Lymphatic Filariasis
Conditions
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
Comparing 400 mg to 800 mg dose
Providing diethylcarbamazine more frequently in combination with albendazole
Sponsors
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Microfilarial Counts at 1 Year | 1 year from time enrolled | Night time microfilarial counts at 1 year |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adult Worm Burdens at 2 Years | 2 years from the time enrolled. | Doppler detected worm nests at 2 years |
| Microfilarial Levels at 2 Years | 2 years from time enrolled | Night time microfilarial levels at 2 years |
| Brugia Specific Immunoglobulin G4 (IgG4) Antibodies | 2 years | IgG4 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
| Arm | Count |
|---|---|
| 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 |
| Total | 40 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Lost to Follow-up | 0 | 0 | 4 |
Baseline characteristics
| Characteristic | Standard Therapy Annual DEC/ALB | High Dose Annual DEC/ALB | High Dose Semiannual DEC/ALB | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 13 Participants | 13 Participants | 14 Participants | 40 Participants |
| Age, Continuous | 36 Years | 39 Years | 37 Years | 37 Years |
| Blood microfilaremia (mf/ml) | 412 MF/ML | 264 MF/ML | 384 MF/ML | 384 MF/ML |
| Region of Enrollment India | 13 participants | 13 participants | 14 participants | 40 participants |
| Sex: Female, Male Female | 9 Participants | 10 Participants | 10 Participants | 29 Participants |
| Sex: Female, Male Male | 4 Participants | 3 Participants | 4 Participants | 11 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 9 / 13 | 8 / 13 | 11 / 14 |
| serious Total, serious adverse events | 0 / 13 | 0 / 13 | 0 / 14 |
Outcome results
Microfilarial Counts at 1 Year
Night time microfilarial counts at 1 year
Time frame: 1 year from time enrolled
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Standard Therapy Annual DEC/ALB | Microfilarial Counts at 1 Year | 0 MF/ML |
| High Dose Annual DEC/ALB | Microfilarial Counts at 1 Year | 0 MF/ML |
| High Dose Semiannual DEC/ALB | Microfilarial Counts at 1 Year | 0 MF/ML |
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Standard Therapy Annual DEC/ALB | Adult Worm Burdens at 2 Years | 0 Number of nests |
| High Dose Annual DEC/ALB | Adult Worm Burdens at 2 Years | 0 Number of nests |
| High Dose Semiannual DEC/ALB | Adult Worm Burdens at 2 Years | 0 Number of nests |
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Standard Therapy Annual DEC/ALB | Brugia Specific Immunoglobulin G4 (IgG4) Antibodies | 150 ng/ml |
| High Dose Annual DEC/ALB | Brugia Specific Immunoglobulin G4 (IgG4) Antibodies | 224 ng/ml |
| High Dose Semiannual DEC/ALB | Brugia Specific Immunoglobulin G4 (IgG4) Antibodies | 128 ng/ml |
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Standard Therapy Annual DEC/ALB | Microfilarial Levels at 2 Years | 0 MF/ML |
| High Dose Annual DEC/ALB | Microfilarial Levels at 2 Years | 0 MF/ML |
| High Dose Semiannual DEC/ALB | Microfilarial Levels at 2 Years | 0 MF/ML |