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Lymphatic FilariasisNCT02974049

Lymphatic Filariasis (LF) in Ivory Coast

A study testing Albendazole, Ivermectin and Diethylcarbamazine in people with Lymphatic Filariasis, run by University Hospitals Cleveland Medical Center at 1 site in Côte d’Ivoire.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The recommended treatment for elimination of LF in sub-Saharan Africa is annual mass drug administration (MDA) with single dose Albendazole (ALB) plus Ivermectin (IVM) given for at least 5-7 years. However, in areas where LF is co-endemic with a related filarial parasite, Loa loa, co-infection with L. Read more about this study

Who is it for?
Ages 18 to 70 years
Conditions the study is for
Lymphatic Filariasis
What is being tested?
Albendazole, Ivermectin and Diethylcarbamazine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
189 participants
Where
1 siteCôte d’Ivoire
Study dates
Jan 2015to 25 Sep 2018
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Women and men 18-70 years
  • ≥50 MF/mL based on Nuclepore filtration
  • Willing to give informed consent

Who cannot join

  • Prior treatment for LF within last 5 years
  • Pregnancy (perform pregnancy test)
  • Hemoglobin <7 g/dL
  • Permanent disability, serious medical illness that prevents or impedes study participation and/or comprehension
  • AST/ALT and creatinine >1.5 upper limit of normal
  • Proteinuria or hematuria >3+
  • Skin snip positivity for O. volvulus MF

Trial locations and contacts

1 site in 1 country.

Côte d’Ivoire1 site
  • Cote d'Ivoire

    Abidjan

Other trials in Côte d’Ivoire

About this study

Official title: Alternative Chemotherapies for Lymphatic Filariasis (LF) Treatment and Elimination in Africa [Cote d'Ivoire]

The recommended treatment for elimination of LF in sub-Saharan Africa is annual mass drug administration (MDA) with single dose Albendazole (ALB) plus Ivermectin (IVM) given for at least 5-7 years. However, in areas where LF is co-endemic with a related filarial parasite, Loa loa, co-infection with L. loa represents a serious barrier to LF elimination because IVM used in LF MDA can result in severe reactions and even death in individuals with high microfilaria (mf) levels of L. loa. Screening for heavy L. loa infection is problematic. To overcome this problem, monotherapy with ALB is possible, since this drug has little or no effect on circulating mf and thus would not cause adverse effects in people with heavy L. loa infections. Moreover ALB has been shown to have embryostatic or embryocidal effects in female adult worms resulting in decreased mf levels with time as natural attrition of circulating mf occurs. Thus this open-label, randomized clinical trial will examine treatment with ALB monotherapy administered twice per year over a period of 3 years with the primary endpoint being the proportion of individuals with total clearance of mf at 36 months and Alere antigen test negativity (a more sensitive circulating antigen test of filarial infection). Two of the treatment arms will include ALB at two different doses, 400mg or 800mg (fixed dose twice yearly) as compared to standard treatment of ALB (400 mg) plus IVM (150-200 µg/kg) administered annually. Observations from an ongoing clinical trial in Papua New Guinea suggest that a single dose of triple therapy with ALB + IVM + DEC may be highly effective in sterilizing adult female worms. Therefore to confirm and expand these important preliminary observations in a different population, a fourth arm will be included in the current clinical trial in which subjects will receive all three drugs. The clinical trial will be performed in a region of Cote d'Ivoire where onchocerciasis and loiasis are not endemic.

Read the detailed description

Lymphatic filariasis (LF) is a deforming and disabling infectious disease that causes elephantiasis and genital deformity (especially hydroceles). The infection affects some 120 million people in 81 countries in tropical and subtropical regions with well over 1 billion people at risk of acquiring the disease. LF is caused by Wuchereria bancrofti and Brugia spp. (B. malayi and B. timori), nematode parasites that are transmitted by mosquitoes. The World Health Organization (WHO) developed a plan for LF elimination that is based on using novel approaches to rapidly map endemic areas and 4 to 6 annual rounds of MDA with antifilarial medication. A recent summary from WHO reported that more than 4 billion doses of MDA were distributed between 2000 and 2012. Thus, the Global Program to Eliminate Lymphatic Filariasis (GPELF) is the largest infectious disease intervention program attempted to date based on MDA (Ottesen, Hooper et al.

2008). MDA has worked better in some areas than others. There are a number of challenges faced by GPELF. These include (among others) inability to conduct MDA programs in areas of Africa where L. loa is coendemic because of the unacceptable risk of Serious Adverse Events (SAE's) with IVM in persons with heavy L. loa infections (Hoerauf, Pfarr et al. 2011), the limited macrofilaricidal activity of current MDA regimens (especially ALB + IVM) that necessitate repeated annual rounds of MDA (Geary and Mackenzie , Hoerauf, Pfarr et al. 2011), and the difficulty of achieving high compliance rates for MDA over a period of years (Hoerauf, Pfarr et al. 2011). It is clear that new (or reformulated) drugs and/or dosing schedules for LF MDA have the potential to greatly improve the number of countries that will successfully eliminate LF by the WHO target date of 2020. This is especially important for areas of Central and West Africa where MDA has not been implemented because of the possible co-infection with L. loa and logistical and financial challenges to delivering annual doses of IVM + ALB MDA to millions of individuals over multiple years.

Being tested
Albendazole, Ivermectin, Diethylcarbamazine
Keywords
Ivermectin, Albendazole, Diethylcarbamazine
Medical subject headings
Elephantiasis, Filarial

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AlbendazoleDrug

    Also called ALB

    Subjects in Arms 1, 2, and 4 will receive 400mg of Albendazole

    Subjects in Arm 3 will receive 800mg of Albendazole

  • IvermectinDrug

    Also called IVM

    Subjects in Arms 1 and 4 will receive 200mg/kg body weight

  • DiethylcarbamazineDrug

    Also called DEC

    Participants in Arm 4 will receive 6mg/kg of Diethylcarbamazine per body weight

Study groups in NCT02974049
Study groupRoleWhat they receive
Standard TreatmentActive comparatorAlbendazole 400 mg + Ivermectin 200 µg/kg body weight administered annually (at 0, 12 and 24 months)
Receives: Drug: Albendazole; Drug: Ivermectin
ALB 400 mg x2 per yearExperimentalAlbendazole 400 mg given at 0, 6, 12, 18, 24 and 30 months
Receives: Drug: Albendazole
ALB 800 mg x2 per yearExperimentalAlbendazole 800 mg given at 0, 6, 12, 18, 24 and 30 months
Receives: Drug: Albendazole
ALB 400mg + IVM 200mcg/kg + DEC 6mg/kgExperimentalAlbendazole 400 mg plus Ivermectin 200 µg/kg body weight plus Diethylcarbamazine 6 mg/kg body weight given one time only
Receives: Drug: Albendazole; Drug: Ivermectin; Drug: Diethylcarbamazine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Total clearance of Microfilariae

    The percentage of participants with total clearance of Microfilariae

    Measured: 36 months

Secondary outcomes (7)
  1. Total clearance of MF at 24 months

    Percentage of subjects with total clearance of MF at 24 months

    Measured: 24 months

  2. Percent MF reduction

    Percent MF reduction at 24 and 36 months compared to baseline level

    Measured: 24 and 36 months

  3. Reduction in W. bancrofti antigen level

    Percent reduction in W. bancrofti antigen level measured by Og4C3 assay at 12, 24 and 36 months compared to baseline level

    Measured: 12, 24 and 36 months

  4. Alere Filariasis Test Strip negative

    Percentage of subjects that become Alere Filariasis Test Strip negative at 12, 24 and 36 months

    Measured: 12, 24 and 36 months

  5. reduction in viable worm nests

    Percent reduction in viable worm nests relative to baseline (time 0) based on follow up scrotal ultrasound examination performed at 12, 24 and 36 months

    Measured: 12, 24, and 36 months

  6. Diversity of parasites

    Diversity of parasites before and after treatment using genetic markers

    Measured: 0 and 36 months

  7. type and level of parasite-specific host immune response

    Relation of type and level of parasite-specific host immune response with the initial and sustained clearance of parasites

    Measured: 0 and 36 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Nov 2016 (estimated)
  2. Study startJan 2015
  3. Primary completionSep 2018
  4. Study completion25 Sep 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
189 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02974049
Sponsor's protocol ID
08-14-13
Status last verified
Apr 2019
First submitted
22 Nov 2016
Last updated
21 Apr 2022
Results posted
No
Data monitoring committee
Yes
Individual data sharing
Yes: Not personal identifying data but infection levels will be shared.

Publications

  • Awadzi K, Edwards G, Duke BO, Opoku NO, Attah SK, Addy ET, Ardrey AE, Quartey BT. The co-administration of ivermectin and albendazole--safety, pharmacokinetics and efficacy against Onchocerca volvulus. Ann Trop Med Parasitol. 2003 Mar;97(2):165-78. doi: 10.1179/000349803235001697.

    PubMed 12803872
  • Awadzi K, Edwards G, Opoku NO, Ardrey AE, Favager S, Addy ET, Attah SK, Yamuah LK, Quartey BT. The safety, tolerability and pharmacokinetics of levamisole alone, levamisole plus ivermectin, and levamisole plus albendazole, and their efficacy against Onchocerca volvulus. Ann Trop Med Parasitol. 2004 Sep;98(6):595-614. doi: 10.1179/000349804225021370.

    PubMed 15324466
  • Bockarie MJ, Tavul L, Ibam I, Kastens W, Hazlett F, Tisch DJ, Alpers MP, Kazura JW. Efficacy of single-dose diethylcarbamazine compared with diethylcarbamazine combined with albendazole against Wuchereria bancrofti infection in Papua New Guinea. Am J Trop Med Hyg. 2007 Jan;76(1):62-6.

    PubMed 17255231
  • Boussinesq M, Kamgno J, Pion SD, Gardon J. What are the mechanisms associated with post-ivermectin serious adverse events? Trends Parasitol. 2006 Jun;22(6):244-6. doi: 10.1016/j.pt.2006.04.006. Epub 2006 Apr 24. No abstract available.

    PubMed 16632406
  • Chu, B. K., P. J. Hooper, M. H. Bradley, D. A. McFarland and E. A. Ottesen

  • Geary TG. Ivermectin 20 years on: maturation of a wonder drug. Trends Parasitol. 2005 Nov;21(11):530-2. doi: 10.1016/j.pt.2005.08.014. Epub 2005 Aug 26.

    PubMed 16126457
  • Ottesen EA. Lymphatic filariasis: Treatment, control and elimination. Adv Parasitol. 2006;61:395-441. doi: 10.1016/S0065-308X(05)61010-X.

    PubMed 16735170
  • Geary TG, Mackenzie CD. Progress and challenges in the discovery of macrofilaricidal drugs. Expert Rev Anti Infect Ther. 2011 Aug;9(8):681-95. doi: 10.1586/eri.11.76.

    PubMed 21819332
  • Hoerauf A, Pfarr K, Mand S, Debrah AY, Specht S. Filariasis in Africa--treatment challenges and prospects. Clin Microbiol Infect. 2011 Jul;17(7):977-85. doi: 10.1111/j.1469-0691.2011.03586.x.

    PubMed 21722251
  • Hooper PJ, Bradley MH, Biswas G, Ottesen EA. The Global Programme to Eliminate Lymphatic Filariasis: health impact during its first 8 years (2000-2007). Ann Trop Med Parasitol. 2009 Oct;103 Suppl 1:S17-21. doi: 10.1179/000349809X12502035776513.

    PubMed 19843394
  • Horton J. Albendazole: a broad spectrum anthelminthic for treatment of individuals and populations. Curr Opin Infect Dis. 2002 Dec;15(6):599-608. doi: 10.1097/00001432-200212000-00008.

    PubMed 12821837
  • Horton J. The development of albendazole for lymphatic filariasis. Ann Trop Med Parasitol. 2009 Oct;103 Suppl 1:S33-40. doi: 10.1179/000349809X12502035776595.

    PubMed 19843396
  • Hotez PJ, Savioli L, Fenwick A. Neglected tropical diseases of the Middle East and North Africa: review of their prevalence, distribution, and opportunities for control. PLoS Negl Trop Dis. 2012;6(2):e1475. doi: 10.1371/journal.pntd.0001475. Epub 2012 Feb 28.

    PubMed 22389729
  • Kitzman D, Wei SY, Fleckenstein L. Liquid chromatographic assay of ivermectin in human plasma for application to clinical pharmacokinetic studies. J Pharm Biomed Anal. 2006 Mar 3;40(4):1013-20. doi: 10.1016/j.jpba.2005.08.026. Epub 2005 Oct 19.

    PubMed 16242280
  • Mand S, Debrah A, Batsa L, Adjei O, Hoerauf A. Reliable and frequent detection of adult Wuchereria bancrofti in Ghanaian women by ultrasonography. Trop Med Int Health. 2004 Oct;9(10):1111-4. doi: 10.1111/j.1365-3156.2004.01304.x.

    PubMed 15482404

Questions about this trial

What is this clinical trial studying?

A study testing Albendazole, Ivermectin and Diethylcarbamazine in people with Lymphatic Filariasis, run by University Hospitals Cleveland Medical Center at 1 site in Côte d’Ivoire.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 21 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Côte d’Ivoire. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Total clearance of Microfilariae (time frame: 36 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02974049, which also lists 24 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Apr 2022.

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