Ivermectin is a potent microfilaricide that also blocks microfilarial release while albendazole i... more Ivermectin is a potent microfilaricide that also blocks microfilarial release while albendazole is toxic to all intrauterine stages. We investigated whether their combination would permanently sterilize the adult worms. In the first open phase, all 69 patients received 150 micrograms/kg of ivermectin. In the second double-blind phase one week later, 35 patients were randomized to receive 800 mg of albendazole with a fatty breakfast for three consecutive days while 34 patients received matching placebo tablets. Detailed clinical and laboratory examinations were done before treatment and were repeated at intervals over one year. Nodules were excised at three and six months. There was a rapid reduction in skin microfilariae, maximal at four weeks (99.9%). Counts increased subsequently and were between 11 and 18% of initial values at one year. Nodule histology showed no macrofilaricidal activity of the combination. A high proportion of the stretched intrauterine microfilariae were degenerate in both groups. Anterior chamber microfilarial counts were unchanged until day 18 and then fell successively. Low levels persisted in several patients at one year. Dead corneal microfilariae and corneal punctate opacities increased initially, fell with time and then disappeared in most patients. Systemic and ocular reactions were mild to moderate and biochemical abnormalities were minor. A pronounced posttreatment eosinophilia subsided by day 30. There was no significant difference between the two groups in clinical and laboratory tolerance or in alterations in skin and ocular parasites and no important differences in the effect on the adult worms. The combination of ivermectin with albendazole given one week apart is well tolerated but produces no additional effect against Onchocerca volvulus when compared to ivermectin given alone.
Ivermectin is the drug of choice for the treatment of onchocerciasis. However at the recommended ... more Ivermectin is the drug of choice for the treatment of onchocerciasis. However at the recommended dose of 150 micrograms/kg, it neither kills nor permanently sterilises the adult worms. We investigated whether high doses given with and without a preceding 150 micrograms/kg 'clearing' dose would be tolerable as well as effective against the adult worms. Seventy-five healthy males with moderate to heavy infections with Onchocerca volvulus were enrolled in a double-blind trial to receive one of the following treatment regimens: 150 micrograms/kg followed by placebo (9 patients); 400 micrograms/kg with (9 patients) or without (16 patients) a clearing dose; 600 micrograms/kg with (8 patients) or without (16 patients) a clearing dose and 800 micrograms/kg with (8 patients) or without (9 patients) a clearing dose. Detailed examinations were conducted before and at various times after treatment. A preliminary report on the clinical and laboratory safety as at 30 days is presented. All the regimens were well tolerated. No clinical or laboratory drug related effects were observed. The overall severity of the Mazzotti reaction was similar in all groups. Ocular reactions were minimal and there were no changes in ocular function or in fluorescein angiograms. The groups were similar in the extent of microfilaricidal activity; there was however a suggestion that microfilariae were killed more rapidly at 400 micrograms/kg and 600 micrograms/kg but not at 800 micrograms/kg. This needs further study. Single doses of ivermectin up to 800 micrograms/kg are well tolerated; no special precautions for treatment monitoring are required and a 'clearing' dose is not necessary.
Onchocerciasis is a parasitic disease that is the second most common cause of infectious blindnes... more Onchocerciasis is a parasitic disease that is the second most common cause of infectious blindness in the world, affecting 25 million people, mostly in sub-saharan Africa. Mass drug administration (MDA) with ivermectin has been the mainstay of a successful international effort to reduce the burden of vision loss. Despite improvements in infection rates and blindness through MDA with ivermectin, adult worms are not killed or permanently sterilized by this drug and can live for greater than 10 years. Therefore, new treatments for onchocerciasis are critical to accelerating the rate of elimination of this blinding disease. Here we discuss an ongoing study of a new treatment for onchocerciasis.
An improved short-term in vitro culture system was used for the routine screening of hundreds of ... more An improved short-term in vitro culture system was used for the routine screening of hundreds of promising new compounds with the target organism, the filarial nematode Onchocerca volvulus. The most active leads were identified among the pyrimidinylguanidines, amidine derivatives, the imidazolinylhydrazones, thiosemicarbazone derivatives and thiadiazole derivatives. Single compounds of these leads demonstrated strong macrofilaricidal efficacy in minimum effective dose trials down to 0.1 microM and in experiments evaluating the minimum time of exposure after less than 6 h exposure. In the group of the pyrimidinylguanidines we found a significant correlation of structure and activity: change of a single side-group in the molecules had dramatic influence on compound activity. Most of the new compounds that were active on the macrofilariae did not show significant activity on microfilariae (mf) in in vitro trials. Only one compound with significant activity against female O. volvulus worms killed mf at very low concentrations. Some of the promising leads will be processed in further trials on a preclinical level with predictive cattle models.
Tropical medicine and parasitology : official organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ), 1995
We report the clinical and parasitological effects of a modified treatment regimen for suramin. T... more We report the clinical and parasitological effects of a modified treatment regimen for suramin. Twenty adult males received up to 5 g (72.5 to 84.7 mg/kg) of suramin over 36 days. Detailed clinical and laboratory examinations were done before treatment and then at intervals over 2 years. Nodules were removed at 6, 13, 26 and 52 weeks for histology. Systemic tolerance was good. Anterior segment inflammation was however common and 2 patients required intervention to prevent posterior synechiae. No new posterior segment lesions developed; a rare improvement occurred in one patient with papillitis. Proteinuria, mostly mild, occurred in nearly all patients. Previously unreported renal glycosuria was documented in one patient. Microfilariae in the skin and anterior chamber did not change significantly for 5 or more weeks after which rapid reductions occurred. Ocular parasites were absent at 2 years and skin microfilariae were near zero. Peripheral blood eosinophil counts fell in parallel ...
Background Onchocerciasis (“river blindness”) has been targeted for elimination. New treatments t... more Background Onchocerciasis (“river blindness”) has been targeted for elimination. New treatments that kill or permanently sterilize female worms could accelerate this process. Prior studies have shown that triple drug treatment with ivermectin plus diethylcarbamazine and albendazole (IDA) leads to prolonged clearance of microfilaremia in persons with lymphatic filariasis. We now report results from a randomized clinical trial that compared the tolerability and efficacy of IDA vs. a comparator treatment (ivermectin plus albendazole, IA) in persons with onchocerciasis. Methods and findings The study was performed in the Volta region of Ghana. Persons with microfiladermia and palpable subcutaneous nodules were pre-treated with two oral doses of ivermectin (150 μg/kg) separated by at least 6 months prior to treatment with either a single oral dose of ivermectin 150 μg/kg plus albendazole 400 mg (IA), a single oral dose of IDA (IDA1, IA plus diethylcarbamazine (DEC. 6 mg/kg) or three cons...
Background After ivermectin became available, diethylcarbamazine (DEC) use was discontinued becau... more Background After ivermectin became available, diethylcarbamazine (DEC) use was discontinued because of severe adverse reactions, including ocular reactions, in individuals with high O. volvulus microfilaridermia. Assuming long-term ivermectin use led to < 5 microfilariae/mg skin (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 ivermectin-naïve individuals with ≥ 10 SmfD for skin and ocular microfilariae and adverse events (AEs) for 12–18 months after a single treatment (8mg moxidectin, n = 978 or 150µg/kg ivermectin n = 494).Methods We descriptively analyzed the data from 1463 participants with both eyes evaluated using six (0, 1–5, 6–10, 11–20, 21–40, > 40) categories for microfilariae in the anterior chamber (mfAC) and three pre-treatment (< 20, 20-<50, ≥ 50) and post-treatment (0, >...
<p>A Time of nadir among participants with any intensity of infection, B Time of nadir amon... more <p>A Time of nadir among participants with any intensity of infection, B Time of nadir among severely infected participants, C Time of start of sustained increase (time of two subsequent measurements above the nadir) among participants with any intensity of infection, D Time of start of sustained increase among severely infected participants. Data analyzed are those of participants who completed the study excluding participants with a decrease in skin microfilariae levels not meeting the criteria for ‘adequate response’ (SOMRs).</p
<p>The boundaries and names shown and the designations used in this map do not imply the ex... more <p>The boundaries and names shown and the designations used in this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.</p
<p>A Ivermectin. The data for the three participants treated with ivermectin whose decrease... more <p>A Ivermectin. The data for the three participants treated with ivermectin whose decrease in skin microfilariae levels did not meet the criteria of ‘adequate response’ are indicated by markers at the evaluation time points. B 2 mg moxidectin, C 4 mg moxidectin, D 8 mg moxidectin.</p
<p>B. Skin microfilaria density pre-treatment by number of live female macrofilariae and su... more <p>B. Skin microfilaria density pre-treatment by number of live female macrofilariae and sum of live (LI) and dead, non-calcified female macrofilariae (LIDD). Only data from participants who had not more palpable nodule sites at month 18 than at pre-treatment and who had agreed to excision of all palpable nodules or who had no palpable nodules are included. For display reasons, the×axis maximum in Figure B was set to 9. The data from the man with 8 nodules in Figure A who had 13 live female macrofilariae and 3 dead, non-calcified female macrofilariae and 50.2 mf/mg skin pre-treatment are thus not displayed.</p
Ivermectin is a potent microfilaricide that also blocks microfilarial release while albendazole i... more Ivermectin is a potent microfilaricide that also blocks microfilarial release while albendazole is toxic to all intrauterine stages. We investigated whether their combination would permanently sterilize the adult worms. In the first open phase, all 69 patients received 150 micrograms/kg of ivermectin. In the second double-blind phase one week later, 35 patients were randomized to receive 800 mg of albendazole with a fatty breakfast for three consecutive days while 34 patients received matching placebo tablets. Detailed clinical and laboratory examinations were done before treatment and were repeated at intervals over one year. Nodules were excised at three and six months. There was a rapid reduction in skin microfilariae, maximal at four weeks (99.9%). Counts increased subsequently and were between 11 and 18% of initial values at one year. Nodule histology showed no macrofilaricidal activity of the combination. A high proportion of the stretched intrauterine microfilariae were degenerate in both groups. Anterior chamber microfilarial counts were unchanged until day 18 and then fell successively. Low levels persisted in several patients at one year. Dead corneal microfilariae and corneal punctate opacities increased initially, fell with time and then disappeared in most patients. Systemic and ocular reactions were mild to moderate and biochemical abnormalities were minor. A pronounced posttreatment eosinophilia subsided by day 30. There was no significant difference between the two groups in clinical and laboratory tolerance or in alterations in skin and ocular parasites and no important differences in the effect on the adult worms. The combination of ivermectin with albendazole given one week apart is well tolerated but produces no additional effect against Onchocerca volvulus when compared to ivermectin given alone.
Ivermectin is the drug of choice for the treatment of onchocerciasis. However at the recommended ... more Ivermectin is the drug of choice for the treatment of onchocerciasis. However at the recommended dose of 150 micrograms/kg, it neither kills nor permanently sterilises the adult worms. We investigated whether high doses given with and without a preceding 150 micrograms/kg 'clearing' dose would be tolerable as well as effective against the adult worms. Seventy-five healthy males with moderate to heavy infections with Onchocerca volvulus were enrolled in a double-blind trial to receive one of the following treatment regimens: 150 micrograms/kg followed by placebo (9 patients); 400 micrograms/kg with (9 patients) or without (16 patients) a clearing dose; 600 micrograms/kg with (8 patients) or without (16 patients) a clearing dose and 800 micrograms/kg with (8 patients) or without (9 patients) a clearing dose. Detailed examinations were conducted before and at various times after treatment. A preliminary report on the clinical and laboratory safety as at 30 days is presented. All the regimens were well tolerated. No clinical or laboratory drug related effects were observed. The overall severity of the Mazzotti reaction was similar in all groups. Ocular reactions were minimal and there were no changes in ocular function or in fluorescein angiograms. The groups were similar in the extent of microfilaricidal activity; there was however a suggestion that microfilariae were killed more rapidly at 400 micrograms/kg and 600 micrograms/kg but not at 800 micrograms/kg. This needs further study. Single doses of ivermectin up to 800 micrograms/kg are well tolerated; no special precautions for treatment monitoring are required and a 'clearing' dose is not necessary.
Onchocerciasis is a parasitic disease that is the second most common cause of infectious blindnes... more Onchocerciasis is a parasitic disease that is the second most common cause of infectious blindness in the world, affecting 25 million people, mostly in sub-saharan Africa. Mass drug administration (MDA) with ivermectin has been the mainstay of a successful international effort to reduce the burden of vision loss. Despite improvements in infection rates and blindness through MDA with ivermectin, adult worms are not killed or permanently sterilized by this drug and can live for greater than 10 years. Therefore, new treatments for onchocerciasis are critical to accelerating the rate of elimination of this blinding disease. Here we discuss an ongoing study of a new treatment for onchocerciasis.
An improved short-term in vitro culture system was used for the routine screening of hundreds of ... more An improved short-term in vitro culture system was used for the routine screening of hundreds of promising new compounds with the target organism, the filarial nematode Onchocerca volvulus. The most active leads were identified among the pyrimidinylguanidines, amidine derivatives, the imidazolinylhydrazones, thiosemicarbazone derivatives and thiadiazole derivatives. Single compounds of these leads demonstrated strong macrofilaricidal efficacy in minimum effective dose trials down to 0.1 microM and in experiments evaluating the minimum time of exposure after less than 6 h exposure. In the group of the pyrimidinylguanidines we found a significant correlation of structure and activity: change of a single side-group in the molecules had dramatic influence on compound activity. Most of the new compounds that were active on the macrofilariae did not show significant activity on microfilariae (mf) in in vitro trials. Only one compound with significant activity against female O. volvulus worms killed mf at very low concentrations. Some of the promising leads will be processed in further trials on a preclinical level with predictive cattle models.
Tropical medicine and parasitology : official organ of Deutsche Tropenmedizinische Gesellschaft and of Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ), 1995
We report the clinical and parasitological effects of a modified treatment regimen for suramin. T... more We report the clinical and parasitological effects of a modified treatment regimen for suramin. Twenty adult males received up to 5 g (72.5 to 84.7 mg/kg) of suramin over 36 days. Detailed clinical and laboratory examinations were done before treatment and then at intervals over 2 years. Nodules were removed at 6, 13, 26 and 52 weeks for histology. Systemic tolerance was good. Anterior segment inflammation was however common and 2 patients required intervention to prevent posterior synechiae. No new posterior segment lesions developed; a rare improvement occurred in one patient with papillitis. Proteinuria, mostly mild, occurred in nearly all patients. Previously unreported renal glycosuria was documented in one patient. Microfilariae in the skin and anterior chamber did not change significantly for 5 or more weeks after which rapid reductions occurred. Ocular parasites were absent at 2 years and skin microfilariae were near zero. Peripheral blood eosinophil counts fell in parallel ...
Background Onchocerciasis (“river blindness”) has been targeted for elimination. New treatments t... more Background Onchocerciasis (“river blindness”) has been targeted for elimination. New treatments that kill or permanently sterilize female worms could accelerate this process. Prior studies have shown that triple drug treatment with ivermectin plus diethylcarbamazine and albendazole (IDA) leads to prolonged clearance of microfilaremia in persons with lymphatic filariasis. We now report results from a randomized clinical trial that compared the tolerability and efficacy of IDA vs. a comparator treatment (ivermectin plus albendazole, IA) in persons with onchocerciasis. Methods and findings The study was performed in the Volta region of Ghana. Persons with microfiladermia and palpable subcutaneous nodules were pre-treated with two oral doses of ivermectin (150 μg/kg) separated by at least 6 months prior to treatment with either a single oral dose of ivermectin 150 μg/kg plus albendazole 400 mg (IA), a single oral dose of IDA (IDA1, IA plus diethylcarbamazine (DEC. 6 mg/kg) or three cons...
Background After ivermectin became available, diethylcarbamazine (DEC) use was discontinued becau... more Background After ivermectin became available, diethylcarbamazine (DEC) use was discontinued because of severe adverse reactions, including ocular reactions, in individuals with high O. volvulus microfilaridermia. Assuming long-term ivermectin use led to < 5 microfilariae/mg skin (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 ivermectin-naïve individuals with ≥ 10 SmfD for skin and ocular microfilariae and adverse events (AEs) for 12–18 months after a single treatment (8mg moxidectin, n = 978 or 150µg/kg ivermectin n = 494).Methods We descriptively analyzed the data from 1463 participants with both eyes evaluated using six (0, 1–5, 6–10, 11–20, 21–40, > 40) categories for microfilariae in the anterior chamber (mfAC) and three pre-treatment (< 20, 20-<50, ≥ 50) and post-treatment (0, >...
<p>A Time of nadir among participants with any intensity of infection, B Time of nadir amon... more <p>A Time of nadir among participants with any intensity of infection, B Time of nadir among severely infected participants, C Time of start of sustained increase (time of two subsequent measurements above the nadir) among participants with any intensity of infection, D Time of start of sustained increase among severely infected participants. Data analyzed are those of participants who completed the study excluding participants with a decrease in skin microfilariae levels not meeting the criteria for ‘adequate response’ (SOMRs).</p
<p>The boundaries and names shown and the designations used in this map do not imply the ex... more <p>The boundaries and names shown and the designations used in this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.</p
<p>A Ivermectin. The data for the three participants treated with ivermectin whose decrease... more <p>A Ivermectin. The data for the three participants treated with ivermectin whose decrease in skin microfilariae levels did not meet the criteria of ‘adequate response’ are indicated by markers at the evaluation time points. B 2 mg moxidectin, C 4 mg moxidectin, D 8 mg moxidectin.</p
<p>B. Skin microfilaria density pre-treatment by number of live female macrofilariae and su... more <p>B. Skin microfilaria density pre-treatment by number of live female macrofilariae and sum of live (LI) and dead, non-calcified female macrofilariae (LIDD). Only data from participants who had not more palpable nodule sites at month 18 than at pre-treatment and who had agreed to excision of all palpable nodules or who had no palpable nodules are included. For display reasons, the×axis maximum in Figure B was set to 9. The data from the man with 8 nodules in Figure A who had 13 live female macrofilariae and 3 dead, non-calcified female macrofilariae and 50.2 mf/mg skin pre-treatment are thus not displayed.</p
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