Ivermectin for malaria control in mass drug administration programmes – Authors' reply

Abstract

We thank Astrid Christine Erber and Robert Colebunders for their comments on our Article on mass drug administration of ivermectin and dihydroartemisinin–piperaquine for malaria control.1Dabira ED Soumare HM Conteh B et al.Mass drug administration of ivermectin and dihydroartemisinin–piperaquine against malaria in settings with high coverage of standard control interventions: a cluster-randomised controlled trial in The Gambia.Lancet Infect Dis. 2022; (published online Nov 25.)https://doi.org/10.1016/S1473-3099(21)00680-0Summary Full Text Full Text PDF Scopus (3) Google Scholar Dihydroartemisinin–piperaquine should not be administered during the first trimester of pregnancy,2D'Alessandro U Hill J Tarning J et al.Treatment of uncomplicated and severe malaria during pregnancy.Lancet Infect Dis. 2018; 18: e133-e146Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar and women who are pregnant and those who are breastfeeding should not be given ivermectin,3Erber AC Ariyo E Olliaro P Nicolas P Chaccour C Colebunders R Treatment of pregnant women with ivermectin during mass drug distribution: time to investigate its safety and potential benefits.Pathogens. 2021; 10: 1-8Crossref Scopus (1) Google Scholar both of which restrict the size of the target population and thus the intervention coverage and impact. Although approximately 15% of pregnant women have been inadvertently exposed to ivermectin, primarily in their first trimester,3Erber AC Ariyo E Olliaro P Nicolas P Chaccour C Colebunders R Treatment of pregnant women with ivermectin during mass drug distribution: time to investigate its safety and potential benefits.Pathogens. 2021; 10: 1-8Crossref Scopus (1) Google Scholar through mass drug administration programmes, safety data during pregnancy are scarce.4Nicolas P Maia MF Bassat Q et al.Safety of oral ivermectin during pregnancy: a systematic review and meta-analysis.Lancet Glob Health. 2020; 8: e92-100Summary Full Text Full Text PDF PubMed Scopus (40) Google Scholar A recent systematic review found that available studies have been inadequately designed to address the question of ivermectin safety during pregnancy and concluded that treatment campaigns should prevent inadvertent treatment of pregnant women.4Nicolas P Maia MF Bassat Q et al.Safety of oral ivermectin during pregnancy: a systematic review and meta-analysis.Lancet Glob Health. 2020; 8: e92-100Summary Full Text Full Text PDF PubMed Scopus (40) Google Scholar This might prove to be challenging if mass drug administration with ivermectin becomes a standard malaria control intervention in national control programmes, although such precautions have been taken for mass drug administration for control of onchocerciasis and lymphatic filariasis. Therefore, establishing the safety of ivermectin during pregnancy is a priority. Potential approaches could be to conduct reproductive toxicological studies in primates and to develop an open data repository of inadvertent drug exposures during pregnancy.4Nicolas P Maia MF Bassat Q et al.Safety of oral ivermectin during pregnancy: a systematic review and meta-analysis.Lancet Glob Health. 2020; 8: e92-100Summary Full Text Full Text PDF PubMed Scopus (40) Google Scholar Concerning the willingness of the local populations to participate in mass drug administration programmes, we have carried out several qualitative studies that showed mass drug administration campaigns to be feasible and acceptable and that identified factors and enablers associated with uptake.5Dierickx S Gryseels C Mwesigwa J et al.Factors associated with non-participation and non-adherence in directly observed mass drug administration for malaria in the Gambia.PLoS One. 2016; 11e0148627Crossref Scopus (28) Google Scholar These include continuous sensitisation and provision of adequate and accurate information, including the potential risks for pregnant women, and timing of the mass drug administration. In conclusion, we agree with Erber and Colebunders that establishing the safety of ivermectin in pregnant and breastfeeding women, and in children weighting less than 15 kg, who are currently untreated during mass drug administration campaigns because of a scarcity of safety data, should be a priority. Including these three groups in the target population for ivermectin mass drug administration will increase the coverage potentially achievable and thus the impact of the intervention. We declare no competing interests. Ivermectin for malaria control in mass drug administration programmesWe read with interest the Article by Edgard Dabira and colleagues1 about mass drug administration of ivermectin and dihydroartemisinin–piperaquine against malaria in The Gambia (the MASSIV trial).1 Although using ivermectin as an endectocide to kill Anopheles spp mosquitoes is an interesting new opportunity for malaria control, to implement such a strategy via national malaria and neglected tropical disease control programmes could be a major challenge. Full-Text PDF Mass drug administration of ivermectin and dihydroartemisinin–piperaquine against malaria in settings with high coverage of standard control interventions: a cluster-randomised controlled trial in The GambiaThe intervention was safe and well tolerated. In an area with high coverage of standard control interventions, mass drug administration of ivermectin and dihydroartemisinin–piperaquine significantly reduced malaria prevalence; however, no effect of ivermectin on vector parous rate was observed. Full-Text PDF