A Cluster Randomized Study of The Safety of Integrated Treatment of Trachoma and Lymphatic Filariasis in Children and Adults in Sikasso, Mali

Yaya Ibrahim Coulibaly,Fadima Cheick Haidara,Adama Daou,Moussa Doumbia,John Horton,Caroline Whately-Smith,Samba Ousmane Sow,Moussa Hama Sankare,Mahamadou Minamba Keita,Modibo Keita,Ilo Dicko,Patrick J Lammie

doi:10.1371/journal.pntd.0002221

Abstract

BackgroundNeglected tropical diseases are co-endemic in many areas of the world, including sub Saharan Africa. Currently lymphatic filariasis (albendazole/ivermectin) and trachoma (azithromycin) are treated separately. Consequently, financial and logistical benefit can be gained from integration of preventive chemotherapy programs in such areas.Methodology/Findings4 villages in two co-endemic districts (Kolondièba and Bougouni) of Sikasso, Mali, were randomly assigned to coadministered treatment (ivermectin/albendazole/azithromycin) or standard therapy (ivermectin/albendazole with azithromycin 1 week later). These villages had previously undergone 4 annual MDA campaigns with ivermectin/albendazole and 2 with azithromycin. One village was randomly assigned to each treatment arm in each district. There were 7515 eligible individuals in the 4 villages, 3011(40.1%) of whom participated in the study. No serious adverse events occurred, and the majority of adverse events were mild in intensity (mainly headache, abdominal pain, diarrhoea and “other signs/symptoms”). The median time to the onset of the first event, of any type, was later (8 days) in the two standard treatment villages than in the co-administration villages. Overall the number of subjects reporting any event was similar in the co-administration group compared to the standard treatment group [18.7% (281/1501) vs. 15.8% (239/1510)]. However, the event frequency was higher in the coadministration group (30.4%) than in the standard treatment group (11.0%) in Kolondièba, while the opposite was observed in Bougouni (7.1% and 20.9% respectively). Additionally, the overall frequency of adverse events in the co-administration group (18.7%) was comparable to or lower than published frequencies for ivermectin+albendazole alone.ConclusionsThese data suggest that co-administration of ivermectin+albendazole and azithromycin is safe; however the small number of villages studied and the large differences between them resulted in an inability to calculate a meaningful overall estimate of the difference in adverse event rates between the regimens. Further work is therefore needed before co-administration can be definitively recommended.Trial RegistrationClinicalTrials.gov; NCT01586169

Highlights

Lymphatic filariasis (LF), a leading cause of permanent and longterm disability globally, affects over 120 million people in more than 80 countries in tropical and subtropical areas [1]
These data suggest that co-administration of ivermectin+albendazole and azithromycin is safe; the small number of villages studied and the large differences between them resulted in an inability to calculate a meaningful overall estimate of the difference in adverse event rates between the regimens
Study Population There were 9109 persons in the villages in the two districts of whom 7515 were eligible for inclusion. 3011 subjects were chosen at random from this pool to be included in the study population (Table 2), selection continuing until the target number in a village was reached, with 1510 receiving the standard treatment (755 in each district) and 1501 receiving the coadministered treatment (750 in Bougouni, 751 in Kolondieba) (Figure 1)

Summary

Introduction

Lymphatic filariasis (LF), a leading cause of permanent and longterm disability globally, affects over 120 million people in more than 80 countries in tropical and subtropical areas [1]. Trachoma is the main cause of infectious blindness, responsible for around 5% of the world’s blind people [2]. These two infections represent important public health problems in West Africa. Azithromycin, an antibiotic, has been used safely for over 10 years in trachoma treatment programs [4,5]. Lymphatic filariasis (albendazole/ivermectin) and trachoma (azithromycin) are treated separately. Financial and logistical benefit can be gained from integration of preventive chemotherapy programs in such areas

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