectin or ivermectin of 20 horses with clinical cyathostominosis were studied during a 3-week observation period. Both treatments were effective in completely eliminating larvae from the faeces within 1 or 2 weeks, but no significant improvement in body weight or clinical parameters could be demonstrated over the observation period. The poor short time results of the treatment support the need for an adequate prevention of cyathostominosis in horses.

Comparative efficacy, persistent effect, and treatment intervals of anthelmintic pastes in naturally infected horses

Eighty horses were involved in a comparative, controlled, and randomised field study conducted in Australia and Brazil. This study was undertaken to address the duration of efficacy (by faecal egg count reduction) of four anthelmintic pastes and to measure the time required between treatments on horses naturally infected by gastrointestinal nematodes. The treatment interval was based on the egg reappearance period (ERP), defined as "the period after treatment when horses have reached a positive egg count equal or superior to 200 eggs per gram (epg) of faeces". Horses were ranked according to pre-treatment faecal egg counts and randomly allocated on Day 0 to one of the four treatment groups (n=16). Group A received a combination of ivermectin at 200 microg/kg and praziquantel at 1.5mg/kg, Group B received an ivermectin paste at 200 microg/kg, Group C received a reference product containing ivermectin at 200 microg/kg, Group D received a moxidectin paste at 400 microg/kg, and Group E received a placebo. Horses were individually faecal sampled at weekly interval from Days 0 to 70 after treatment and coprocultures were made on pooled samples at the pre-treatment time on D-7 in Brazil and D-6 in Australia. The nematode population was mainly composed of small strongyles (Cyathostominae, Gyalocephalus spp., Triodontophorus spp.). All products were efficient (>90% efficacy) until Day 42 with no statistical difference between groups. From Day 49 onwards, Group C reached the threshold, while Group B exceeded this threshold on Day 56. Groups A and D remained below 200 epg for the entire study period (70 days). The interval between two anthelmintic treatments can vary according to the threshold. The ERP was defined as the period after treatment while the output of eggs is negligible or considered as acceptable. The mean number of days calculated to recurrence of 200 epg and more was, respectively, 60 days for product A, 56 days for products B and C, and 64 days for product D. If treatments are combined with other methods of limiting exposure to infective larvae on pasture, the number of treatments required will be reduced even further.

Re-evaluation of ivermectin efficacy against equine gastrointestinal parasites

Two trials were conducted to confirm the efficacy of ivermectin paste against endoparasites of horses. In these trials, 20 ponies were treated with ivermectin oral paste at 200 mcg x kg body weight once on Day 0, and 20 ponies served as unmedicated controls. The animals carried naturally acquired parasite infections as confirmed by pretrial fecal examination. The animals were necropsied for worm recovery on Days 14, 15 or 16. Parasites recovered were identified to species. Horses treated with ivermectin had significantly (P<0.05) fewer (>99.0% reduction) adult small strongyles (Coronocyclus spp including C. coronatus, C. labiatus, C. labratus; Cyathostomum spp including C. catinatum, C. pateratum; Cylicocyclus spp including C. ashworthi, C. elongatus, C. insigne, C. leptostomum, C. nassatus, C. radiatus; Cylicodontophorus bicoronatus; Cylicostephanus spp including C. asymetricus, C. bidentatus, C. calicatus, C. goldi, C. longibursatus, C. minutus; Gyalocephalus capitatus; Parapoteriostomum spp including P. euproctus, P. mettami; Petrovinema poculatum; Poteriostomum spp including P. imparidentatum, P. ratzii) and adult large strongyles (Strongylus edentatus, S. vulgaris; Triodontophorus spp including T. brevicauda, T. serratus; Craterostomum acuticaudatum) than the controls. Ivermectin was also highly effective (94% to >99%, P<0.05-0.01) against Gasterophilus intestinalis larvae, Habronema spp., Oxyuris equi, Parascaris equorum. The data from these two trials confirm that ivermectin paste administered to horses orally at 200mcg x kg(-1) continues to be highly effective for treatment and control of a broad range of small and large strongyle species as well as other species of gastrointestinal parasites.

Efficacy of moxidectin 2 per cent gel against naturally acquired strongyle infections in horses, with particular reference to larval cyathostomes

The efficacy of moxidectin 2 per cent equine gel against naturally acquired strongyle infections was assessed in 18 ponies which had grazed on contaminated pasture before being housed for eight weeks. Twenty-four hours before the treatment, two randomly selected ponies were euthanased and their worm burdens were determined. Eight of the remaining 16 ponies were treated with moxidectin 2 per cent gel while the other eight were given a placebo gel. Eight weeks later the 16 animals were necropsied and their worm burdens established. A 100 per cent efficacy was recorded against adult and lumenal L4 cyathostomes and adult Strongylus and Triodontophorus species. Digest recoveries of larval cyathostomes indicated a 90.8 per cent (P<0.002) reduction in early L3 and a 99.9 per cent (P<0.001) reduction in developing stages. There was a reduction in faecal egg output of between 96 and 100 per cent in the treated animals compared with the controls.

Larval cyathostomiasis

Over the past few years, cyathostomiasis has become increasingly recognized as a clinical problem of horses in the United States. Clinical cyathostomiasis has been reported frequently in Europe for a considerable time. This clinical syndrome is usually related to the sudden release of large numbers of the larval stages of small strongyles from the mucosa of the large intestine. Typical clinical signs include diarrhea, ventral abdominal edema, pyrexia, colic, weight loss, and poor body condition. Hypoalbuminemia and the presence of large numbers of small strongyles being passed in the feces are also characteristic features of the disease. The disease may occur seasonally in late winter and early spring or after drug treatment to remove the luminal stages of small strongyles. Two commercially available drugs, moxidectin and fenbendazole, have been shown to be effective against the encysted larval stages of the parasites. Drug resistance of small strongyles to all classes of currently available antiparasitic compounds except the macrocyclic lactones (ivermectin and moxidectin) is a limiting factor in controlling these parasites and may result in an increased prevalence of clinical cyathostomiasis over time.

Historical perspective of cyathostomes: prevalence, treatment and control programs

Small strongyles are highly prevalent in horses and can be found worldwide. Even though over 50 species of these parasites have been described, about 10 species comprise the bulk of the total number present in horses. Efforts to control small strongyles and other equine internal parasites have been undertaken for many years. Some of the early medications and control measures provided questionable activity against endoparasites; whether effective or not, they could be detrimental to the horse. Beginning in the early 1900s, scientific effort was used to evaluate activity of antiparasitic compounds. Only a relatively low number of classes of compounds has been used for parasite control. Progressively, in time, newer drugs have become broad-spectrum, safer, and available in lower dose rates than previously. With extensive use of parasiticides, small strongyles have been found to be resistant to all commercially-available classes of compounds except the macrocyclic lactones. Innovative parasite-control programs, relying less on drugs, need to be developed.

Experimental cyathostome challenge of ponies maintained with or without benefit of daily pyrantel tartrate feed additive: comparison of parasite burdens, immunity and colonic pathology

Eighteen mixed-breed, naturally infected ponies ranging in age from 1 to 16 yr and four cyathostome-naïve ponies reared and maintained under parasite-free conditions ranging in age from 1 to 4 yr were used in this study. Naturally-infected ponies were treated with 1 dose of ivermectin (IVM) at 200 micrograms kg-1, followed by a 5-day regimen of oxibendazole (OBZ) at 20 mg kg-1 to remove existing cyathostome burdens; cyathostome-naïve control ponies were treated with IVM alone. The naturally infected ponies were matched on age and gender, then randomly assigned to one of three treatment groups of six animals per group; the four cyathostome-naïve ponies constituted a fourth group. Following OBZ treatment, Group 1 ponies were treated with pyrantel tartrate (PT) in their pelleted ration; the remaining ponies received only the pelleted ration. Beginning on experiment Day 3, a daily challenge infection of 10(4) mixed cyathostome larvae was administered orally to ponies of Group 1, Group 2 and the cyathostome-naïve controls. Group 3 ponies served as unchallenged controls to determine residual parasite burdens following IVM/OBZ treatment. Necropsy examinations were performed on three Group 3 ponies on Day 1; the remainder of the necropsy examinations began on Day 41. Cyathostome burdens were evaluated by recovery of larvae and adults from the luminal contents, by digestions of the intestinal mucosa, and by mural transillumination of full-thickness intestinal sections. Differences in postchallenge clinical responses were also compared. Necropsy examinations included comparisons of grossly visible inflammation of the large bowel, weights of biopsy specimens from each region, and histologic evaluations of these biopsies. Parasite recoveries at necropsy indicated a strong protective effect derived from daily PT treatment. Mean weights of intestinal biopsies corresponded with worm burdens, but histological evaluation did not reveal architectural or cellular changes to account for the increase in weight; therefore, edema was suspected. A strong age-related resistance to challenge infection was apparent in both the PT-treated and control groups by virtue of the lower mean worm burdens found in older ponies compared to younger ponies of the same treatment group; however, daily PT treatment of older ponies reduced the variability of their worm burdens to a uniformly low level. Comparisons of luminal and mucosal parasite burdens of age stratified nontreated controls further suggest that the age related resistance, which is acquired, targets increasing numbers of parasite stages as this resistance matures. Further, there is no evidence for an immune mediated acquisition of hypobiotic L3.

Comparative studies of ivermectin and moxidectin in the control of naturally acquired cyathostome infections in horses

The control of naturally acquired cyathostome infections in horses by treatments with ivermectin and moxidectin was evaluated in three field studies. In a first study the efficacy of both drugs was assessed in a faecal egg count reduction test. Both ivermectin and moxidectin demonstrated efficacies greater than 99 per cent for up to 60 days after treatment. In a second study, the period required for strongyle eggs to reappear was estimated in horses treated either with ivermectin or moxidectin. For the horses treated with ivermectin the period varied between 10 and approximately 13 weeks, and for moxidectin between 22 and approximately 24 weeks. With both drugs strongyle eggs started to reappear in the faeces significantly earlier in foals and young horses than in adults. In a third study, two prophylactic dosing schemes involving three ivermectin treatments at intervals of eight weeks, and two moxidectin treatments 12 weeks apart, were found to be highly effective in controlling strongyle infections of horses on pasture.

Clinical trial of moxidectin oral gel in horses

A clinical trial carried out over 98 days was done to evaluate treatment of horses with moxidectin gel for efficacy as measured by (1) reduction in the production of parasite ova post treatment, (2) a comparison of the posttreatment parasite egg count suppression of moxidectin to ivermectin, and (3) assessment of the field safety, animal acceptance of the moxidectin formulation, and the utility of the moxidectin delivery device. One hundred and fifty Standardbred horses with naturally acquired parasite infections were used in the study. Moxidectin had more prolonged and greater suppressive influence than did ivermectin on reappearance and magnitude of strongyle egg counts post treatment. Differences were not observed between the capability of ivermectin or moxidectin to reduce and suppress low Parascaris equorum egg counts. Adverse reactions to treatments were not observed, and the utility of the moxidectin delivery syringe and animal acceptance of moxidectin treatment were satisfactory.

Controlled dose confirmation study of a 2% moxidectin equine gel against equine internal parasites in The Netherlands

The efficacy of a 2% moxidectin equine gel at a dosage rate of 0.4 mg kg-1 was evaluated in a controlled trial at Utrecht University. Twelve yearling castrated male Shetland ponies grazed a pasture of 2 ha from May 1994 until housing in November. Six ponies were treated with moxidectin, whereas the others served as non-treated controls. Necropsy was carried out 35 days after treatment. Greater than 99% efficacy of moxidectin was observed on faecal egg output. No effect of moxidectin was observed on mucosal inhibited early cyathostome L3 (EL3) or on the total numbers of mucosal developing stages. However, a 89.6% reduction was observed on large mucosal fourth stage larvae (L4). Moxidectin treatment probably triggered resumption of development of EL3. Moxidectin appeared to be highly effective (95-100%) on lumenal L4 cyathostomes, adult strongylids, Strongylus vulgaris larvae from the arteries, S. edentatus larvae from the abdominal wall and Trichostrongylus axei. Moxidectin had relatively poor efficacy against Gasterophilus intestinalis and had no effect on Anoplocephala perfoliata. No side-effects of moxidectin treatment were observed.

Comparison of moxidectin oral gel and ivermectin oral paste against a spectrum of internal parasites of ponies with special attention to encysted cyathostome larvae

Two dosages of moxidectin oral gel were evaluated and compared to a therapeutic dose of ivermectin oral paste in the control of a spectrum of gastrointestinal parasites of ponies naturally infected in southern Louisiana or Mississippi. Thirty-two mixed-breed ponies ranging in age from one to 21 years were used in this controlled test. Eight weeks prior to the experiment, ponies grazing on contaminated pasture were moved to a paddock and fed a pelleted ration, thus reducing or eliminating the potential for additional infection and ensuring the existence of a population of encysted larvae. Ponies were then allocated to replicates of four animals based on values of fecal strongyle egg counts and percent strongyle larvae composition determined from Baermann sedimentations of fecal cultures. Members of replicates were allocated to one of four treatment groups: moxidectin oral gel administered at 300 micrograms kg-1 body weight, moxidectin oral gel at 400 micrograms kg-1, the oral gel vehicle as negative control, and ivermectin oral paste at 200 micrograms kg-1. Prior to treatment, ponies were confined in pairs to covered concrete runs by treatment group. Two weeks following treatment, necropsy examinations of all animals were performed. Parasites were recovered from the lumen of the stomach, the intestinal tract, the cranial mesenteric artery and its major branches, the peritoneal body wall and from pepsin digests of mucosal scrapings taken from the cecum and large colon. Encysted cyathostome larval burdens were also compared using mural transillumination of segments of the large colon for visualization of the encysted forms. Control ponies were not uniformly infected with the spectrum of parasites; however, moxidectin, at either dosage, compared favorably with ivermectin in the control of the adults of Strongylus vulgaris, Strongylus edentatus, Triodontophorus spp., Oesophagodontus robustus, Trichostrongylus axei, Oxyuris equi, Parascaris equorum, Habronema muscae, as well as both the adult and larval Cyathostominae recovered from the lumen. Moxidectin also appears as efficacious as ivermectin against migrating large strongyle larvae at the two weeks post-treatment evaluation. Moxidectin demonstrated a trend towards greater efficacy against encysted cyathostome larvae than a therapeutic dosage of ivermectin, but this difference was not statistically significant. Moxidectin was less effective than ivermectin against Gasterophilus intestinalis and was equally ineffective as ivermectin against Anoplocephala perfoliata.

Larval cyathostomiasis as a cause of death in two regularly dewormed horses

Two horses were presented with complaints of chronic weight loss and subcutaneous oedema, one of them presenting diarrhoea. Both animals were grazed with other unaffected horses, all of them being regularly dewormed. Blood chemistry revealed hypoalbuminaemia and a low albumin-globulin ratio. Faecal egg counts were negative and no cyathostome larvae could be found in the faeces. Neither of these horses could be saved, despite intensive treatment. Postmortem examination revealed severe typhlitis and colitis due to numerous inhibited cyathostome larvae.