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Researchers at the Case Western Reserve University School of Medicine have shown that a single "cocktail" of pills-based pills is far more effective at killing microscopic worms from larvae in people with lymphatic filariasis , commonly known as elephantiasis, compared to other standard combinations of two drugs previously used in the global effort to eliminate this infectious disease. A combination of the three drugs administered simultaneously has never been tested so far. An estimated 120 million people in more than 50 tropical and subtropical countries are infected with lymphatic filariasis and 856 million people are at risk.
Following these conclusions, published in this day's issue of the New England Journal of Medicine, the World Health Organization has revised its treatment guidelines for preventive chemotherapy for lymphatic filariasis in many countries around the world where current mass treatment regimens have failed to be eliminated or have not yet begun . Papua New Guinea (where the study was conducted), Haiti, Indonesia, Fiji, India, Samoa, Madagascar, Kenya, São Tomé and Príncipe, Zimbabwe and Guyana are included countries considering mass treatment with this new regime.
The disease is characterized by hypertrophy of the limbs and breast (elephantiasis) and massive swelling of the scrotum (hydrocele). Among those infected, an estimated 25 million men with hydrocele and 15 million, mainly women, an elephantiasis of limbs and breast.
"The WHO has targeted the elimination of lymphatic filariasis in the largest mass treatment program ever launched for the treatment of an infectious disease," said the leading author of the lymphatic filariasis. study, Christopher L. King, professor of international health, medicine, medicine, and pathology at the Case Western Reserve University School of Medicine. "Our results promise to effectively ban this disease from a long list of health threats faced by people in many developing countries." In 2000, the World Health Organization targeted lymphatic filariasis for global elimination by 2020.
Although progress has been made with the two existing treatment regimens – a 32% reduction in the number of people at risk for lymphatic filariasis has been achieved worldwide – countries with poor health infrastructures have faced with the need to perform at least five rounds of mass drug therapy with a 65% population coverage in order to achieve elimination. This new treatment regimen should require fewer annual treatment cycles because of its greater effectiveness and, therefore, increase the potential for global elimination. However, even with better treatment regimens, elimination can only be achieved if people living in areas where lymphatic filariasis is endemic do not take the drugs. An important aspect of the upcoming elimination program will be to ensure better coverage at the population level.
Ivermectin (IVM), diethylcarbamazine (DEC) and albendazole (ALB) are all established anti-parasite drugs. In the 182-patient study conducted in Papua New Guinea, the researchers found that a single dose of a three-drug regimen that included IVM, DEC, and ALB resulted in a much longer sustained elimination of microscopic worms than single dose of two drugs. DEC and ALB scheme. The single dose of three drugs was as effective as the two-drug regimen administered once a year for three years. This finding is particularly noteworthy as public health programs struggle to ensure that people living in endemic areas of filariasis take pest control medication every year for at least five years.
"Lymphatic filariasis is one of the leading causes of permanent disability in the world," said James W. Kazura, MD, lead author of the study, distinguished professor and director of the Center for Global Health and Diseases, Faculty of Medicine, Case Western Reserve University. "In addition to its devastating physical ramifications, which often make it difficult to work and normal daily activities, gross disfigurement can have psychosocial consequences, such as being rejected by their communities."
Lymphatic filariasis is a roundworm infection associated with the heartworm of the dog, where adult worms, both male and female, are localized in the lymphatic system of the human body. Female worms release microscopic larvae (microfilaria) that circulate in the blood and can be ingested by mosquitoes. Mosquitoes can then allow the development of infective larvae that can be transmitted to new hosts during the blood supply. The larvae become adult worms resembling threads that obstruct the human lymphatic system, causing significant fluid retention and swelling of the arms, legs, breasts and scrotum.
To date, 6.7 billion bi-drugs have been administered at least once to more than 850 million people in 66 countries. For more than three decades, pharmaceutical companies Merck Inc. and GlaxoSmithKline donated drugs used to eradicate lymphatic filariasis. More recently, Eisai Co. Ltd. in Japan donated DEC.
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With the support of the Papua New Guinea Medical Research Institute, the National Department of Public Health of the country, the Bill & Melinda Gates Foundation and the NIH, King and Kazura, as well as others Case Western Reserve medical scientists, have researched and treated lymphatic filariasis for over 30 years. Some of the seminal studies using ivermectin for filariasis were conducted by faculty members of the school several decades ago. Besides King and Kazura, other researchers from the new study belong to the Papua New Guinea Medical Research Institute and the Faculty of Medicine at the Washington University of St. Louis.
The study was funded by the Bill & Melinda Gates Foundation.
For more information on Case Western Reserve University School of Medicine, please visit: case.edu/medicine.
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