Moxidectin noninferior to ivermectin for strongyloidiasis treatment
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Key takeaways:
- Cure rates were comparable for patients with strongyloidiasis treated with either moxidectin (93.6%) or ivermectin (95.7%).
- The most common adverse events for either treatment were abdominal pain and headache.
Moxidectin was noninferior to ivermectin for patients with strongyloidiasis, according to data published in The Lancet Infectious Diseases.
“Moxidectin was approved by FDA in 2018. We had tested in the lab against Strongyloides ratti and had observed excellent activity,” Jennifer Keiser, PhD, professor in the department of medical parasitology and infection biology at the Swiss Tropical and Public Health Institute, told Healio. “As alternative treatments for Strongyloides are needed we conducted a phase 2a and then a 2b study.”
For the phase 2b/3 study, Keiser and colleagues conducted a randomized, double-blind, parallel-group, noninferiority trial in communities in Laos and Cambodia.
According to the study, adults aged 18 to 65 years were screened for Strongyloides stercoralis larvae in their stool and patients who were clinically eligible were randomly assigned 1:1 to receive single oral doses of either moxidectin (8 mg) and ivermectin-matched placebo, or ivermectin (200 g/kg body weight) and moxidectin-matched placebo. The primary endpoint of the study was cure rate within 14 to 21 days after treatment.
In total, 4,291 patients were screened between Dec. 6, 2020, and May 21, 2022, 726 of whom were enrolled and randomly assigned to moxidectin (n = 363) or ivermectin (n = 363). Overall, the researchers recorded a cure rate of 93.6% (95% CI, 90.5-96) in the moxidectin group and 95.7% (95% CI, 93-97.6) in the ivermectin group.
The most common adverse events reported were abdominal pain (9% of patients treated with moxidectin vs. 9% of patients treated with ivermectin) and headache (7% of patients treated with moxidectin vs. 8% of patients treated with ivermectin), which were predominantly mild, according to the study.
“We observed an excellent activity in both trials. Moxidectin is noninferior to ivermectin and could be recommended for the treatment of strongyloidiasis,” Keiser concluded.
In a related commentary, Viravarn Luvira, MD, and Dorn Watthanakulpanich, MD, PhD, both associate professors at Mahidol University, wrote that these findings are “promising evidence” for moxidectin's efficacy and include supporting data for the use of moxidectin as an alternative treatment for strongyloidiasis as well as other infections such as hookworm and Trichuris trichiura.
“Aligning with WHO's control program for strongyloidiasis, it is particularly important to have an alternative drug, especially where drug resistance (eg, resistance to ivermectin) might be commonplace in the future,” they wrote.
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