Adverse reactions following mass drug administration with diethylcarbamazine in lymphatic filariasis endemic areas in the Northeast of Brazil

Abstract

Introduction:The Global Programme to Eliminate Lymphatic Filariasis was launched with the goal of eliminating this disease via the annual mass drug administration (MDA) of a single dose of antifilarial drugs. Adverse drug reactions following MDA are a major factor of poor treatment adherence in several countries. This study assessed the occurrence of adverse drug reactions (ADRs) following the first round of mass treatment in two communities treated with different dosages of diethylcarbamazine (DEC) in the City of Recife, Brazil. Methods: Population-based cross-sectional surveys were conducted in a random sample of the population living in both communities (Areas I and II). The dose of DEC recommended by the WHO (6mg/kg) was calculated based on the individual's weight-for-age. In Area II, weight differences between the genders were also considered when determining dosage. Data were obtained through interviews conducted in the first 12 to 48h and on the 5 th day after MDA during household visits. Results: A total of 487 and 365 individuals were interviewed in Areas I and II, respectively. The prevalence of ADRs in Area I (23.6; 95%CI: 19.1-29.5) was higher than in Area II (16.2; 95%CI:11.9-21.5)(p=0.0078). The prevalence of ADRs among females was higher than in males in Area I (p=0.0021). In Area II, no significant difference between the genders was observed (p=0.1840). Age was not associated with ADRs in either area. Conclusions: Adjusting MDA dosage schedules according to weight-for-age and sex may be may contribute to reduce the occurrence of adverse drug reactions in the population.

Adverse events following single dose treatment of lymphatic filariasis: Observations from a review of the literature

“…Localized AEs following LF treatment are much less common than systemic AEs. They include the development of subcutaneous or scrotal nodules, spermatic cord swelling, new onset or increased hydrocele, dilated and inflamed lymphatic vessels (the “string sign”) [ 68 ], arthritis, lymphadenitis (sometimes with suppuration), and new onset lymphedema [ 76 ]. Local reactions may occur within 24–48 hours after treatment, but often the onset is later (1 week or more after treatment) [ 15 , 17 , 44 , 45 , 55 , 59 , 66 , 72 , 77 ].…”

“…However, two community MDA studies with passive AE surveillance reported higher rates in women. This may reflect gender-specific differences in reporting, rather than physiologic differences [ 76 , 92 ]. In one large MDA study in Haiti, moderate AEs (those interfering with school or work) were more frequently reported by men, and these were most commonly due to scrotal pain [ 72 ].…”

The safety of double- and triple-drug community mass drug administration for lymphatic filariasis: A multicenter, open-label, cluster-randomized study

“…Since most of the excess AEs in females were of severity grade 1, it is possible that females were more likely than males to report mild AEs. Other studies have reported increased AE rates in females following MDA [21,22].…”

A Randomized Controlled Trial of Increased Dose and Frequency of Albendazole with Standard Dose DEC for Treatment of Wuchereria bancrofti Microfilaremics in Odisha, India

“…Increased adverse events/side effects directly due to the higher dose of albendazole or as a result of interaction with DEC could be a limiting factor to deployment [ 16 , 17 , 18 , 19 ]. However, 800mg albendazole has been extensively used for longer periods for systemic helminth infections such as echinococcosis and neurocysticercosis and is generally well tolerated [ 20 ].…”