Treatment of co-infection with bancroftian filariasis and onchocerciasis: a safety and efficacy study of albendazole with ivermectin compared to treatment of single infection with bancroftian filariasis

Abstract

BackgroundIn order to use a combination of ivermectin and albendazole for the elimination of lymphatic filariasis, it is important to assess the potential risk of increased adverse events in individuals infected with both lymphatic filariasis and onchocerciasis. We compared the safety and efficacy of albendazole (400 mg) in combination with ivermectin (150 micrograms/kg), for the treatment of co-infections of Wuchereria bancrofti and Onchocerca volvulus with single infection of W. bancrofti.MethodsThe safety study on co-infections was a crossover, double blind design, while for the single infection of bancroftian filariasis an open design comparing two treatments was used. For co-infection, one group was allocated a single dose of ivermectin (150 micrograms/kg) plus albendazole (400 mg) (Group A). The other group received placebo (Group B). Five days later the treatment regime was reversed, with the Group A receiving placebo and Group B receiving treatment. For the single bancroftian filariasis infection, one group received a single dose of albendazole (400 mg) plus ivermectin (150 μg/kg) (Group C) while the other group received a single dose of albendazole (400 mg) alone (Group D). Blood and skin specimens were collected on admission day, day 0, and on days 2, 3, and 7 to assess drug safety and efficacy. Thereafter, blood and skin specimens were collected during the 12 months follow up for the assessment of drug efficacy. Study individuals were clinically monitored every six hours during the first 48 hours following treatment, and routine clinical examinations were performed during the hospitalisation period and follow-up.ResultsIn individuals co-infected with bancroftian filariasis and onchocerciasis, treatment with ivermectin and albendazole was safe and tolerable. Physiological indices showed no differences between groups with co-infection (W. bancrofti and O. volvulus) or single infection (W. bancrofti). The frequency of adverse events in co-infected individuals was 63% (5/8, Group A, albendazole + ivermectin) and 57% (4/7, Group B, placebo) and of mild or moderate intensity. In single W. bancrofti infection the frequency of adverse events was 50% (6/12, Group C, albendazole + ivermectin) and 38% (5/13, Group D, albendazole) and of a similar intensity to those experienced with co-infection. There were no differences in adverse events between treatment groups. There was no significant difference in the reduction of microfilaraemia following treatment with albendazole and ivermectin in groups with single or co-infection.ConclusionOur findings suggest that ivermectin plus albendazole is a safe and tolerable treatment for co-infection of bancroftian filariasis and onchocerciasis.

Efficacy and safety of co-administered ivermectin plus albendazole for treating soil-transmitted helminths: A systematic review, meta-analysis and individual patient data analysis

“…The quality and types of potential biases of these five studies is summarized in Fig 7 . Two studies reached the highest quality grading [ 20 , 40 ], while one did not clearly state about blinding of outcome assessors [ 41 ] and two studies followed an open-label or only partly blinded study design [ 30 , 42 ], provided incomplete information on random allocation measures and thus reached lower grading.…”

“…Within the trials, most studies involved participants with filariasis such as LF due to Wuchereria bancrofti (n = 7) [ 41 , 43 , 49 , 50 , 54 – 56 ] or Brugia malayi (n = 2) [ 39 , 53 ], onchocerciasis due to Onchocerca volvulus (n = 1) [ 40 ], mansonellosis due to Mansonella perstans (n = 2) [ 37 , 38 ] or co-infections of the above (n = 3) [ 42 , 47 , 51 ]. Three studies assessed the safety of ivermectin-albendazole co-administration in patients infected with STHs [ 20 , 24 , 30 ] and one study in patients with schistosomiasis caused by Schistosoma haematobium and/or S .…”

Seroepidemiology of helminths and the association with severe malaria among infants and young children in Tanzania

“…This obviously provides a framework for adding multiple (up to 50) antigens to gain a comprehensive assessment of seroreactivity in a single assay [ 38 ]. Other helminths contribute to polyparasitism in Tanzania including: Onchocerca volvulus , the causative agent of onchocerciasis [ 39 ]; S . mansoni and S .…”

“…However, one advantage of using serology is that we are able to observe cumulative exposure, rather than assessing exposure at a single point in time. Secondly, this well-established serologic assay specifically uses Brugia malayi antigens, based on the substantial antigenic cross-reactivity among all filarial species [ 8 – 10 , 39 ], and as a result this assesses filarial exposure without assignment to an exact species. However, the age-specific profile aligns much more closely with W .…”

A systematic study on structure and function of ATPase of wuchereria bancrofti

“…[ 7 ] A mixture of albendazole and ivermectin or DEC and albendazoles can be used for eliminating microfilaria, but they only interrupt the mature females reproductive capability. [ 8 9 ] An indication of the efficiency of this combination treatment is still inadequate[ 10 11 12 13 ] and quantitative efficiency estimates are not yet available. Hence, the new antifilarial drug combinations are estimated to increase compliance, coverage, and decrease costs by familiarizing simple effective drug delivery and distribution methods.…”