In:
PLOS Neglected Tropical Diseases, Public Library of Science (PLoS), Vol. 16, No. 2 ( 2022-2-9), p. e0010096-
Kurzfassung:
Papua New Guinea (PNG) has a high burden of lymphatic filariasis (LF) caused by Wuchereria bancrofti , with an estimated 4.2 million people at risk of infection. A single co-administered dose of ivermectin, diethylcarbamazine and albendazole (IDA) has been shown to have superior efficacy in sustained clearance of microfilariae compared to diethylcarbamazine and albendazole (DA) in small clinical trials. A community-based cluster-randomised trial of DA versus IDA was conducted to compare the safety and efficacy of IDA and DA for LF in a moderately endemic, treatment-naive area in PNG. Methodology All consenting, eligible residents of 24 villages in Bogia district, Madang Province, PNG were enrolled, screened for W . bancrofti antigenemia and microfilaria (Mf) and randomised to receive IDA (N = 2382) or DA (N = 2181) according to their village of residence. Adverse events (AE) were assessed by active follow-up for 2 days and passive follow-up for an additional 5 days. Antigen-positive participants were re-tested one year after MDA to assess treatment efficacy. Principal findings Of the 4,563 participants enrolled, 96% were assessed for AEs within 2 days after treatment. The overall frequency of AEs were similar after either DA (18%) or IDA (20%) treatment. For those individuals with AEs, 87% were mild (Grade 1), 13% were moderate (Grade 2) and there were no Grade 3, Grade 4, or serious AEs (SAEs). The frequency of AEs was greater in Mf-positive than Mf-negative individuals receiving IDA (39% vs 20% p 〈 0.001) and in Mf-positive participants treated with IDA (39%), compared to those treated with DA (24%, p = 0.023). One year after treatment, 64% (645/1013) of participants who were antigen-positive at baseline were re-screened and 74% of these participants (475/645) remained antigen positive. Clearance of Mf was achieved in 96% (52/54) of infected individuals in the IDA arm versus 84% (56/67) of infected individuals in the DA arm (relative risk (RR) 1.15; 95% CI, 1.02 to 1.30; p = 0.019). Participants receiving DA treatment had a 4-fold higher likelihood of failing to clear Mf (RR 4.67 (95% CI: 1.05 to 20.67; p = 0.043). In the DA arm, a significant predictor of failure to clear was baseline Mf density (RR 1.54; 95% CI, 1.09 to 2.88; p = 0.007). Conclusion IDA was well tolerated and more effective than DA for clearing Mf. Widespread use of this regimen could accelerate LF elimination in PNG. Trial registration Registration number NCT02899936 ; https://clinicaltrials.gov/ct2/show/NCT02899936 .
Materialart:
Online-Ressource
ISSN:
1935-2735
DOI:
10.1371/journal.pntd.0010096
DOI:
10.1371/journal.pntd.0010096.g001
DOI:
10.1371/journal.pntd.0010096.g002
DOI:
10.1371/journal.pntd.0010096.g003
DOI:
10.1371/journal.pntd.0010096.g004
DOI:
10.1371/journal.pntd.0010096.g005
DOI:
10.1371/journal.pntd.0010096.g006
DOI:
10.1371/journal.pntd.0010096.g007
DOI:
10.1371/journal.pntd.0010096.t001
DOI:
10.1371/journal.pntd.0010096.t002
DOI:
10.1371/journal.pntd.0010096.t003
DOI:
10.1371/journal.pntd.0010096.t004
DOI:
10.1371/journal.pntd.0010096.t005
DOI:
10.1371/journal.pntd.0010096.s001
DOI:
10.1371/journal.pntd.0010096.s002
DOI:
10.1371/journal.pntd.0010096.s003
DOI:
10.1371/journal.pntd.0010096.s004
DOI:
10.1371/journal.pntd.0010096.s005
DOI:
10.1371/journal.pntd.0010096.s006
DOI:
10.1371/journal.pntd.0010096.s007
Sprache:
Englisch
Verlag:
Public Library of Science (PLoS)
Publikationsdatum:
2022
ZDB Id:
2429704-5
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