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Moxidectin plus albendazole reduces egg burden of trichuriasis worm
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In adolescent patients with trichuriasis, moxidectin plus albendazole is noninferior to albendazole plus oxantel pamoate in terms of egg reduction rate in Trichuris trichiura worms, researchers reported recently in The Lancet Infectious Diseases. But their study showed that treatment with albendazole plus oxantel pamoate — the most effective single-dose treatment against T. trichiura — yielded a significantly higher cure rate.
“The recommended anthelmintics show low efficacy in a single-dose regimen against Trichuris trichiura,” Beatrice Barda, MD, PhD, of the Swiss Tropical and Public Health Institute in Basel, Switzerland, and colleagues wrote. “Moxidectin, a new treatment for river blindness, might complement the drug armamentarium for the treatment and control of soil-transmitted helminthiasis. However, its efficacy against T. trichiura has not yet been studied. The aim of the study was to assess the efficacy of moxidectin alone and in coadministrations against T. trichiura infection.”
In a randomized, single-blind, noninferiority trial, Barda and colleagues enrolled 701 students infected with T. trichiura aged between 12 and 18 years in two primary and one secondary school in Pemba, Tanzania, and assigned them in a 5:5:3:3 ratio to receive moxidectin (8 mg) plus albendazole (400 mg); albendazole (400 mg) plus oxantel pamoate (25 mg/kg; reference regimen); moxidectin (8 mg) plus tribendimidine (200 mg or 400 mg); or moxidectin monotherapy (8 mg). The primary outcome was noninferiority with a 2 percentage-point margin for egg reduction ratio (ERR) against T. trichiura from baseline to 14 to 21 days after treatment. Cure rates (CRs) and tolerability were secondary outcomes.
According to Barda and colleagues, moxidectin plus albendazole was noninferior to albendazole plus oxantel pamoate in terms of ERR (98.5% vs. 99.8%; absolute difference –1.2 percentage points; 95% CI, –1.8 to –0.79). Moxidectin plus albendazole was superior to moxidectin monotherapy (98.5% vs. 83.2%; difference, –15.3 percentage points; 95% CI, –21.1 to –11).
The CR in the group treated with moxidectin plus albendazole was significantly lower compared with that of the group treated with albendazole plus oxantel pamoate (CR = 50.8% vs. 83%; OR, 4.7; 95% CI, 3-7.6; P < .0001). Moxidectin plus albendazole yielded a 64% CR for light infection and a 23% CR for moderate infection. The CR for moxidectin plus tribendimidine was 29% for light infection and 9% for moderate infection. For moxidectin monotherapy, it was 20% for light infection and 3% for moderate infection. None of the treatments cured any of the high-intensity infections of T. trichiura, Barda and colleagues reported.
There were no serious adverse events reported during the study interval — only mild adverse events that did not require treatment.
In a related editorial, Mathieu Maneu-Giroux, ScD, and Serene A. Joseph, PhD, of the department of epidemiology, biostatistics and occupational therapy at McGill University, Montreal, said the findings add to the body of evidence to support moxidectin as a powerful antiparasitic agent.
“As control and elimination of neglected tropical diseases are being integrated and scaled up, new combinations of antimicrobials could further improve programs’ impact,” they wrote. “However, these findings should not detract from the implementation gaps. Although global coverage of deworming has been increasing, program efficiency could be optimized with up-to-date mapping of endemic regions by monitoring and assessing the effect of long-term treatment on morbidity, and through improved integration of complementary interventions, including sustainable water and sanitation and health education, which remain insufficiently funded.” – by Jennifer Byrne
Disclosures: The authors report no relevant disclosures. Joseph reports no relevant financial disclosures. Maneu-Giroux reports a salary award from the Fonds de recherche du Québec-Santé and grants from Gilead outside the submitted work.
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