Multiple-dose versus single-dose ivermectin for Strongyloides stercoralis infection (Strong Treat 1 to 4): a multicentre, open-label, phase 3, randomised controlled superiority trial

Buonfrate, Dora; Salas-Coronas, Joaquín; Muñóz, José; Maruri, Begoña Trevino; Rodari, Paola; Castelli, Francesco; Zammarchi, Lorenzo; Bianchi, Leila; Gobbi, Federico; Fernández, Sara; Requena-Méndez, Ana; Godbole, Gauri; Silva, Ronaldo; Romero, Marilena; Chiodini, Peter L.; Bisoffi, Zeno

doi:10.1016/s1473-3099(19)30289-0

Cited by 145 publications

(117 citation statements)

References 34 publications

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“…Ivermectin has an established safety profile for human use (Gonzalez Canga et al, 2008;Jans et al, 2019;Buonfrate et al, 2019), and is FDA-approved for a number of parasitic infections (Gonzalez Canga et al, 2008;Buonfrate et al, 2019). Importantly, recent reviews and meta-analysis indicate that high dose ivermectin has comparable safety as the standard low-dose treatment, although there is not enough evidence to make conclusions about the safety profile in pregnancy (Navarro et al, 2020;Nicolas et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro

et al. 2020

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Section: Introductionmentioning

confidence: 99%

The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro

et al. 2020

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“…In confirmed uncomplicated infection the efficacy of a single-dose treatment has been well established [26], longer treatment being suggested in hyperinfection/dissemination [27]. In our case the underlying immunosuppressive treatment prompted us to adopt a treatment longer than that proposed for uncomplicated infection.…”

Section: Discussionmentioning

confidence: 79%

Strongyloides infection manifested during immunosuppressive therapy for SARS-CoV-2 pneumonia

et al. 2020

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Background SARS-CoV-2 pandemic has posed formidable public health and clinical challenges. The use of immunosuppressive agents, such as high dose corticosteroids and cytokine inhibitors (e.g., Tocilizumab) has been suggested to contrast the hyperinflammatory process involved in the pathogenesis of the severe disease, with conflicting evidence. Among the drawbacks of immunosuppressive therapy, the risk of reactivation of latent infections, including parasitic infestations, is to be considered. Case presentation We report a case of a 59-year-old Italian patient treated with high dose intravenous dexamethasone and two intravenous doses of Tocilizumab for interstitial bilateral pneumonia associated with SARS-CoV-2 infection who developed itching, abdominal pain, and an increased eosinophil count. Stool examination confirmed the presence of S. stercoralis larvae. The patient was treated with a 4-day course of Ivermectin with full recovery. Discussion We report the first case of S. stercoralis infection following an 11-day treatment with high-dose steroids and Tocilizumab for severe COVID-19. Clinicians should be aware of the risk of strongyloidiasis as a complication of the treatment for severe COVID-19.

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“…Findings relating to this cohort therefore may well be applicable to ethnic minority groups in the UK who originate from Strongyloides-endemic areas, such as those from Sub-Saharan Africa. A case may also exist for improving access to ivermectin in the primary care setting-although unlicensed, this has been proven to be a safe and effective treatment for infection with Strongyloides as a single dose [29]. A recent systematic review has also supported the role of screening for and treating strongyloidiasis in migrant populations and further evaluated the cost-effectiveness of presumptive single dose treatment with ivermectin [30].…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Strongyloides among South Asian Migrants in Primary Care―Associations with Eosinophilia and Gastrointestinal Symptoms

et al. 2020

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Gastrointestinal (GI) symptoms are a frequent reason for primary care consultation, and common amongst patients with strongyloidiasis. We conducted a prospective cohort and nested case control study in East London to examine the predictive value of a raised eosinophil count or of GI symptoms, for Strongyloides infection in South Asian migrants. We included 503 patients in the final analyses and all underwent a standardised GI symptom questionnaire, eosinophil count and Strongyloides serology testing. Positive Strongyloides serology was found in 33.6% in the eosinophilia cohort against 12.5% in the phlebotomy controls, with adjusted odds ratio of 3.54 (95% CI 1.88–6.67). In the GI symptoms cohort, 16.4% were seropositive but this was not significantly different compared with controls, nor were there associations between particular symptoms and Strongyloidiasis. Almost a third (35/115) of patients with a positive Strongyloides serology did not have eosinophilia at time of testing. Median eosinophil count declined post-treatment from 0.5 cells × 109/L (IQR 0.3–0.7) to 0.3 (0.1–0.5), p < 0.001. We conclude Strongyloides infection is common in this setting, and the true symptom burden remains unclear. Availability of ivermectin in primary care would improve access to treatment. Further work should clarify cost-effectiveness of screening strategies for Strongyloides infection in UK migrant populations.

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Multiple-dose versus single-dose ivermectin for Strongyloides stercoralis infection (Strong Treat 1 to 4): a multicentre, open-label, phase 3, randomised controlled superiority trial

Cited by 145 publications

References 34 publications

The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro

The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro

Strongyloides infection manifested during immunosuppressive therapy for SARS-CoV-2 pneumonia

High Prevalence of Strongyloides among South Asian Migrants in Primary Care―Associations with Eosinophilia and Gastrointestinal Symptoms

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