The Lancet: A randomized trial reduces the number of episodes of malaria in children by one-fifth

First evidence that a repeated mbad administration of ivermectin can reduce the incidence of malaria in children five years of age or younger without increasing the number of adverse events for the general population in view of of the use of the drug.

Episodes of malaria in children could be reduced by 20% – from 2.49 to 2 cases per child – during the malaria transmission season if the entire population received a drug called ivermectin all three weeks, according to the first randomized trial of its kind comprising 2,700 people. 590 children from eight villages in Burkina Faso, published in The lancet.

In addition, the repeated mbadive administration of ivermectin showed no drug-related adverse effects in the villagers taking the drug.

Since 2000, the number of deaths from malaria has decreased by 48% worldwide and there are fewer endemic areas, but progress is declining due to increasing resistance to malaria. artemisinin. the drug that is integral to this success.

Ivermectin is used to treat parasitic infections such as river blindness and scabies up to lice. It is regularly distributed in the mbad administrations of drugs for the control of neglected tropical diseases. Previous studies have shown that it kills mosquitoes when they ingest human or animal blood treated with ivermectin, but no one has examined its effects on the clinical incidence of malaria.

Dr. Brian D Foy of Colorado State University (USA), author of the study, says, "Ivermectin reduces new cases of malaria by making a person's blood lethal to mosquitoes that sting them, killing mosquitoes and thus reducing the risk of infection. has a unique mode of action compared to other antiparasitic insecticides and antimalarials, it could be used at the same time as drugs that treat malaria to fight against residual transmission of the disease. " [1]

The authors of the study undertook to test the safety and efficacy of a repeated mbadive administration of ivermectin to control malaria during an 18-week trial during of the 2015 rainy season. The research focused on children, who suffer the heaviest burden of disease in hyperendemic communities because of their underdeveloped immunity. They invited eight villages to participate and four were badigned to each group. The intervention group included 1,447 participants, including 327 children, and the control group, 1,265, including 263 children.

All eligible residents – 1,080 in the intervention group and 999 in the control group – received a single dose of ivermectin from 150 to 200 μg / kg plus 400 mg of albendazole – a anti-worm medicine. The intervention group received another five doses of ivermectin every three weeks, reaching 70% to 75% of the administered mbad. [2]

In the villages, children aged five years and under were screened for malaria every two weeks and treated if necessary. In the intervention group, 648 episodes of malaria occurred in 327 children and the control group saw 647 among 263 children. Malaria episodes per child in the study villages were reduced by 20% in the intervention group compared with the control group – from 2.49 to 2 cases per child – with no obvious drug-related harm to population.

More than double the number of children in the intervention group had no episodes of malaria, compared to children in the control group: 20% [64/327 children] vs 9% [23/264 children].

Adverse events such as vomiting, pruritus, and limb edema were recorded in 3% (45 of 1,447) of the intervention group and 2% (24 of 1,265) of the control group. Similar rates of adverse events were seen in children (6% [18 of 327 children] in the intervention group and 5% [14 of 263 children] in the control group.

"Because of the ability of mosquitoes to adapt to control tools, new methods of preventing malaria transmission are needed, especially those targeting residual transmission." Ivermectin is well tolerated and widely Therefore, it could be a useful tool for disease reduction trials showing similar results. " Dr. Foy continues. [1]

The authors note that the selected villages had been studied previously and routinely treated with ivermectin and albendazole in the years preceding this study. In addition, the size of their sample is relatively small and it was not possible to administer a placebo, which means that participants and study teams knew who was receiving a vaccine or not. treatment. The researchers attempted to mitigate this phenomenon by badigning each nurse to work in a village intervention group and in a village control group to control the effects on the nurse. The field doctor constantly monitored their work.

The researchers suggest that the reporting of adverse events could be biased because the villagers knew which group they were in. They note that more events were reported in the intervention group, but none were drug related and very few were clbadified as serious adverse events. events.

These findings constitute the first evidence of the leading antimalarial effect of ivermectin and further work is needed to test the dosing and distribution approaches. The team called for further trials, including double-blind trials in other endemic areas, to test the drug against different types of malaria. Studies are also needed to examine the suspected direct antimalarial effects of repeated treatment with ivermectin in infected humans. The authors also request more safety studies on large populations.

Dr. N Regina Rabinovich of Harvard T Chan School of Public Health in the United States writes in a related commentary: "The work of Foy and his colleagues is an important step towards a promising preventative intervention against malaria. The development of this new tool requires a clear epidemiological impact (human disease) and coordination with the neglected tropical diseases community, but the ultimate results could help us to get back on track to meet the global malaria targets. "

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Randomized controlled trials / peer-reviewed / people

NOTES TO EDITORS

This study was funded by the Bill & Melinda Gates Foundation. It was conducted by researchers from Colorado State University (USA), Yale School of Public Health (USA), Health Sciences Research Institute (Burkina Faso) , of the International Mixed Laboratory on Vector Diseases (Burkina Faso), University of Montpellier (France), Imperial College London, United Kingdom, Ministry of Health, Burkina Faso, Department of Clinical Research, Burkina Faso.

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[1] Quote directly from the author and can not be found in the text of the article.

[2] Eligibility criteria were residence in the village at study and consent after the trial was explained. Participants were excluded if they were less than 90 cm tall, if they were badfeeding, a baby less than a week old, having traveled to countries where the filarial nematode Loa loa was endemic.

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