Side reactions following ivermectin therapy in high density bancroftian microfilaraemics

Kar, Shantanu Kumar; Patnaik, Satyadarshi; Kumaraswami, V.; murty, Rohit srinu

doi:10.1016/0001-706x(93)90045-d

Cited by 14 publications

(5 citation statements)

References 11 publications

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“…Transient mild to moderate adverse reactions such as fever, headache, dizziness, malaise, myalgia, fatigue, and gastrointestinal upset are common after treatment of LF and are primarily related to dying Mf [ 5 , 6 , 62 ]. Less commonly reported AEs include cough and dyspnea [ 15 , 17 , 23 , 40 ] (sometimes associated with blood-tinged sputum and transient pulmonary infiltrates [ 63 ] or bronchoconstriction [ 40 , 64 ]), urticaria or other rash [ 45 , 63 , 65 ], transient proteinuria or hematuria [ 9 , 44 , 63 , 66 ], elevated alkaline phosphatase [ 63 ] or transaminase levels [ 46 , 59 , 65 ], palpebral edema (with DEC) [ 17 ], increased eosinophilia 7–14 days post-treatment [ 17 , 40 , 59 , 67 ], and postural hypotension [ 16 , 23 , 40 , 45 , 68 ]. Systemic AEs generally occur with 24–48 hours after the first dose of microfilaricidal medications (IVM or DEC) [ 23 , 24 , 29 , 30 , 40 , 43 – 45 , 54 , 56 , 64 , 67 – 75 ], including when low “clearing doses” of drugs are given before full therapeutic doses [ 14 , 15 ...…”

Section: Resultsmentioning

confidence: 99%

“…They are generally self-limited, resolving over the course of one to several weeks. They are thought to be caused by the death of adult filarial worms in lymphatic vessels [ 14 , 15 , 17 , 19 , 44 , 63 , 78 , 79 ]; prior to the development of adult worm antigen assays and ultrasound visualization of adult worms [ 79 ], rates of scrotal reactions were frequently used as a surrogate measure of macrofilaricidal activity [ 15 , 59 , 77 ]. Biopsies of scrotal nodules confirm the presence of dead or dying adult worms and excised nodules sometimes contain both dying and healthy adult worms [ 79 – 81 ].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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BackgroundWHO’s Global Programme to Eliminate Lymphatic Filariasis (LF) uses mass drug administration (MDA) of anthelmintic medications to interrupt LF transmission in endemic areas. Recently, a single dose combination of ivermectin (IVM), diethylcarbamazine (DEC), and albendazole (ALB) was shown to be markedly more effective than the standard two-drug regimens (DEC or IVM, plus ALB) for achieving long-term clearance of microfilaremia.Objective and methodsTo provide context for the results of a large-scale, international safety trial of MDA using triple drug therapy, we searched Ovid Medline for studies published from 1985–2017 that reported adverse events (AEs) following treatment of LF with IVM, DEC, ALB, or any combination of these medications. Studies that reported AE rates by treatment group were included.FindingsWe reviewed 162 published manuscripts, 55 of which met inclusion criteria. Among these, 34 were clinic or hospital-based clinical trials, and 21 were community-based studies. Reported AE rates varied widely. The median AE rate following DEC or IVM treatment was greater than 60% among microfilaremic participants and less than 10% in persons without microfilaremia. The most common AEs reported were fever, headache, myalgia or arthralgia, fatigue, and malaise.InterpretationMild to moderate systemic AEs related to death of microfilariae are common following LF treatment. Post-treatment AEs are transient and rarely severe or serious. Comparison of AE rates from different community studies is difficult due to inconsistent AE reporting, varied infection rates, and varied intensity of follow-up. A more uniform approach for assessing and reporting AEs in LF community treatment studies would be helpful.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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“…Signs and symptoms during the five days following treatment with ivermectin/albendazole in individuals who were positive for circulating filarial antigen. India, 21 and Brazil, 22 where post-treatment reaction prevalences in response to ivermectin in microfilaremic individuals have been reported as 90%, 68%, 97%, and 95%, respectively. However, our results are consistent with what was reported in Ghana, where 36.3% of microfilaremic individuals treated with ivermectin/albendazole experienced a symptom during the post-treatment period, despite having higher numbers of circulating microfilariae than our study (GM intensity ‫ס‬ 1,585 mf/ml with a 95% confidence interval of 1,069 to 2,350).…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Post-Treatment Reactions to Ivermectin/Albendazole for Wuchereria Bancrofti in a Region Co-Endemic for Mansonella Perstans

Keiser

Coulibaly²,

Keita³

et al. 2003

The American Journal of Tropical Medicine and Hygiene

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Post-treatment reactions to single-dose ivermectin (200 g/kg) and albendazole (400 mg) were studied in a filarial endemic region of Mali. The prevalence of Wuchereria bancrofti in this region was 48.3% (69 of 143), and coinfection with Mansonella perstans was common (30 of 40, 75%). Microfilarial levels of M. perstans correlated positively with age (P ‫ס‬ 0.006) and with W. bancrofti microfilarial levels (P ‫ס‬ 0.006). Forty individuals (28 infected and 12 uninfected) were treated, with mild post-treatment reactions occurring in 35.7% (7 of 28) of the W. bancrofti-infected subjects. Reaction severity correlated with pretreatment W. bancrofti microfilarial levels (P ‫ס‬ 0.001). There were no significant differences in the prevalence or severity of post-treatment reactions in those who were co-infected with M. perstans. It is concluded that co-infection with M. perstans does not significantly alter the post-treatment reaction profile to single-dose ivermectin/albendazole in W. bancrofti infection in this community, and that acute post-treatment reactions should not limit patient compliance in community-based programs to eliminate lymphatic filariasis.

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“…All subjects were admitted to hospital for drug administration and for 2 days post drug to monitor for side effects / adverse events. Side effects/ adverse events were graded based on a previously used scale [ 15 ] and managed with simple remedies. Clinical evaluators were blind to the treatment given.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2015

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Although current programmes to eliminate lymphatic filariasis have made significant progress it may be necessary to use different approaches to achieve the global goal, especially where compliance has been poor and ‘hot spots’ of continued infection exist. In the absence of alternative drugs, the use of higher or more frequent dosing with the existing drugs needs to be explored. We examined the effect of higher and/or more frequent dosing with albendazole with a fixed 300mg dose of diethylcarbamazine in a Wuchereria bancrofti endemic area in Odisha, India. Following screening, 104 consenting adults were randomly assigned to treatment with the standard regimen annually for 24 months (S1), or annually with increased dose (800mg albendazole)(H1) or with increased frequency (6 monthly) with either standard (S2) or increased (H2) dose. Pre-treatment microfilaria counts (GM) ranged from 348 to 459 mf/ml. Subjects were followed using microfilaria counts, OG4C3 antigen levels and ultrasound scanning for adult worm nests. Microfilarial counts tended to decrease more rapidly with higher or more frequent dosing at all time points. At 12 months, Mf clearance was marginally greater with the high dose regimens, while by 24 months, there was a trend to higher Mf clearance in the arm with increased frequency and 800mg of albendazole (76.9%) compared to other arms, (S1:64%, S2:69.2% & H1:73.1%). Although higher and/or more frequent dosing showed a trend towards a greater decline in antigenemia and clearance of “nests”, all regimens demonstrated the potential macrofilaricidal effect of the combination. The higher doses of albendazole did not result in a greater number or more severe side effects. The alternative regimens could be useful in the later stages of existing elimination programmes or achieving elimination more rapidly in areas where programmes have yet to start.

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Side reactions following ivermectin therapy in high density bancroftian microfilaraemics

Cited by 14 publications

References 11 publications

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

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

Clinical Characteristics of Post-Treatment Reactions to Ivermectin/Albendazole for Wuchereria Bancrofti in a Region Co-Endemic for Mansonella Perstans

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

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