Lymphatic Filariasis (LF) in Ivory Coast

NCT ID: NCT02974049

Last Updated: 2022-04-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

189 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-01-31

Study Completion Date

2018-09-25

Brief Summary

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The recommended treatment for elimination of LF in sub-Saharan Africa is annual mass drug administration (MDA) with single dose Albendazole (ALB) plus Ivermectin (IVM) given for at least 5-7 years. However, in areas where LF is co-endemic with a related filarial parasite, Loa loa, co-infection with L. loa represents a serious barrier to LF elimination because IVM used in LF MDA can result in severe reactions and even death in individuals with high microfilaria (mf) levels of L. loa. Screening for heavy L. loa infection is problematic. To overcome this problem, monotherapy with ALB is possible, since this drug has little or no effect on circulating mf and thus would not cause adverse effects in people with heavy L. loa infections. Moreover ALB has been shown to have embryostatic or embryocidal effects in female adult worms resulting in decreased mf levels with time as natural attrition of circulating mf occurs. Thus this open-label, randomized clinical trial will examine treatment with ALB monotherapy administered twice per year over a period of 3 years with the primary endpoint being the proportion of individuals with total clearance of mf at 36 months and Alere antigen test negativity (a more sensitive circulating antigen test of filarial infection). Two of the treatment arms will include ALB at two different doses, 400mg or 800mg (fixed dose twice yearly) as compared to standard treatment of ALB (400 mg) plus IVM (150-200 µg/kg) administered annually. Observations from an ongoing clinical trial in Papua New Guinea suggest that a single dose of triple therapy with ALB + IVM + DEC may be highly effective in sterilizing adult female worms. Therefore to confirm and expand these important preliminary observations in a different population, a fourth arm will be included in the current clinical trial in which subjects will receive all three drugs. The clinical trial will be performed in a region of Cote d'Ivoire where onchocerciasis and loiasis are not endemic.

Detailed Description

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Lymphatic filariasis (LF) is a deforming and disabling infectious disease that causes elephantiasis and genital deformity (especially hydroceles). The infection affects some 120 million people in 81 countries in tropical and subtropical regions with well over 1 billion people at risk of acquiring the disease. LF is caused by Wuchereria bancrofti and Brugia spp. (B. malayi and B. timori), nematode parasites that are transmitted by mosquitoes. The World Health Organization (WHO) developed a plan for LF elimination that is based on using novel approaches to rapidly map endemic areas and 4 to 6 annual rounds of MDA with antifilarial medication. A recent summary from WHO reported that more than 4 billion doses of MDA were distributed between 2000 and 2012. Thus, the Global Program to Eliminate Lymphatic Filariasis (GPELF) is the largest infectious disease intervention program attempted to date based on MDA (Ottesen, Hooper et al.

2008). MDA has worked better in some areas than others. There are a number of challenges faced by GPELF. These include (among others) inability to conduct MDA programs in areas of Africa where L. loa is coendemic because of the unacceptable risk of Serious Adverse Events (SAE's) with IVM in persons with heavy L. loa infections (Hoerauf, Pfarr et al. 2011), the limited macrofilaricidal activity of current MDA regimens (especially ALB + IVM) that necessitate repeated annual rounds of MDA (Geary and Mackenzie , Hoerauf, Pfarr et al. 2011), and the difficulty of achieving high compliance rates for MDA over a period of years (Hoerauf, Pfarr et al. 2011). It is clear that new (or reformulated) drugs and/or dosing schedules for LF MDA have the potential to greatly improve the number of countries that will successfully eliminate LF by the WHO target date of 2020. This is especially important for areas of Central and West Africa where MDA has not been implemented because of the possible co-infection with L. loa and logistical and financial challenges to delivering annual doses of IVM + ALB MDA to millions of individuals over multiple years.

Conditions

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Lymphatic Filariasis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Standard Treatment

Albendazole 400 mg + Ivermectin 200 µg/kg body weight administered annually (at 0, 12 and 24 months)

Group Type ACTIVE_COMPARATOR

Albendazole

Intervention Type DRUG

Subjects in Arms 1, 2, and 4 will receive 400mg of Albendazole

Subjects in Arm 3 will receive 800mg of Albendazole

Ivermectin

Intervention Type DRUG

Subjects in Arms 1 and 4 will receive 200mg/kg body weight

ALB 400 mg x2 per year

Albendazole 400 mg given at 0, 6, 12, 18, 24 and 30 months

Group Type EXPERIMENTAL

Albendazole

Intervention Type DRUG

Subjects in Arms 1, 2, and 4 will receive 400mg of Albendazole

Subjects in Arm 3 will receive 800mg of Albendazole

ALB 800 mg x2 per year

Albendazole 800 mg given at 0, 6, 12, 18, 24 and 30 months

Group Type EXPERIMENTAL

Albendazole

Intervention Type DRUG

Subjects in Arms 1, 2, and 4 will receive 400mg of Albendazole

Subjects in Arm 3 will receive 800mg of Albendazole

ALB 400mg + IVM 200mcg/kg + DEC 6mg/kg

Albendazole 400 mg plus Ivermectin 200 µg/kg body weight plus Diethylcarbamazine 6 mg/kg body weight given one time only

Group Type EXPERIMENTAL

Albendazole

Intervention Type DRUG

Subjects in Arms 1, 2, and 4 will receive 400mg of Albendazole

Subjects in Arm 3 will receive 800mg of Albendazole

Ivermectin

Intervention Type DRUG

Subjects in Arms 1 and 4 will receive 200mg/kg body weight

Diethylcarbamazine

Intervention Type DRUG

Participants in Arm 4 will receive 6mg/kg of Diethylcarbamazine per body weight

Interventions

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Albendazole

Subjects in Arms 1, 2, and 4 will receive 400mg of Albendazole

Subjects in Arm 3 will receive 800mg of Albendazole

Intervention Type DRUG

Ivermectin

Subjects in Arms 1 and 4 will receive 200mg/kg body weight

Intervention Type DRUG

Diethylcarbamazine

Participants in Arm 4 will receive 6mg/kg of Diethylcarbamazine per body weight

Intervention Type DRUG

Other Intervention Names

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ALB IVM DEC

Eligibility Criteria

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Inclusion Criteria

* Women and men 18-70 years
* ≥50 MF/mL based on Nuclepore filtration
* Willing to give informed consent

Exclusion Criteria

* Prior treatment for LF within last 5 years
* Pregnancy (perform pregnancy test)
* Hemoglobin \<7 g/dL
* Permanent disability, serious medical illness that prevents or impedes study participation and/or comprehension
* AST/ALT and creatinine \>1.5 upper limit of normal
* Proteinuria or hematuria \>3+
* Skin snip positivity for O. volvulus MF
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Washington University School of Medicine

OTHER

Sponsor Role collaborator

University Hospitals Cleveland Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Christopher L. King, MD, PhD

Professor of International Health, Medicine and Pathology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Christopher L King, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Case Western Reserve University

Locations

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Cote d'Ivoire

Abidjan, , Côte d’Ivoire

Site Status

Countries

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Côte d’Ivoire

References

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Other Identifiers

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08-14-13

Identifier Type: -

Identifier Source: org_study_id

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