Comparison of Ivermectin and Diethylcarbamazine in the Treatment of Onchocerciasis

• Published in: The New England journal of medicine Vol. 313; no. 3; pp. 133 - 138
• Main Authors: Greene, Bruce M, Taylor, Hugh R, Cupp, Eddie W, Murphy, Robert P, White, Albert T, Aziz, Mohammed A, Schulz-Key, Hartwig, D'Anna, Salvatore A, Newland, Henry S, Goldschmidt, Leonard P, Auer, Cheryl, Hanson, Aloysius P, Freeman, S. Vaanii, Reber, Earl W, Williams, P. Noel
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 18.07.1985
• Subjects: Adult; Anthelmintics - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiparasitic Agents; Biological and medical sciences; Biomedical research; Body weight; Clinical Trials as Topic; Cornea; Cornea - parasitology; Corneal Opacity - chemically induced; Diethylcarbamazine - adverse effects; Diethylcarbamazine - therapeutic use; Dirofilaria immitis; Double-Blind Method; Eye Diseases - drug therapy; Eye Diseases - etiology; Filaricides - adverse effects; Filaricides - therapeutic use; Hospitals; Humans; Infections; Ivermectin; Laboratories; Lactones - adverse effects; Lactones - therapeutic use; Male; Medical imaging; Medical sciences; Medicine; Middle Aged; Nodules; Onchocerca volvulus; Onchocerciasis; Onchocerciasis - complications; Onchocerciasis - drug therapy; Onchocerciasis - parasitology; Pharmacology. Drug treatments; Pruritus; Random Allocation; Skin; Skin - parasitology; Skin Diseases, Parasitic - parasitology; Time Factors; Human; Anthelmintic; Africa; Onchocerca volvulus; Controlled therapeutic trial; Helminthiasis; Onchocerciasis; Infection; Liberia; Chemotherapy; Nematod disease; Double blind study; Filariosis; Comparative study
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198507183130301

We compared ivermectin with diethylcarbamazine for the treatment of onchocerciasis in a double-blind, placebo-controlled trial. Thirty men with moderate to heavy infection and ocular involvement were randomly assigned to receive ivermectin in a single oral dose (200 μg per kilogram of body weight), diethylcarbamazine daily for eight days, or placebo. Diethylcarbamazine caused a significantly more severe systemic reaction than ivermectin (P<0.001), whereas the reaction to ivermectin did not differ from the reaction to placebo. Diethylcarbamazine markedly increased the number of punctate opacities in the eye (P<0.001), as well as the number of dead and living microfilariae in the cornea over the first week of therapy. Ivermectin had no such effect. Both ivermectin and diethylcarbamazine promptly reduced skin microfilaria counts, but only in the ivermectin group did counts remain significantly lower (P<0.005) than in the placebo group at the end of six months of observation. Analysis of adult worms isolated from nodules obtained two months after the start of therapy showed no effect of either drug on viability. Ivermectin appears to be a better tolerated, safer, and more effective microfilaricidal agent than diethylcarbamazine for the treatment of onchocerciasis. (N Engl J Med 1985; 313:133–8.) TREATMENT of Onchocerca volvulus infection, a major filarial disease among human beings and one of the leading causes of blindness, remains problematic. Diethylcarbamazine, the most widely used agent, has frequent side effects and complications. 1 2 3 4 5 6 These include a variety of symptomatic effects, such as pruritus, lymph-node pain, myalgias and arthralgias, headache, dizziness, and conjunctivitis, as well as more serious complications, such as hypotension, keratitis, chorioretinal damage, and optic neuritis. It is therefore recommended that diethylcarbamazine be used conservatively and only for clear indications, such as sight-threatening or debilitating disease. 7 , 8 Suramin, the other available drug, is impractical for mass therapy since it . . .