Limits...
A randomized controlled trial of increased dose and frequency of albendazole with standard dose DEC for treatment of Wuchereria bancrofti microfilaremics in Odisha, India.

Kar SK, Dwibedi B, Kerketa AS, Maharana A, Panda SS, Mohanty PC, Horton J, Ramachandran CP - PLoS Negl Trop Dis (2015)

Bottom Line: At 12 months, Mf clearance was marginally greater with the high dose regimens, while by 24 months, there was a trend to higher Mf clearance in the arm with increased frequency and 800 mg of albendazole (76.9%) compared to other arms, (S1:64%, S2:69.2% & H1:73.1%).Although higher and/or more frequent dosing showed a trend towards a greater decline in antigenemia and clearance of "nests", all regimens demonstrated the potential macrofilaricidal effect of the combination.The higher doses of albendazole did not result in a greater number or more severe side effects.

View Article: PubMed Central - PubMed

Affiliation: Regional Medical Research Centre (ICMR), Chandrasekharpur, Bhubaneswar, Odisha, India.

ABSTRACT
Although current programmes to eliminate lymphatic filariasis have made significant progress it may be necessary to use different approaches to achieve the global goal, especially where compliance has been poor and 'hot spots' of continued infection exist. In the absence of alternative drugs, the use of higher or more frequent dosing with the existing drugs needs to be explored. We examined the effect of higher and/or more frequent dosing with albendazole with a fixed 300 mg dose of diethylcarbamazine in a Wuchereria bancrofti endemic area in Odisha, India. Following screening, 104 consenting adults were randomly assigned to treatment with the standard regimen annually for 24 months (S1), or annually with increased dose (800 mg albendazole)(H1) or with increased frequency (6 monthly) with either standard (S2) or increased (H2) dose. Pre-treatment microfilaria counts (GM) ranged from 348 to 459 mf/ml. Subjects were followed using microfilaria counts, OG4C3 antigen levels and ultrasound scanning for adult worm nests. Microfilarial counts tended to decrease more rapidly with higher or more frequent dosing at all time points. At 12 months, Mf clearance was marginally greater with the high dose regimens, while by 24 months, there was a trend to higher Mf clearance in the arm with increased frequency and 800 mg of albendazole (76.9%) compared to other arms, (S1:64%, S2:69.2% & H1:73.1%). Although higher and/or more frequent dosing showed a trend towards a greater decline in antigenemia and clearance of "nests", all regimens demonstrated the potential macrofilaricidal effect of the combination. The higher doses of albendazole did not result in a greater number or more severe side effects. The alternative regimens could be useful in the later stages of existing elimination programmes or achieving elimination more rapidly in areas where programmes have yet to start.

Show MeSH

Related in: MedlinePlus

Mean percentage reduction in individual microfilarial count compared to baseline.Percentage changes from baseline values for individuals were calculated at each follow-up point and then means for each treatment group derived.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4363665&req=5

pntd.0003583.g001: Mean percentage reduction in individual microfilarial count compared to baseline.Percentage changes from baseline values for individuals were calculated at each follow-up point and then means for each treatment group derived.

Mentions: There was a progressive decrease in microfilaraemia and clearance of microfilaria from the circulation in all the four arms over the 24months (Table 2). The increase in dose and frequency reduced Mf counts significantly at the end of 12 months (p = 0.021) compared to the standard regimen (S1). At 24 months, Mf clearance was higher in H2 arm (76.9%) compared to other arms, (S1:64%, S2:69.2% & H1:73.1%) although this was not statistically significant (p = 0.77). The mean microfilarial density showed a sharp reduction by 6 months from baseline (S1:84.23%, S2:80.30%, H1:82.85%, H2:85.57%) in all four arms with a slower decline thereafter (Table 3). Mean percentage reductions in microfilarial density from individual baseline values are shown in Fig. 1. The differences in geometric mean Mf density are shown in Tables 4 & 5 (log transformed data). The analysis shows that, at 12 months, if albendazole is given biannually (S2 & H2), instead of annually (S1 and H1) there is an extra reduction in mf count of 0.5 log units and if albendazole is given 800 mg (H1 and H2), instead of 400mg (S1 & S2), there is an extra reduction of 0.94 log units. Biannual treatment with 800mg albendazole (H2) reduces the Mf count by 1.44 log units which is statistically significant (p = 0.021).


A randomized controlled trial of increased dose and frequency of albendazole with standard dose DEC for treatment of Wuchereria bancrofti microfilaremics in Odisha, India.

Kar SK, Dwibedi B, Kerketa AS, Maharana A, Panda SS, Mohanty PC, Horton J, Ramachandran CP - PLoS Negl Trop Dis (2015)

Mean percentage reduction in individual microfilarial count compared to baseline.Percentage changes from baseline values for individuals were calculated at each follow-up point and then means for each treatment group derived.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4363665&req=5

pntd.0003583.g001: Mean percentage reduction in individual microfilarial count compared to baseline.Percentage changes from baseline values for individuals were calculated at each follow-up point and then means for each treatment group derived.
Mentions: There was a progressive decrease in microfilaraemia and clearance of microfilaria from the circulation in all the four arms over the 24months (Table 2). The increase in dose and frequency reduced Mf counts significantly at the end of 12 months (p = 0.021) compared to the standard regimen (S1). At 24 months, Mf clearance was higher in H2 arm (76.9%) compared to other arms, (S1:64%, S2:69.2% & H1:73.1%) although this was not statistically significant (p = 0.77). The mean microfilarial density showed a sharp reduction by 6 months from baseline (S1:84.23%, S2:80.30%, H1:82.85%, H2:85.57%) in all four arms with a slower decline thereafter (Table 3). Mean percentage reductions in microfilarial density from individual baseline values are shown in Fig. 1. The differences in geometric mean Mf density are shown in Tables 4 & 5 (log transformed data). The analysis shows that, at 12 months, if albendazole is given biannually (S2 & H2), instead of annually (S1 and H1) there is an extra reduction in mf count of 0.5 log units and if albendazole is given 800 mg (H1 and H2), instead of 400mg (S1 & S2), there is an extra reduction of 0.94 log units. Biannual treatment with 800mg albendazole (H2) reduces the Mf count by 1.44 log units which is statistically significant (p = 0.021).

Bottom Line: At 12 months, Mf clearance was marginally greater with the high dose regimens, while by 24 months, there was a trend to higher Mf clearance in the arm with increased frequency and 800 mg of albendazole (76.9%) compared to other arms, (S1:64%, S2:69.2% & H1:73.1%).Although higher and/or more frequent dosing showed a trend towards a greater decline in antigenemia and clearance of "nests", all regimens demonstrated the potential macrofilaricidal effect of the combination.The higher doses of albendazole did not result in a greater number or more severe side effects.

View Article: PubMed Central - PubMed

Affiliation: Regional Medical Research Centre (ICMR), Chandrasekharpur, Bhubaneswar, Odisha, India.

ABSTRACT
Although current programmes to eliminate lymphatic filariasis have made significant progress it may be necessary to use different approaches to achieve the global goal, especially where compliance has been poor and 'hot spots' of continued infection exist. In the absence of alternative drugs, the use of higher or more frequent dosing with the existing drugs needs to be explored. We examined the effect of higher and/or more frequent dosing with albendazole with a fixed 300 mg dose of diethylcarbamazine in a Wuchereria bancrofti endemic area in Odisha, India. Following screening, 104 consenting adults were randomly assigned to treatment with the standard regimen annually for 24 months (S1), or annually with increased dose (800 mg albendazole)(H1) or with increased frequency (6 monthly) with either standard (S2) or increased (H2) dose. Pre-treatment microfilaria counts (GM) ranged from 348 to 459 mf/ml. Subjects were followed using microfilaria counts, OG4C3 antigen levels and ultrasound scanning for adult worm nests. Microfilarial counts tended to decrease more rapidly with higher or more frequent dosing at all time points. At 12 months, Mf clearance was marginally greater with the high dose regimens, while by 24 months, there was a trend to higher Mf clearance in the arm with increased frequency and 800 mg of albendazole (76.9%) compared to other arms, (S1:64%, S2:69.2% & H1:73.1%). Although higher and/or more frequent dosing showed a trend towards a greater decline in antigenemia and clearance of "nests", all regimens demonstrated the potential macrofilaricidal effect of the combination. The higher doses of albendazole did not result in a greater number or more severe side effects. The alternative regimens could be useful in the later stages of existing elimination programmes or achieving elimination more rapidly in areas where programmes have yet to start.

Show MeSH
Related in: MedlinePlus