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Effect of Albendazole Dose on Treatment of Lymphatic Filariasis

Effect of Albendazole Dose and Interval on Brugia Malayi Microfilarial Clearance in India: A Randomized, Open Label Study

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00511004
Enrollment
40
Registered
2007-08-03
Start date
2007-07-31
Completion date
2014-02-28
Last updated
2015-08-31

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Lymphatic Filariasis

Keywords

Brugia Malayi, Lymphatic Filariasis, Albendazole, Diethylcarbamazine

Brief summary

This study is conducted in Kerala, India. It will determine whether a new treatment regimen of albendazole and diethylcarbamazine (DEC) for lymphatic filariasis can eliminate the disease more quickly than the standard regimen. Lymphatic filariasis is caused by infection with very small parasitic worms that are spread by mosquitoes. The disease can cause swelling of the arms, legs, breast and scrotum and can progress to permanent swelling of the legs or arms called elephantiasis. The study will see if a higher and more frequent dose of albendazole is better at clearing filarial worms from the blood than the current treatment. Healthy people between 18 and 55 years of age who are in good health and who are infected with filarial worms may be eligible for this study. Participants undergo the following procedures: 3-day hospital stay at the Filariasis Chemotherapy Unit of the T.D. Medical College Hospital in Kerala, India * Random assignment to receive either: 400 mg albendazole and DEC 300 mg given once a year for 2 years (standard treatment); or 800 mg albendazole and DEC 300 mg given once a year for 2 years; or 800 mg albendazole and DEC 300 mg given twice a year for 2 years. * Urine pregnancy test for women of childbearing age . * Ultrasound test to look for filarial worms. * Treatment dose. * Monitoring for symptoms 6-month 3-day hospital stay * Medical history, physical examination and blood test. * Repeat ultrasound in subjects whose first ultrasound detected adult worms. * Treatment dose for subjects receiving medicine every 6 months. * Urine pregnancy test for women of childbearing age. 1-year 3-day hospital stay * Medical history, physical examination and blood test. * Treatment dose. * Repeat ultrasound in subjects whose first ultrasound detected adult worms. * Urine pregnancy test for women of childbearing age. 18-month 3-day hospital stay * Medical history, physical examination and blood test. * Treatment dose for subjects receiving medicine every 6 months. * Urine pregnancy test for women of childbearing age. 24-month 3-day hospital stay * Medical history, physical examination and blood test. * Treatment dose. * Repeat ultrasound in subjects whose first ultrasound detected adult worms. * Urine pregnancy test for women of childbearing age.

Detailed description

Albendazole and diethylcarbamazine (DEC) are currently used in combination for annual mass treatment of lymphatic filariasis in all parts of the world except Africa. Although the drugs have been donated, the cost of such programs is very high and has proven to be a major impediment to the success of programs in many countries with limited financial resources. Data from albendazole treatment of other filarial infections and one study comparing single to multi-dose DEC/albendazole in lymphatic filariasis suggest that increased dose and/or frequency of albendazole dosing may be more effective in clearing microfilariae. In this study, 75 volunteers with microfilaremic Brugia malayi infection will be randomized to receive standard annual therapy (albendazole 400 mg + DEC 300 mg), annual therapy with increased dosing of albendazole (albendazole 800 mg + DEC 300 mg), or semiannual therapy with an increased albendazole dose (albendazole 800 mg + DEC 300 mg). Microfilarial levels will be followed every 6 months for 2 years to determine whether the higher dose, and/or the more frequent regimen, is more effective.

Interventions

DRUGAlbendazole

Comparing 400 mg to 800 mg dose

Providing diethylcarbamazine more frequently in combination with albendazole

Sponsors

National Institute of Allergy and Infectious Diseases (NIAID)
Lead SponsorNIH

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
No

Inclusion criteria

* INCLUSION CRITERIA: Inclusion Criteria for Screening: * Age 18 years to 55 years inclusive * Both genders * Not pregnant or breastfeeding by history * If selected, subjects must be willing to spend 3 days on the Filariasis Chemotherapy Unit at the T.D. Medical College Hospital, Alleppey, Kerala, India * If selected, subjects must be willing to undergo nighttime blood draws once every 6 months and Doppler ultrasound twice yearly for 2 years * If selected, agree to have blood stored for future studies * Ability to understand and give informed consent Inclusion Criteria for Treatment: * Age 18 to 55 years inclusive * Men and non-pregnant or non-breast feeding women * Microfilarial levels greater than 50mf/mL * Willingness to spend 3 days on the Filariasis Chemotherapy Unit at the T.D. Medical College Hospital, Alleppey, Kerala, India every 6 months for 2 years * Willingness to undergo nighttime blood draws once every 6 months for 2 years * Ability to understand and give informed consent * Hemaglobin (Hgb) levels for inclusion greater than 9 g/dL * Creatinine (Cr) less than or equal to 1.2 mg/dL * Alanine aminotransferase (ALT) less than 30 U/L * Willingness to have blood stored for future studies

Design outcomes

Primary

MeasureTime frameDescription
Microfilarial Counts at 1 Year1 year from time enrolledNight time microfilarial counts at 1 year

Secondary

MeasureTime frameDescription
Adult Worm Burdens at 2 Years2 years from the time enrolled.Doppler detected worm nests at 2 years
Microfilarial Levels at 2 Years2 years from time enrolledNight time microfilarial levels at 2 years
Brugia Specific Immunoglobulin G4 (IgG4) Antibodies2 yearsIgG4 antibodies directed against Brugia malayi antigen

Countries

India

Participant flow

Recruitment details

Adults living in Kerala, India with Brugia malayi microfilaremia were recruited from field sites around the city of Alleppey and the study performed in the outpatient department of the TD Medical College.

Participants by arm

ArmCount
Standard Therapy Annual DEC/ALB
Group randomized to standard therapy that consists of Annual diethylcarbamazine (300 mg) and albendazole (400mg)
13
High Dose Annual DEC/ALB
Group randomized to yearly high dose albendazole that consists of Annual diethylcarbamazine (300 mg) and albendazole (800mg)
13
High Dose Semiannual DEC/ALB
Group randomized to twice-yearly high dose albendazole that consists of Annual diethylcarbamazine (300 mg) and albendazole (800mg)
14
Total40

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Overall StudyLost to Follow-up004

Baseline characteristics

CharacteristicStandard Therapy Annual DEC/ALBHigh Dose Annual DEC/ALBHigh Dose Semiannual DEC/ALBTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
0 Participants0 Participants0 Participants0 Participants
Age, Categorical
Between 18 and 65 years
13 Participants13 Participants14 Participants40 Participants
Age, Continuous36 Years39 Years37 Years37 Years
Blood microfilaremia (mf/ml)412 MF/ML264 MF/ML384 MF/ML384 MF/ML
Region of Enrollment
India
13 participants13 participants14 participants40 participants
Sex: Female, Male
Female
9 Participants10 Participants10 Participants29 Participants
Sex: Female, Male
Male
4 Participants3 Participants4 Participants11 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
9 / 138 / 1311 / 14
serious
Total, serious adverse events
0 / 130 / 130 / 14

Outcome results

Primary

Microfilarial Counts at 1 Year

Night time microfilarial counts at 1 year

Time frame: 1 year from time enrolled

ArmMeasureValue (MEDIAN)
Standard Therapy Annual DEC/ALBMicrofilarial Counts at 1 Year0 MF/ML
High Dose Annual DEC/ALBMicrofilarial Counts at 1 Year0 MF/ML
High Dose Semiannual DEC/ALBMicrofilarial Counts at 1 Year0 MF/ML
p-value: <0.2Fisher Exact
Secondary

Adult Worm Burdens at 2 Years

Doppler detected worm nests at 2 years

Time frame: 2 years from the time enrolled.

Population: By 2 years, 4 subjects in High Dose Group lost to followup

ArmMeasureValue (MEDIAN)
Standard Therapy Annual DEC/ALBAdult Worm Burdens at 2 Years0 Number of nests
High Dose Annual DEC/ALBAdult Worm Burdens at 2 Years0 Number of nests
High Dose Semiannual DEC/ALBAdult Worm Burdens at 2 Years0 Number of nests
p-value: 0.9Fisher Exact
Secondary

Brugia Specific Immunoglobulin G4 (IgG4) Antibodies

IgG4 antibodies directed against Brugia malayi antigen

Time frame: 2 years

Population: By 2 years, 4 subjects in High Dose Group lost to followup

ArmMeasureValue (MEDIAN)
Standard Therapy Annual DEC/ALBBrugia Specific Immunoglobulin G4 (IgG4) Antibodies150 ng/ml
High Dose Annual DEC/ALBBrugia Specific Immunoglobulin G4 (IgG4) Antibodies224 ng/ml
High Dose Semiannual DEC/ALBBrugia Specific Immunoglobulin G4 (IgG4) Antibodies128 ng/ml
Secondary

Microfilarial Levels at 2 Years

Night time microfilarial levels at 2 years

Time frame: 2 years from time enrolled

Population: By 2 years, 4 subjects in High Dose Group lost to followup

ArmMeasureValue (MEDIAN)
Standard Therapy Annual DEC/ALBMicrofilarial Levels at 2 Years0 MF/ML
High Dose Annual DEC/ALBMicrofilarial Levels at 2 Years0 MF/ML
High Dose Semiannual DEC/ALBMicrofilarial Levels at 2 Years0 MF/ML

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026