Long-term efficacy of single-dose combinations of albendazole, ivermectin and diethylcarbamazine for the treatment of bancroftian filariasis

Abstract

In a 'blinded' trial (in Sri Lanka, 1996-98) of 47 male asymptomatic microfilaraemic subjects with Wuchereria bancrofti infection, the safety, tolerability and filaricidal efficacy of 3 single-dose combination regimens were compared: albendazole 400 mg with ivermectin 200 micrograms/kg, albendazole 400 mg with diethylcarbamazine citrate (DEC) 6 mg/kg or albendazole 600 mg with ivermectin 400 micrograms/kg. Treated subjects were followed-up for 24 months. This represents the first long-term study using combinations of albendazole with DEC or ivermectin in the above doses against bancroftian filariasis. All subjects had pre-treatment microfilaria (mf) counts over 100/mL. All 3 treatments significantly reduced mf counts, with the albendazole-DEC-treated group showing the lowest mf levels at 18 and 24 months post-treatment. Filarial antigen tests suggested that all 3 treatments had significant activity against adult W. bancrofti; albendazole-DEC combination had the greatest activity according to this test, with antigen levels decreasing to 30.5% of pre-treatment antigen levels, 24 months after therapy. All 3 treatments were clinically safe and well tolerated. These results suggest that a single dose of albendazole 400 mg together with DEC 6 mg/kg is a safe and effective combination for suppression of microfilaraemia of bancroftian filariasis that could be considered for use in filariasis control programmes based on mass treatment of endemic populations.

Frequency, Severity, and Costs of Adverse Reactions Following Mass Treatment for Lymphatic Filariasis Using Diethylcarbamazine and Albendazole in Leogane, Haiti, 2000

“…[9][10][11][12] Some adult worms may die as a result of treatment with diethylcarbamazine (DEC), which causes painful inflammatory granulomas, especially in the intrascrotal lymphatic vessels in men. [13][14][15] A few clinical studies have assessed adverse reactions following treatment with DEC and albendazole, 9,16 but the burden of adverse reactions in large community-based interventions using DEC and albendazole has not been adequately documented. Little is known about the costs of adverse reaction management.…”

The Impact of Two Semiannual Treatments with Albendazole Alone on Lymphatic Filariasis and Soil-Transmitted Helminth Infections: A Community-Based Study in the Republic of Congo

“…8 In addition, several clinical trials showed that a single dose of ALB can reduce W. bancrofti microfilaria (mf) densities by 50% or more, and this reduction is sustained for 1 year or more after treatment. Of course, the decline in mf counts after ALB alone was slower and less dramatic than after combination treatment with either IVM + ALB or DEC + ALB, 9,10 but a small study found that a second dose of ALB given 1 year after the first led to a further decrease in mf counts. 11 The aim of MDA in LF elimination programs is to reduce the mf reservoir in populations to levels that cannot support sustained transmission of W. bancrofti by mosquitoes.…”

Homology Modeling of NAD + -Dependent DNA Ligase of the Wolbachia Endosymbiont of Brugia malayi and Its Drug Target Potential Using Dispiro-Cycloalkanones

“…It is caused by the nematode parasites Wuchereria bancrofti, Brugia malayi, and Brugia timori, affecting Ͼ1.3 billion people in 81 countries worldwide, and several millions more are at risk of infection. The mainstay of filarial disease control has been a limited number of drugs, such as diethylcarbamazine, albendazole, and ivermectin, which are principally microfilaricidal, thus necessitating the need for repeated administrations (1,2). Furthermore, signs of emerging drug resistance are becoming increasingly apparent, especially against albendazole and ivermectin (3-5).…”