Abstract
BackgroundLittle information is available on the effect of ivermectin on the third- and fourth-stage larvae of Onchocerca volvulus. To assess a possible prophylactic effect of ivermectin on this parasite, we compared the effects of different ivermectin regimens on the acquisition of onchocercal nodules.MethodsWe analyzed data from a controlled randomized clinical trial of ivermectin conducted in the Mbam Valley (Cameroon) between 1994 and 1998 in a cohort of onchocerciasis infected individuals. The number of nodules that appeared between the start and the end of the clinical trial was analyzed, using ANOVA and multivariable Poisson regressions, between four treatment arms: 150 µg/kg annually, 800 µg/kg annually, 150 µg/kg 3-monthly, and 800 µg/kg 3-monthly.ResultsThe mean number of nodules that appeared during the trial was reduced by 17.7% in subjects treated 3-monthly compared to those treated annually (regardless of the dose). Poisson regression model, adjusting on subject’s age and weight, initial number of nodules and intensity of O. volvulus infection in his village of residence, confirmed that the incidence of new nodules was reduced in 3-monthly treatment arms compared to annually treatment arms, and that the dosage of ivermectin does not seem to influence this effect. Furthermore, the number of newly acquired nodules was positively associated with the initial number of nodules. Analysis of disappearance of nodules did not show any significant difference between the treatment groups.ConclusionsTo our knowledge, these results suggest for the first time in humans, that ivermectin has a partial prophylactic effect on O. volvulus. Three-monthly treatment seems more effective than annual treatment to prevent the appearance of nodules.
Highlights
Little information is available on the effect of ivermectin on the third- and fourth-stage larvae of Onchocerca volvulus
Bonferroni correction showed that the number of new nodules was significantly lower in the group which had received 150 μg/kg 3-monthly than in the group treated with 800 μg/kg annually (P = 0.008)
We found no significant association between community microfilarial load (CMFL) and appearance of nodules, we hypothesise that with a larger sample size, the association between CMFL exposition and appearance of new nodules may appear
Summary
Little information is available on the effect of ivermectin on the third- and fourth-stage larvae of Onchocerca volvulus. Little information is available on the effect of IVM on the third- and fourth-stage larvae (L3s and L4s) which develop to the adult stage during the first months following the bite of an infective blackfly, and on the immature adults. The effect on these L3s, L4s, and immature adults, which would prevent the development up to the stage of fecund adult worms releasing mf, has been called causal prophylaxis, or suppressive effect [1]. We will use the term “prophylactic effect” throughout the text below
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