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Ivermectin safe but ineffective against trichuriasis in children
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The use of ivermectin to treat Trichuris trichiura infection is ineffective at 200-µg/kg doses in preschool- and school-aged children, with less efficacy observed in school-aged children when 600-µg/kg doses were administered to school-aged children.
“Despite its use for decades, important characteristics of ivermectin still remain unknown, such as the optimal dosage of this drug against T. trichiura infection,” David Wimmersberger, from the department of medical parasitology and infection biology at the Swiss Tropical and Public Health Institute, and colleagues wrote. “Moreover, with exception of a single retrospective study in 15 infants suffering from scabies, safety of this drug has never been thoroughly studied in children younger than 5 years of age.”
“Presently, ivermectin is approved for use in children at least 15 kg of weight or 5 years of age,” the researchers continued. “However, preventive chemotherapy is recommended as a public health intervention for all children — preschool-aged and school-aged children — living in soil-transmitted helminth endemic areas.”
To examine the safety and efficacy of increasing ivermectin doses for the treatment of T. trichiura in preschool- and school-aged children, Wimmersberger and colleagues conducted a randomized placebo-controlled trial in which children residing in rural Côte d’Ivoire. The rate of infection was assessed after this treatment was administered, alongside egg reduction and cure rates.
Of the 292 preschool- and school-aged children with T. trichiura infection included in the trial, 20.9% were cured using 200 µg/kg of ivermectin (95% CI, 11.9%-52.8%) as opposed to 19.5% who received a placebo (95% CI, 10.4%-49.9%). The researchers also observed similar geometric mean egg reduction rates between the ivermectin group (78.6%; 95% CI, 60.1%-89.5%) and the placebo group (68.2%; 95% CI, 40.5%-84.8%).
Wimmersberger and colleagues observed that when school-aged children received 600 µg/kg of ivermectin, they were less likely to be cured of the infection (12.2%; 95% CI, 4.8%-32.3%). Furthermore, when administered this dose of ivermectin, school-aged children demonstrated moderate, but reduced, egg reduction rates (66.3%; 95% CI, 43.8%-80.2%).
Although ineffective at reducing infection rates and increasing egg reduction rates, ivermectin demonstrated safety in these cohorts, with no organ toxicity found through serum biomarkers and only mild adverse events reported.
“The weak performance of ivermectin against trichuriasis in the present trial contrasts with the findings of the three most recent studies by Wen et al., Beach et al. and Bélizario et al., who reported cure rates of 66.7%, 44.3% and 35.1%, respectively, using a standard dose of 200 µg/kg,” Wimmersberger and colleagues wrote. “These conflicting results might be explained by spatiotemporal differences since these studies were performed 10 to 20 years ago in the Americas and Asia; moreover, two studies included patients with significantly lower infection intensities and one study also included nine adults.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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