Clinical and parasitological responses after up to 6.5 years of ivermectin treatment for onchocerciasis.
There are plans to use mass treatment with ivermectin to clear all Africa of the worst ocular and cutaneous effects of onchocerciasis. However, there remains uncertainty about the most suitable treatment regimen and the likely effects of ivermectin on onchocercal skin disease. We have followed 948 subjects for over 6 years in a double-blind, randomized, controlled study of ivermectin for onchocerciasis in a hyperendemic focus in Sierra Leone. Using an intention-to-treat analysis we found a microfilarial prevalence of 16% 6 months after up to 4 annual doses of ivermectin, and 13% prevalence in the group receiving up to 10 doses of ivermectin at 6-monthly intervals. Microfilarial loads were well suppressed in both groups, but repopulation data suggest that adult female worms are still alive and fecund, strongly underlining the need to continue treatment. A clear effect of ivermectin was demonstrated on itching, with about one-third of cases being alleviated. Significant reductions in the prevalence of serious hyperkeratosis, and possibly dyspigmentation (leopard skin), were noted, but not for any other onchocercal skin lesion. Six-monthly and annual treatment regimens with ivermectin were equally effective in terms of dermatological and parasitological impact.
Whitworth
J A
JA
Tropical Health Epidemiology Unit, London School of Hygiene and Tropical Medicine.
Maude
G H
GH
Downham
M D
MD
D000293:Adolescent; D000328:Adult; D000818:Animals; D000969:Antinematodal Agents / Q000627:therapeutic use*; D002648:Child; D003430:Cross-Sectional Studies; D003872:Dermatitis / Q000188:drug therapy / Q000469:parasitology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use*; D008297:Male; D009854:Onchocerca / Q000187:drug effects; D009855:Onchocerciasis / Q000188:drug therapy* / Q000453:epidemiology*; D015995:Prevalence; D011537:Pruritus / Q000188:drug therapy*; D012807:Sierra Leone / Q000453:epidemiology
D000969:Antinematodal Agents; D007559:Ivermectin