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Elmehy DA, Gamea GA, El-Guindy DM, Tahoon DM, Elkholy RA, Zoghroban HS. Moxidectin versus Ivermectin in the prevention and treatment of acute and chronic experimental trichinellosis. Exp Parasitol 2024; 262:108775. [PMID: 38735518 DOI: 10.1016/j.exppara.2024.108775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/30/2024] [Accepted: 05/10/2024] [Indexed: 05/14/2024]
Abstract
The limited activity of the traditional medications against T. spiralis encysted larvae handicaps complete cure of trichinellosis till now due to decreased permeability and absorption through tissues. MOX is listed worldwide for prevention and treatment of several internal and external nematodes. Consequently, the aim of this work was to investigate the effect of moxidectin versus ivermectin on experimental acute and chronic trichinellosis and to illuminate the potential mechanisms of their effects. 105 Mice were divided into four groups; Group I: Uninfected healthy control; Group II: Infected untreated control; Group III: Infected and treated with IVM and Group IV: Infected and treated with MOX. The groups (II, III and IV) were later subdivided equally into three subgroups (a, b, and c) according to the stage of treatment. Parasitological counting of adults and larvae besides immune-histopathological examination of intestines and muscles were done. Results exhibited that both IVM and MOX succeeded in reducing adults and larvae counts with higher potential of MOX in both intestinal and muscle phase. The preeminence of MOX was indicated by decreased inflammation, a significant reduction in the microvascular density (CD31 immunostaining) as well as a reduction in the percentage of fibroblast activation protein (FAP) immunostaining in muscle tissues. Accordingly, the current work recommends moxidectin as an innovative treatment for trichinellosis.
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Affiliation(s)
- Dalia A Elmehy
- Department of Medical Parasitology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ghada A Gamea
- Department of Medical Parasitology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina M El-Guindy
- Department of Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina M Tahoon
- Department of Pharmacology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Reem A Elkholy
- Department of Pharmacology, Faculty of Medicine, Tanta University, Tanta, Egypt; Department of Pharmacology, School of Medicine, Badr University, Cairo, Egypt
| | - Hager S Zoghroban
- Department of Medical Parasitology, Faculty of Medicine, Tanta University, Tanta, Egypt.
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Luvira V, Watthanakulpanich D. Efficacy and safety of moxidectin against strongyloidiasis. THE LANCET. INFECTIOUS DISEASES 2024; 24:118-119. [PMID: 37949091 DOI: 10.1016/s1473-3099(23)00558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Viravarn Luvira
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Dorn Watthanakulpanich
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Sprecher VP, Hofmann D, Savathdy V, Xayavong P, Norkhankhame C, Huy R, Khieu V, Sayasone S, Hattendorf J, Keiser J. Efficacy and safety of moxidectin compared with ivermectin against Strongyloides stercoralis infection in adults in Laos and Cambodia: a randomised, double-blind, non-inferiority, phase 2b/3 trial. THE LANCET. INFECTIOUS DISEASES 2024; 24:196-205. [PMID: 37949090 DOI: 10.1016/s1473-3099(23)00507-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Infection with the soil-transmitted helminth Strongyloides stercoralis affects up to 600 million people globally, most of whom live in rural areas with poor sanitation. If untreated, infection leads to long-lasting morbidity and might even be life-threatening. Moxidectin might be a promising alternative to ivermectin, the only currently recommended single-dose treatment. We aimed to assess whether moxidectin is non-inferior in terms of efficacy and safety compared with ivermectin. METHODS In this randomised, double-blind, parallel-group, non-inferiority, phase 2b/3 trial in communities in Laos and Cambodia, adults aged 18-65 years were screened for the presence of S stercoralis larvae in their stool via sextuplicate quantitative Baermann assays. Using computer-generated group allocation (block randomisation stratified by infection intensity), parasitologically (two or more positive Baermann assays) and clinically eligible participants were randomly assigned (1:1) to receive single oral doses of either moxidectin (8 mg) and ivermectin-matched placebo, or ivermectin (200 μg/kg bodyweight) and moxidectin-matched placebo. The primary endpoint was cure rate assessed at 14-21 days after treatment, using the available-case population analysed according to intention-to-treat principles. Moxidectin was considered non-inferior to ivermectin if the lower limit of the two-sided 95% CI of the difference was greater than the non-inferiority margin of -10 percentage points. Safety endpoints were assessed before treatment, and at 2-3 h, 24 h, and 14-21 days after treatment. This trial is registered at ClinicalTrials.gov, NCT04056325 and NCT04848688. FINDINGS Between Dec 6, 2020, and May 21, 2022, 4291 participants were screened, 726 of whom were enrolled and randomly assigned to moxidectin (n=363) or ivermectin (n=363). For the participants with primary outcome data, we observed a cure rate of 93·6% (95% CI 90·5 to 96·0; 324 of 346 participants) in the moxidectin group and 95·7% (93·0 to 97·6; 335 of 350 participants) in the ivermectin group, resulting in a between-group difference of -2·1 percentage points (95% CI -5·5 to 1·3). The most common adverse events were abdominal pain (32 [9%] of 363 with moxidectin vs 34 [9%] of 363 with ivermectin) and headache (25 [7%] vs 30 [8%]), which were predominantly mild and transient. INTERPRETATION Moxidectin was non-inferior to ivermectin in terms of efficacy in the treatment of strongyloidiasis. Additionally, both drugs had a similar safety profile. The fixed dose and lower cost of moxidectin compared with ivermectin make it a valuable alternative for people with strongyloidiasis. FUNDING Swiss National Science Foundation.
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Affiliation(s)
- Viviane P Sprecher
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Daniela Hofmann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | | | | | - Rekol Huy
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | | | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
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Gordon CA, Utzinger J, Muhi S, Becker SL, Keiser J, Khieu V, Gray DJ. Strongyloidiasis. Nat Rev Dis Primers 2024; 10:6. [PMID: 38272922 DOI: 10.1038/s41572-023-00490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Strongyloidiasis is a neglected tropical disease caused primarily by the roundworm Strongyloides stercoralis. Strongyloidiasis is most prevalent in Southeast Asia and the Western Pacific. Although cases have been documented worldwide, global prevalence is largely unknown due to limited surveillance. Infection of the definitive human host occurs via direct skin penetration of the infective filariform larvae. Parasitic females reside in the small intestine and reproduce via parthenogenesis, where eggs hatch inside the host before rhabditiform larvae are excreted in faeces to begin the single generation free-living life cycle. Rhabditiform larvae can also develop directly into infectious filariform larvae in the gut and cause autoinfection. Although many are asymptomatic, infected individuals may report a range of non-specific gastrointestinal, respiratory or skin symptoms. Autoinfection may cause hyperinfection and disseminated strongyloidiasis in immunocompromised individuals, which is often fatal. Diagnosis requires direct examination of larvae in clinical specimens, positive serology or nucleic acid detection. However, there is a lack of standardization of techniques for all diagnostic types. Ivermectin is the treatment of choice. Control and elimination of strongyloidiasis will require a multifaceted, integrated approach, including highly sensitive and standardized diagnostics, active surveillance, health information, education and communication strategies, improved water, sanitation and hygiene, access to efficacious treatment, vaccine development and better integration and acknowledgement in current helminth control programmes.
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Affiliation(s)
- Catherine A Gordon
- Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia.
- Faculty of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia.
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Department of Microbiology and Immunology, Parkville, Victoria, Australia
| | - Sören L Becker
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Darren J Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
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da Silva MCM, Pereira RSB, Araujo ACA, Filho EGDS, Dias ADL, Cavalcante KS, de Sousa MS. New Perspectives about Drug Candidates Targeting HTLV-1 and Related Diseases. Pharmaceuticals (Basel) 2023; 16:1546. [PMID: 38004412 PMCID: PMC10674638 DOI: 10.3390/ph16111546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 11/26/2023] Open
Abstract
Among the human T-lymphotropic virus (HTLV) types, HTLV-1 is the most prevalent, and it has been linked to a spectrum of diseases, including HAM/TSP, ATLL, and hyperinfection syndrome or disseminated strongyloidiasis. There is currently no globally standard first-line treatment for HTLV-1 infection and its related diseases. To address this, a comprehensive review was conducted, analyzing 30 recent papers from databases PubMed, CAPES journals, and the Virtual Health Library (VHL). The studies encompassed a wide range of therapeutic approaches, including antiretrovirals, immunomodulators, antineoplastics, amino acids, antiparasitics, and even natural products and plant extracts. Notably, the category with the highest number of articles was related to drugs for the treatment of ATLL. Studies employing mogamulizumab as a new perspective for ATLL received greater attention in the last 5 years, demonstrating efficacy, safe use in the elderly, significant antitumor activity, and increased survival time for refractory patients. Concerning HAM/TSP, despite corticosteroid being recommended, a more randomized clinical trial is needed to support treatment other than corticoids. The study also included a comprehensive review of the drugs used to treat disseminated strongyloidiasis in co-infection with HTLV-1, including their administration form, in order to emphasize gaps and facilitate the development of other studies aiming at better-directed methodologies. Additionally, docking molecules and computer simulations show promise in identifying novel therapeutic targets and repurposing existing drugs. These advances are crucial in developing more effective and targeted treatments against HTLV-1 and its related diseases.
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Affiliation(s)
| | | | | | | | - Anderson de Lima Dias
- Institute of Health Sciences, Faculty of Pharmacy, Federal University of Para, Belem 66079-420, Brazil
| | - Kassio Silva Cavalcante
- Institute of Health Sciences, Faculty of Pharmacy, Federal University of Para, Belem 66079-420, Brazil
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Borrás P, Pérez MG, Repetto S, Barrera JP, Risso MG, Montoya A, Miró G, Fernandez F, Telesca L, Britton C, Ruybal P. First identification of Strongyloides stercoralis infection in a pet dog in Argentina, using integrated diagnostic approaches. Parasit Vectors 2023; 16:389. [PMID: 37891629 PMCID: PMC10605978 DOI: 10.1186/s13071-023-06022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Strongyloides stercoralis is a soil-transmitted intestinal nematode with a complex life cycle that primarily affects humans, non-human primates, dogs, and occasionally cats. This study presents, to the best of our knowledge, the first case of S. stercoralis infection and its genotyping in a domestic dog from Argentina. METHODS The patient was a female wired-haired Teckel dog exhibiting recurrent coughing. Coproparasitological analysis using the Baermann technique revealed the presence of rhabditiform larvae morphologically compatible with S. stercoralis. To confirm this finding, molecular diagnosis (18S ribosomal RNA) and analysis of the cox1 gene were performed. RESULTS We identified a haplotype (HP20) that has previously only been related to S. stercoralis infection in dogs, but was found in the present study to be highly related to the haplotype (HP16) of a zoonotic variant and divergent from those previously described from human patients in Argentina. Furthermore, unlike in human cases following treatment with ivermectin, the dog was negative after moxidectin treatment according to polymerase chain reaction of the sampled faeces. CONCLUSIONS This case report shows the importance of further investigation into potential transmission events and prevalences of S. stercoralis in dogs and humans in South America. The results reported here should also encourage future work that examines different scenarios of infection with S. stercoralis in dogs and humans with the aim of integrating clinical management, diagnosis, treatment and follow-up strategies in the quest for new approaches for the treatment of this disease in animals and humans. The findings support the adoption of a One Health approach, which recognizes the interconnectedness between animal and human health, in addressing parasitic infections such as strongyloidiasis.
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Affiliation(s)
- Pablo Borrás
- Centro de Ciencias Veterinarias, Universidad Maimonides, Buenos Aires, Argentina.
| | - Matías Gastón Pérez
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Silvia Repetto
- Facultad de Medicina, Departamento de Microbiología, Universidad de Buenos Aires, Buenos Aires, Argentina
- Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
- Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, División Infectología, Buenos Aires, Argentina
| | - Juan Pedro Barrera
- Animal Health Department, Veterinary Faculty, Universidad Complutense de Madrid, Madrid, Spain
| | - Marikena Guadalupe Risso
- Facultad de Medicina, Departamento de Microbiología, Universidad de Buenos Aires, Buenos Aires, Argentina
- Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ana Montoya
- Animal Health Department, Veterinary Faculty, Universidad Complutense de Madrid, Madrid, Spain
| | - Guadalupe Miró
- Animal Health Department, Veterinary Faculty, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Laura Telesca
- Private Practice, Veterinaria a Domicilio, Buenos Aires, Argentina
| | - Collette Britton
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Paula Ruybal
- Facultad de Medicina, Departamento de Microbiología, Universidad de Buenos Aires, Buenos Aires, Argentina
- Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), CONICET-Universidad de Buenos Aires, Buenos Aires, Argentina
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Yeh MY, Aggarwal S, Carrig M, Azeem A, Nguyen A, Devries S, Destache C, Nguyen T, Velagapudi M. Strongyloides stercoralis Infection in Humans: A Narrative Review of the Most Neglected Parasitic Disease. Cureus 2023; 15:e46908. [PMID: 37954715 PMCID: PMC10639005 DOI: 10.7759/cureus.46908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Strongyloidiasis is a helminth infection affecting 613.9 million people annually, mainly in the tropics and subtropics. The reported seroprevalence in the United States is 4% with most of the cases reported in immigrants. Human T-lympho-tropic virus 1 (HTLV-1) infections, hypogammaglobulinemia, immunosuppressant use - particularly steroid use, alcoholism, and malnutrition have been associated with an increased risk of strongyloidiasis. Recently, cases of strongyloidiasis hyperinfection syndrome have been described in coronavirus disease 2019 (COVID-19) patients treated with steroids as well. This brief review discusses the epidemiology, clinical features, management, and prevention of strongyloidiasis including some facts about the infection in pregnancy, transplant recipients, and COVID-19 patients. We conducted an online search using the PubMed, Scopus, and Google Scholar databases. Strongyloidiasis can be asymptomatic or present with mild symptoms. Strongyloides stercoralis is known to cause autoinfection. In immunocompromised individuals, it can present with severe symptoms, hyperinfection, or disseminated disease. Reported mortality in cases of disseminated Strongyloidiasis is 87.1%. Serology and detection of larvae in stool by direct microscopy are the most commonly used methods to diagnose strongyloidiasis. The drug of choice for the treatment is ivermectin. However, the use of ivermectin in human pregnancy is not well studied, and its teratogenic risks are unknown. Proactive screening of strongyloidiasis is necessary in immunocompromised individuals to prevent severe disease.
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Affiliation(s)
- Mary Y Yeh
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Sanjana Aggarwal
- Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Margaret Carrig
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Ahad Azeem
- Infectious Diseases, Creighton University School of Medicine, Omaha, USA
| | - Anny Nguyen
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | | | - Chris Destache
- Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, USA
| | - Toan Nguyen
- Internal Medicine, Houston Methodist Hospital, Houston, USA
| | - Manasa Velagapudi
- Infectious Diseases, Creighton University School of Medicine, Omaha, USA
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Constante M, Domingos J, Neves Coelho F, Baptista Fernandes T, Baptista T, Maio Herculano M. Strongyloides stercoralis Dissemination and Hyperinfection Associated with Long-Term Steroid Treatment in a Neurosurgical Population. Case Rep Infect Dis 2023; 2023:4412935. [PMID: 37261247 PMCID: PMC10228231 DOI: 10.1155/2023/4412935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/17/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023] Open
Abstract
Strongyloidiasis develops from the infection with Strongyloides stercoralis (Family: Strongylidae) and was recently considered a neglected tropical disease by the World Health Organization due to its global distribution and high burden of infection. Here, we present the cases of two patients under corticosteroid therapy after neurosurgical surgery who developed septic shock-like hyperinfection syndrome due to disseminated strongyloidiasis. The first case is a 77-year-old man from Cape Verde who was diagnosed with an extra-axial right parietal brain mass. He was given dexamethasone and was submitted to a biparietal craniotomy. His condition deteriorated and he was admitted to the intensive care unit (ICU), where he was diagnosed with disseminated strongyloidiasis with hyperinfection. Anthelmintic treatment and corticosteroid therapy were rapidly tapered and stopped. Neurological dysfunction persisted and the patient was transferred to the ward. The patient had died after complications of hospital-acquired pneumonia. The second case is a 47-year-old man from Guinea-Bissau who was diagnosed with a space-occupying lesion in the right temporal region and started treatment with dexamethasone. He underwent a craniectomy with partial excision of the lesion (high-grade glioma). Later his neurologic state worsened, and he was diagnosed with septic shock and hospital-acquired pneumonia. He was admitted to the ICU, the diagnosis of disseminated strongyloidiasis and hyperinfection syndrome was made and he initiated treatment with ivermectin and albendazole. Corticosteroid therapy was tapered. The patient's clinical status deteriorated, and multiple opportunistic infections were diagnosed during the ICU stay, which lead him to die. Clinicians should have a high index of suspicion when in the presence of corticosteroid-treated patients with sepsis. Preventive strategies and subsequent treatment should be considered in patients with a risk of acquisition or dissemination. Treating severe strongyloidiasis is still a clinical challenge and a delayed diagnosis can significantly worsen the outcomes of the patients affected, as seen in the presented cases.
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Affiliation(s)
- Mariana Constante
- Egas Moniz Hospital, Ocidental Lisbon Hospital Center (Portugal), Department of Internal Medicine, Lisbon, Portugal
| | - João Domingos
- Egas Moniz Hospital, Ocidental Lisbon Hospital Center (Portugal), Department of Infectious Diseases, Lisbon, Portugal
| | - Francisco Neves Coelho
- Egas Moniz Hospital, Ocidental Lisbon Hospital Center (Portugal), Department of Intensive Care, Lisbon, Portugal
| | - Teresa Baptista Fernandes
- Egas Moniz Hospital, Ocidental Lisbon Hospital Center (Portugal), Department of Clinical Pathology and Microbiology, Lisbon, Portugal
| | - Teresa Baptista
- Egas Moniz Hospital, Ocidental Lisbon Hospital Center (Portugal), Department of Infectious Diseases, Lisbon, Portugal
| | - Marta Maio Herculano
- Egas Moniz Hospital, Ocidental Lisbon Hospital Center (Portugal), Department of Intensive Care, Lisbon, Portugal
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Hürlimann E, Hofmann D, Keiser J. Ivermectin and moxidectin against soil-transmitted helminth infections. Trends Parasitol 2023; 39:272-284. [PMID: 36804383 DOI: 10.1016/j.pt.2023.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/19/2023]
Abstract
Ivermectin and moxidectin, two macrocyclic lactones, are potent antiparasitic drugs currently registered and mainly used against filarial diseases; however, their potential value for improved soil-transmitted helminth (STH) control has been acknowledged. This review provides insights on recent studies evaluating the efficacy of ivermectin and moxidectin as single or coadministered therapy against human soil-transmitted helminthiases (including Strongyloides stercoralis infections) and on pharmacokinetic/pharmacodynamic parameters measured in treated populations. Furthermore, we discuss current gaps for research, highlight advantages - but also existing challenges - for uptake of ivermectin and/or moxidectin treatment schemes into routine STH control in endemic countries.
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Affiliation(s)
- Eveline Hürlimann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Daniela Hofmann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
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10
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Buonfrate D. Alternative treatment strategies for trichuriasis. THE LANCET. INFECTIOUS DISEASES 2023; 23:266-267. [PMID: 36354035 DOI: 10.1016/s1473-3099(22)00653-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical diseases and Microbiology, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Verona, Italy.
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11
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Welsche S, Mrimi EC, Hattendorf J, Hürlimann E, Ali SM, Keiser J. Efficacy and safety of moxidectin and albendazole compared with ivermectin and albendazole coadministration in adolescents infected with Trichuris trichiura in Tanzania: an open-label, non-inferiority, randomised, controlled, phase 2/3 trial. THE LANCET. INFECTIOUS DISEASES 2023; 23:331-340. [PMID: 36354034 PMCID: PMC9946839 DOI: 10.1016/s1473-3099(22)00589-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Control efforts against soil-transmitted helminths focus on preventive chemotherapy with albendazole and mebendazole, however these drugs yield unsatisfactory results against Trichuris trichiura infections. We aimed to assess the efficacy and safety of moxidectin and albendazole compared with ivermectin and albendazole against T trichiura in adolescents living on Pemba Island, Tanzania. METHODS This open-label, non-inferiority, randomised, controlled, phase 2/3 trial was done in four secondary schools (Kilindi, Kwale, Ndagoni [Chake Chake District], and Kiuyu [Wete District]) on Pemba Island, Tanzania. Adolescents aged 12-19 years who tested positive for T trichiura in at least two of four Kato-Katz slides with a mean infection intensity of 48 eggs per gram (EPG) of stool or higher were considered for inclusion. Participants were randomly assigned (21:21:2:2:8) to five treatment groups (8 mg moxidectin and 400 mg albendazole [group 1], 200 μg/kg ivermectin and 400 mg albendazole [group 2], 400 mg albendazole [group 3], 200 μg/kg ivermectin [group 4], or 8 mg moxidectin [group 5]) using a computer-generated randomisation code, stratified by baseline T trichiura infection intensity. Study site investigators and participants were not masked to study treatment; however, allocation was concealed to participants. The primary outcome was egg reduction rate (ERR) of T trichiura 14-21 days after treatment in the available case population. Moxidectin and albendazole was considered non-inferior to ivermectin and albendazole (control group) when the lower limit of the two-sided 95% CI of the difference was higher than the non-inferiority margin of -2 percentage points. This study is registered with ClinicalTrials.gov, NCT04700423. FINDINGS Between March 1 and April 30, 2021, 771 participants were assessed for eligibility. 221 (29%) of 771 participants were ineligible and a further 14 (2%) were excluded. 207 (39%) of 536 participants were randomly assigned to moxidectin and albendazole, 211 (39%) to ivermectin and albendazole, 19 (4%) to albendazole, 19 (4%) to ivermectin, and 80 (15%) to moxidectin. Primary outcome data were available for all 536 participants. The geometric mean ERR of T trichiura after 14-21 days was 96·8% (95% CI 95·8 to 97·6) with moxidectin and albendazole and 99·0% (98·7 to 99·3) with ivermectin and albendazole (difference of -2·2 percentage points [-4·2 to -1·4]). No serious adverse events were reported during the study. The most reported adverse events were headache (160 [34%] of 465), abdominal pain (78 [17%]), itching (44 [9%]), and dizziness (26 [6%]). INTERPRETATION Our findings show inferiority of moxidectin and albendazole to ivermectin and albendazole against T trichiura. However, given the high efficacy, moxidectin coadministration might complement treatment progammes, particularly in areas in which ivermectin is not available FUNDING: Bill and Melinda Gates Foundation, reference number OPP1153928.
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Affiliation(s)
- Sophie Welsche
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland
| | - Emmanuel C Mrimi
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland,Ifakara Health Institute, Ifakara, Tanzania
| | - Jan Hattendorf
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland
| | - Eveline Hürlimann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland,University of Basel, Basel, Switzerland
| | - Said M Ali
- Public Health Laboratory Ivo de Carneri, Chake Chake, Pemba Island, Tanzania
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
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12
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Pfarr KM, Krome AK, Al-Obaidi I, Batchelor H, Vaillant M, Hoerauf A, Opoku NO, Kuesel AC. The pipeline for drugs for control and elimination of neglected tropical diseases: 1. Anti-infective drugs for regulatory registration. Parasit Vectors 2023; 16:82. [PMID: 36859332 PMCID: PMC9979492 DOI: 10.1186/s13071-022-05581-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/05/2022] [Indexed: 03/03/2023] Open
Abstract
The World Health Organization 'Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021-2030' outlines the targets for control and elimination of neglected tropical diseases (NTDs). New drugs are needed to achieve some of them. We are providing an overview of the pipeline for new anti-infective drugs for regulatory registration and steps to effective use for NTD control and elimination. Considering drugs approved for an NTD by at least one stringent regulatory authority: fexinidazole, included in WHO guidelines for Trypanosoma brucei gambiense African trypanosomiasis, is in development for Chagas disease. Moxidectin, registered in 2018 for treatment of individuals ≥ 12 years old with onchocerciasis, is undergoing studies to extend the indication to 4-11-year-old children and obtain additional data to inform WHO and endemic countries' decisions on moxidectin inclusion in guidelines and policies. Moxidectin is also being evaluated for other NTDs. Considering drugs in at least Phase 2 clinical development, a submission is being prepared for registration of acoziborole as an oral treatment for first and second stage T.b. gambiense African trypanosomiasis. Bedaquiline, registered for tuberculosis, is being evaluated for multibacillary leprosy. Phase 2 studies of emodepside and flubentylosin in O. volvulus-infected individuals are ongoing; studies for Trichuris trichuria and hookworm are planned. A trial of fosravuconazole in Madurella mycetomatis-infected patients is ongoing. JNJ-64281802 is undergoing Phase 2 trials for reducing dengue viral load. Studies are ongoing or planned to evaluate oxantel pamoate for onchocerciasis and soil-transmitted helminths, including Trichuris, and oxfendazole for onchocerciasis, Fasciola hepatica, Taenia solium cysticercosis, Echinococcus granulosus and soil-transmitted helminths, including Trichuris. Additional steps from first registration to effective use for NTD control and elimination include country registrations, possibly additional studies to inform WHO guidelines and country policies, and implementation research to address barriers to effective use of new drugs. Relative to the number of people suffering from NTDs, the pipeline is small. Close collaboration and exchange of experience among all stakeholders developing drugs for NTDs may increase the probability that the current pipeline will translate into new drugs effectively implemented in affected countries.
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Affiliation(s)
- Kenneth M. Pfarr
- grid.15090.3d0000 0000 8786 803XInstitute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany ,grid.452463.2German Center for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany
| | - Anna K. Krome
- grid.10388.320000 0001 2240 3300Department of Pharmaceutical Technology and Biopharmaceutics, University of Bonn, Bonn, Germany
| | - Issraa Al-Obaidi
- grid.11984.350000000121138138Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Hannah Batchelor
- grid.11984.350000000121138138Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Michel Vaillant
- grid.451012.30000 0004 0621 531XCompetence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Grand Duchy of Luxembourg
| | - Achim Hoerauf
- grid.15090.3d0000 0000 8786 803XInstitute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany ,grid.452463.2German Center for Infection Research, Partner Site Bonn-Cologne, Bonn, Germany
| | - Nicholas O. Opoku
- grid.449729.50000 0004 7707 5975Department of Epidemiology and Biostatistics School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Annette C. Kuesel
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (WHO/TDR), World Health Organization, Geneva, Switzerland
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13
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Buonfrate D, Tamarozzi F, Paradies P, Watts MR, Bradbury RS, Bisoffi Z. The diagnosis of human and companion animal Strongyloides stercoralis infection: Challenges and solutions. A scoping review. ADVANCES IN PARASITOLOGY 2022; 118:1-84. [PMID: 36088083 DOI: 10.1016/bs.apar.2022.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Strongyloidiasis is the infection caused by soil-transmitted nematodes of Strongyloides species, infecting humans and some animals. Strongyloides stercoralis is the species with most clinical and epidemiological relevance in humans and dogs, due to its high prevalence and its capacity of inducing a life-threatening hyperinfection. Diagnosis of strongyloidiasis is challenging, due to the absence of a single reference standard test with high sensitivity and specificity, which also hampers the estimation of the accuracy of other diagnostic tests. In this chapter, we review the deployment and performance of the parasitological, immunological, molecular tests for the diagnosis of strongyloidiasis in humans and in dogs. Further, we comment the available evidence from genotyping studies that have addressed the zoonotic potential of S. stercoralis. Finally, we discuss the use of different diagnostic methods in relation to the purpose (i.e., screening, individual diagnosis, inclusion in a clinical trial) and the setting (endemic/non-endemic areas) and report the accuracy figures reported by systematic reviews on either parasitological, serological or molecular techniques published in literature.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy.
| | - Francesca Tamarozzi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Paola Paradies
- Department of Emergency and Organs Transplantation, Veterinary Section, Campus of Veterinary Medicine, University of Bari, Bari, Italy
| | - Matthew R Watts
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research - New South Wales Health Pathology and Sydney Institute for Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Richard S Bradbury
- School of Health and Life Sciences, Federation University Australia, Berwick, VC, Australia
| | - Zeno Bisoffi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy; Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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14
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Fabara SP, Patel G, Jain N, Bishev D, Tama B, Caputi A, Zarrate D, Al-Tawfiq JA, Tirupathi R. Can Moxidectin Be an Anthelmintic Alternative for Trichuris trichiura and Strongyloides stercoralis: A Systematic Review. Cureus 2022; 14:e27074. [PMID: 36000107 PMCID: PMC9390862 DOI: 10.7759/cureus.27074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/20/2022] [Indexed: 11/06/2022] Open
Abstract
Strongyloides stercoralis and Trichuris trichiura parasitic infections are two of the many neglected tropical diseases. These parasitic infections are of considerable public health relevance, particularly in resource-limited countries. Moxidectin, a well-established drug in veterinary medicine, is now a Food and Drug Administration (FDA) approved medication for human onchocerciasis. For the past five years, this medication has been under clinical trials to evaluate its efficacy and safetiness in other helminthic infections. Moxidectin might complement the already existing treatment and control of soil-transmitted helminthiasis (STH). Therefore, we systematically reviewed existing human interventional studies to evaluate the efficacy and safety of this medication when administered alone or in combination with other antiparasitic medications in order to achieve a cure.
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15
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Unterköfler MS, Eipeldauer I, Merz S, Pantchev N, Hermann J, Brunthaler R, Basso W, Hinney B. Strongyloides stercoralis infection in dogs in Austria: two case reports. Parasit Vectors 2022; 15:168. [PMID: 35570317 PMCID: PMC9107779 DOI: 10.1186/s13071-022-05270-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background Strongyloides stercoralis is endemic in tropical and subtropical regions, but reports of infections in central and northern Europe have been recently increasing. Infections occur mainly in humans and dogs. In dogs, both dog-adapted and zoonotic S. stercoralis genotypes seem to occur. Clinical manifestations mainly include gastrointestinal and respiratory signs. The severity of the disease can vary greatly and depends on the immune status of the host. The infection is potentially fatal in immunosuppressed individuals, either medically induced or due to an underlying disease, in which hyperinfections and disseminated infections with extraintestinal parasite dissemination may occur. Methods Diagnosis was based on coproscopy, including flotation and the Baermann funnel technique, histology of small intestinal biopsies and molecular analysis of mitochondrial cytochrome oxidase subunit I (COI) and hypervariable regions I and IV (HVR I and HVR IV) of the nuclear 18S rDNA loci. Results Two independent cases of severe canine S.stercoralis infection in Austria are presented. In both cases, S. stercoralis was detected in histological sections of the small intestine and with the Baermann funnel technique. Molecular analysis revealed strains with zoonotic potential. Case 1 was a 1-year-old female French bulldog with a long history of respiratory and gastrointestinal signs, severe emaciation and apathy before S.stercoralis infection was diagnosed. Treatment with moxidectin (2.5 mg/kg body weight [BW], oral route) did not eliminate the infection, but treatment with ivermectin (0.2 mg/kg BW, subcutaneously) was successful. Case 2 consisted of two 2-month-old Pomeranian puppies, one female and one male, from a litter of four, which died soon after presenting dyspnoea and haemorrhagic diarrhoea (female) or torticollis (male); S.stercoralis infection was first diagnosed post-mortem. Conclusion More attention should be paid to this nematode because although it appears to be rare in Austria, it is easily overlooked on standard coproscopy unless a Baermann funnel technique is used, and even then, it can be missed. Moxidectin is not always successful in eliminating the infection, and treatment with ivermectin should be considered in cases of infection. Graphical Abstract ![]()
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Affiliation(s)
| | - Iris Eipeldauer
- Institute of Parasitology, University of Veterinary Medicine Vienna, Vienna, Austria
| | | | | | - Josef Hermann
- Veterinary Practice Dipl.Tzt. Josef Hermann, Trautmannsdorf, Austria
| | - René Brunthaler
- Institute of Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Walter Basso
- Institute of Parasitology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Barbara Hinney
- Institute of Parasitology, University of Veterinary Medicine Vienna, Vienna, Austria
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16
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Abstract
Strongyloidiasis has been estimated to affect over 600 million people worldwide. It is caused by Strongyloides stercoralis, a roundworm endemic to the tropics and subtropics, especially areas where sanitation is suboptimal Autochthonous transmission has been documented in rural areas of the USA and Europe. Humans are infected when larvae penetrate the skin or are ingested. Autoinfection, in which larvae generated in the host go on to re-infect the host, leads to a state of chronic asymptomatic infection often with eosinophilia. Hyperinfection syndrome may develop when patients develop immune suppression, due to medications such as corticosteroids or following solid-organ transplantation. Hyperinfection is characterized by exponential increase in parasitic burden, leading to tissue invasion and life-threatening disease and associated bloodstream infections due to enteric organisms. Cases following use of corticosteroids for COVID-19 pneumonia have been described. Strongyloidiasis can be diagnosed by direct visualization of larvae in stool or other body fluids, or by serology. Ivermectin is highly effective in treating the disease. Patients with exposure to endemic areas and those expected to become immune suppressed should be screened and treated before starting immune suppressive agents. Empiric treatment should be considered when timely testing is not readily available.
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17
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Walker M, Freitas LT, Halder JB, Brack M, Keiser J, King CH, Levecke B, Ai-Lian Lim Y, Pieri O, Sow D, Stothard JR, Webster JP, Zhou XN, Terry RF, Guérin PJ, Basáñez MG. Improving anthelmintic treatment for schistosomiasis and soil-transmitted helminthiases through sharing and reuse of individual participant data. Wellcome Open Res 2022; 7:5. [PMID: 35493199 PMCID: PMC9020536 DOI: 10.12688/wellcomeopenres.17468.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 01/13/2023] Open
Abstract
The Infectious Diseases Data Observatory (IDDO, https://www.iddo.org) has launched a clinical data platform for the collation, curation, standardisation and reuse of individual participant data (IPD) on treatments for two of the most globally important neglected tropical diseases (NTDs), schistosomiasis (SCH) and soil-transmitted helminthiases (STHs). This initiative aims to harness the power of data-sharing by facilitating collaborative joint analyses of pooled datasets to generate robust evidence on the efficacy and safety of anthelminthic treatment regimens. A crucial component of this endeavour has been the development of a Research Agenda to promote engagement with the SCH and STH research and disease control communities by highlighting key questions that could be tackled using data shared through the IDDO platform. Here, we give a contextual overview of the priority research themes articulated in the Research Agenda-a 'living' document hosted on the IDDO website-and describe the three-stage consultation process behind its development. We also discuss the sustainability and future directions of the platform, emphasising throughout the power and promise of ethical and equitable sharing and reuse of clinical data to support the elimination of NTDs.
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Affiliation(s)
- Martin Walker
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Luzia T. Freitas
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Julia B. Halder
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Matthew Brack
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Bruno Levecke
- Department of Translational Physiology, Ghent University, Merelbeke, Belgium
| | - Yvonne Ai-Lian Lim
- Department of Parasitology, University of Malaya, Kuala Lumpur, Malaysia
| | - Otavio Pieri
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Fiocruz, Rio de Janiero, Brazil
| | - Doudou Sow
- Service de Parasitologie, Université Gaston Berger de Saint Louis, Saint Louis, Senegal
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanne P. Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, China Center for Disease Control and Prevention, Shanghai, China
| | - Robert F. Terry
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | | | - Maria-Gloria Basáñez
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
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18
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Keiser J, Häberli C. Assessment of FDA-approved drugs against Strongyloides ratti in vitro and in vivo to identify potentially active drugs against strongyloidiasis. Parasit Vectors 2021; 14:615. [PMID: 34949209 PMCID: PMC8705154 DOI: 10.1186/s13071-021-05117-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/04/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Infections with Strongyloides stercoralis belong to the most neglected helminth diseases, and research and development (R&D) efforts on novel drugs are inadequate. METHODS A commercially available library containing 1600 FDA-approved drugs was tested in vitro against Strongyloides ratti larvae (L3) at 100 µM. Hits (activity > 70%) were then evaluated against S. ratti adult worms at 10 µM. Morantel, prasterone, and levamisole were tested in the S. ratti rat model using dosages of 1-100 mg/kg. RESULTS Seventy-one of the 1600 compounds tested against S. ratti L3 revealed activity above 70%. Of 64 compounds which progressed into the adult screen, seven compounds achieved death of all worms (benzethonium chloride, cetylpyridinium chloride, Gentian violet, methylbenzethonium chloride, morantel citrate, ivermectin, coumaphos), and another eight compounds had activity > 70%. Excluding topical and toxic compounds, three drugs progressed into in vivo studies. Prasterone lacked activity in vivo, while treatment with 100 mg/kg morantel and levamisole cured all rats. The highest in vivo activity was observed with levamisole, yielding a median effective dose (ED50) of 1.1 mg/kg. CONCLUSIONS Using a drug repurposing approach, our study identified levamisole as a potential backup drug for strongyloidiasis. Levamisole should be evaluated in exploratory clinical trials.
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Affiliation(s)
- Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.
- University of Basel, 4003, Basel, Switzerland.
| | - Cécile Häberli
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland
- University of Basel, 4003, Basel, Switzerland
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19
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Hofmann D, Smit C, Sayasone S, Pfister M, Keiser J. Optimizing moxidectin dosing for Strongyloides stercoralis infections: Insights from pharmacometric modeling. Clin Transl Sci 2021; 15:700-708. [PMID: 34889057 PMCID: PMC8932710 DOI: 10.1111/cts.13189] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Abstract
Moxidectin is a frontrunner drug candidate in the treatment of strongyloidiasis. A dose of 8 mg is recommended to treat this indication, which shows a reasonably good efficacy and tolerability profile. Yet, owing to the unique life cycle of Strongyloides stercoralis (S. stercoralis) that entails internal autoinfection, a curative treatment would be desirable. Population‐based pharmacometric modeling that would help to identify an ideal dosing strategy are yet lacking. The aims of this study were to (i) explore the exposure‐efficacy response relationship of moxidectin in treating S. stercoralis and (ii) evaluate whether moxidectin treatment outcomes in terms of cure rates at baseline as compared to post‐treatment could be optimized. Our pharmacodynamic model suggests high predictive power (area under the concentration time curve‐receiver operating characteristic [AUC‐ROC] 0.817) in the probability of being cured by linking an exposure metric (i.e., AUC0‐24 or maximum concentration [Cmax]) to baseline infection intensity. Pharmacometric simulations indicate that with a minimum dose of 4 mg a maximum cure rate of ~ 95% is established in the low infection intensity group (larvae per gram [LPG] ≥0.4–1), whereas in the moderate‐to‐high intensity group (LPG >1) the cure rate plateaus at ~ 87%, following an 8 mg dose. To enhance efficacy further, studies using repeated dosing based on the duration of the autoinfection cycle, for example a two‐dose regimen 3 weeks apart should be considered. Simulations revealed similar Cmax in both treatment courses of a two‐dose regimen; hence safety should not be a concern. Collectively, our results provide evidence‐based guidance for enhanced dosing strategies and should be considered when designing future treatment strategies.
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Affiliation(s)
- Daniela Hofmann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Cornelis Smit
- Pediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Somphou Sayasone
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.,Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital (UKBB), Basel, Switzerland.,Certara, Princeton, New Jersey, USA
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
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20
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Welsche S, Mrimi EC, Keller L, Hürlimann E, Hofmann D, Hattendorf J, Ali SM, Keiser J. Efficacy and safety of moxidectin and albendazole compared to ivermectin and albendazole co-administration in adolescents infected with Trichuris trichiura: a randomized controlled trial protocol. Gates Open Res 2021; 5:106. [PMID: 34632308 PMCID: PMC8488464 DOI: 10.12688/gatesopenres.13299.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Infections with soil-transmitted helminths (STHs) predominantly affect impoverished populations in tropical environments. The periodic administration of single dose benzimidazoles (i.e., albendazole, mebendazole) to at-risk individuals in endemic regions is at the center of STH control strategies. Given the low efficacy of these drugs against trichuriasis, investigation of drug combinations including moxidectin and ivermectin has recently been initiated, yet the identification of the best treatment option requires more research. We present the protocol for a trial investigating the efficacy and safety of co-administered moxidectin and albendazole compared to co-administered ivermectin and albendazole against
Trichuris trichiura. Methods: We will conduct a randomized controlled trial enrolling 540
T. trichiura-infected adolescents aged 12-19 years on Pemba Island (Tanzania). The trial will be open-label with blinded outcome assessors. The primary objective is to demonstrate non-inferiority of orally co-administered single-dose moxidectin (8 mg)/albendazole (400 mg) compared to orally co-administered single-dose ivermectin (200 µg/kg)/albendazole (400 mg) in terms of egg reduction rates (ERRs) against
T. trichiura infections assessed by Kato-Katz at 14-21 days post-treatment. Secondary objectives include the assessment of the drug combinations’ superiority compared to their respective monotherapies, of the cure rates (CRs) against
T. trichiura, and the safety and tolerability of all treatments, as well as CRs and ERRs against concomitant STH infections (
Ascaris lumbricoides and hookworm). Potential effects of the treatment regimens on follow-up prevalences of STH at 5-6 weeks and 3 months post-treatment and pharmacokinetic/ pharmacodynamic parameters will also be assessed. Conclusions: Results from this trial will help to inform decision- and policymakers on which anthelminthic combination therapy might improve existing deworming programs and provide a valuable adjunct tool for interrupting STH transmission. Clinicaltrials.govregistration: NCT04700423 (07/01/2021)
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Affiliation(s)
- Sophie Welsche
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Emmanuel C Mrimi
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Ladina Keller
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Eveline Hürlimann
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Daniela Hofmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jan Hattendorf
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Said M Ali
- Public Health Laboratory Ivo de Carneri, Chake Chake, Pemba, Tanzania
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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21
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Buonfrate D, Fittipaldo A, Vlieghe E, Bottieau E. Clinical and laboratory features of Strongyloides stercoralis infection at diagnosis and after treatment: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:1621-1628. [PMID: 34325063 DOI: 10.1016/j.cmi.2021.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The clinical and laboratory characterization of Strongyloides stercoralis infection at diagnosis and after treatment is still poorly defined. OBJECTIVES The primary objective was to describe the pattern and frequency of clinical and laboratory characteristics associated with S. stercoralis infection. The secondary objectives were (a) comparison of characteristics reported in endemic versus non-endemic areas; and (b) the evaluation of the resolution of identified characteristics after treatment. METHODS We searched PubMed, EMBASE, LILACS and CENTRAL up to May 2021. Eligible studies were randomized controlled trials (RCTs) for the treatment of S. stercoralis infection and prospective observational studies reporting data on symptoms caused by strongyloidiasis in individuals diagnosed with a highly specific test. Quality assessment was performed to assess the risk of bias. Demographic and clinical data were summarized using descriptive statistics. Meta-analysis was done by pooling the proportion of participants with symptoms with random effects model. RESULTS Twenty studies were included: nine RCTs and 13 observational studies. Overall, symptoms were reported in 50.4% cases (95% CI 47.6-53.1), and were more often reported in non-endemic (58.6%, 95% CI 55.0-62.2) than in endemic (35.7%, 95% CI 31.4-39.9) areas. The removal of an article of lower quality did not impact on figures. Frequency of symptoms tended to reduce after treatment. Three studies reported the proportion of participants with eosinophilia before and after treatment: 76.9% of participants (95% CI 73.4-80.4) had eosinophilia at diagnosis, reducing to 27.4% (95% CI 24.0-30.7) after treatment. CONCLUSIONS About half of infected people complain at least of one symptom and almost 70% have eosinophilia. The frequency of symptoms and eosinophilia decreased after treatment, though the association with cure is not clearly defined. Providing relief from symptoms and eosinophilia is another reason, in addition to prevention of disseminated disease, for promoting screening and treatment of individuals with strongyloidiasis.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
| | - Andrea Fittipaldo
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Erika Vlieghe
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of General Internal Medicine Infectious Diseases and Tropical Medicine, University Hospital Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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22
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Smit C, Hofmann D, Sayasone S, Keiser J, Pfister M. Characterization of the Population Pharmacokinetics of Moxidectin in Adults Infected with Strongyloides Stercoralis: Support for a Fixed-Dose Treatment Regimen. Clin Pharmacokinet 2021; 61:123-132. [PMID: 34296417 PMCID: PMC8761718 DOI: 10.1007/s40262-021-01048-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 12/03/2022]
Abstract
Background Moxidectin has recently attracted attention as a novel candidate for the treatment of helminth infections, including Strongyloides stercoralis. This study aims to characterize the population pharmacokinetics (PPK) of moxidectin in S. stercoralis-infected adults using a pharmacometric approach, and to perform model-based simulations to explore different drug dosing strategies. Methods A PPK study embedded in a dose-escalation phase IIa trial was conducted in NamBak, Laos. Eight micro blood samples were collected from each of 96 S. stercoralis-infected adults following a moxidectin dose-ranging study, from 2 to 12 mg. A PPK model was developed using nonlinear mixed-effects modeling, and dosing strategies were explored using simulations in S. stercoralis-infected subjects with varying age and body weight (n = 5000 per dosing strategy). Results A two-compartment model including delayed absorption with lag-time best described the available PK data. Allometric scaling was applied to account for the influence of body weight. High clearance was found in the infected adults (4.47 L/h [95% confidence interval 3.63–5.39] for a 70 kg individual) compared with that previously reported for healthy adults. Model-based simulations indicated similar variability in mean ± standard deviation area under the curve from time zero to infinity of 1907 ± 1552 and 2175 ± 1670 ng × h/mL in the 60–70 kg weight group, after 8 mg fixed- or weight-based dosing, respectively. Conclusion We describe the first PPK model for moxidectin in adults with S. stercoralis infection. Equivalent exposures after fixed-dose and weight-dependent dosing strategies support the use of a simple fixed-dose approach, particularly in large-scale treatment programs. Trial Registration Registered at ClinicalTrials.gov (NCT04056325). Supplementary Information The online version contains supplementary material available at 10.1007/s40262-021-01048-4.
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Affiliation(s)
- Cornelis Smit
- Pediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland
| | - Daniela Hofmann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Somphou Sayasone
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Socinstrasse 57, 4051, Basel, Switzerland.,Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Socinstrasse 57, 4051, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland. .,Certara, Princeton, NJ, USA.
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23
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Welsche S, Mrimi EC, Keller L, Hürlimann E, Hofmann D, Hattendorf J, Ali SM, Keiser J. Efficacy and safety of moxidectin and albendazole compared to ivermectin and albendazole co-administration in adolescents infected with Trichuris trichiura: a randomized controlled trial protocol. Gates Open Res 2021; 5:106. [DOI: 10.12688/gatesopenres.13299.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Infections with soil-transmitted helminths (STHs) predominantly affect impoverished populations in tropical environments. The periodic administration of single dose benzimidazoles (i.e., albendazole, mebendazole) to at-risk individuals in endemic regions is at the center of STH control strategies. Given the low efficacy of these drugs against trichuriasis, investigation of drug combinations including moxidectin and ivermectin has recently been initiated, yet the identification of the best treatment option requires more research. We present the protocol for a trial investigating the efficacy and safety of co-administered moxidectin and albendazole compared to co-administered ivermectin and albendazole against Trichuris trichiura. Methods: We will conduct a randomized controlled trial enrolling 540 T. trichiura-infected adolescents aged 12-19 years on Pemba Island (Tanzania). The primary objective is to demonstrate non-inferiority of orally co-administered single-dose moxidectin (8 mg)/albendazole (400 mg) compared to orally co-administered single-dose ivermectin (200 µg/kg)/albendazole (400 mg) in terms of egg reduction rates (ERRs) against T. trichiura infections assessed by Kato-Katz at 14-21 days post-treatment. Secondary objectives include the assessment of the drug combinations’ superiority compared to their respective monotherapies, of the cure rates (CRs) against T. trichiura, and the safety and tolerability of all treatments, as well as CRs and ERRs against concomitant STH infections (Ascaris lumbricoides and hookworm). Potential effects of the treatment regimens on follow-up prevalences of STH at 5-6 weeks and 3 months post-treatment, infection status derived by quantitative polymerase chain reaction (qPCR), and pharmacokinetic/ pharmacodynamic parameters will also be assessed. Furthermore, a subsample of stool specimens will be analyzed by an updated version of the FECPAKG2 platform. Conclusions: Results from this trial will help to inform decision- and policymakers on which anthelminthic combination therapy might improve existing deworming programs and provide a valuable adjunct tool for interrupting STH transmission. Clinicaltrials.gov registration: NCT04700423 (07/01/2021)
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24
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Bisoffi Z, Buonfrate D. Moxidectin: an ally to ivermectin for treating Strongyloides stercoralis? THE LANCET. INFECTIOUS DISEASES 2021; 21:1060-1061. [PMID: 33798488 DOI: 10.1016/s1473-3099(20)30718-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Zeno Bisoffi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona 37024, Italy; Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Dora Buonfrate
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona 37024, Italy
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25
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Hofmann D, Sayasone S, Keiser J. Development and validation of an LC-MS/MS method for the quantification of the anthelmintic drug moxidectin in a volumetric absorptive microsample, blood, and plasma: Application to a pharmacokinetic study of adults infected with Strongyloides stercoralis in Laos. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1166:122556. [PMID: 33535101 DOI: 10.1016/j.jchromb.2021.122556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 02/04/2023]
Abstract
Moxidectin is a promising candidate for addition to the lean repertoire of drugs against neglected tropical diseases (NTD) including strongyloidiasis. Pharmacokinetic (PK) and -dynamic studies are required to support its clinical development. Microsampling approaches enable PK studies in the challenging environments where NTDs are most prevalent, due to simplified collection and processing. We developed a liquid chromatography tandem mass spectrometry method for the sensitive quantification of moxidectin in human blood obtained by capillary sampling with the microsampling device Mitra® compared to blood and plasma obtained by venous sampling. Sample preparation consisted of protein precipitation, evaporation and reconstitution and also included phospholipid filtration for blood and plasma. Moxidectin was detected by multiple reaction monitoring (640.4 → 528.5 m/z) using a Luna C8(2) (30 × 2.0 mm, 3 µm particle size, 100 Å) analytical column with a gradient program of 6 min duration. Validation was performed with respect to accuracy, precision, sensitivity, selectivity, linearity, stability, recovery, and haematocrit influence with a limit of quantification of 0.5 and 2.5 ng/mL, for venous and capillary blood respectively. Moxidectin was stable up to 2 months at storage condition (blood and plasma: -20 °C, microsamples: room temperature), 3 cycles of temperature shift, for at least 4 h on the bench-top and 24 h in the autosampler (4 °C). Deviations of inter- and intra-assay accuracy and precision were smaller than 12.6% and recoveries were in the range of 80.7-111.2%. The method was applied to samples obtained from nine Strongyloides stercoralis-infected adults from northern Laos. A good agreement in the time-concentration profiles of moxidectin and a high consistency in PK parameters was found between the different matrixes and sampling strategies: e.g. identical time to reach maximal concentration of 4.0 h and a similar maximal concentration of 83.9-88.5 ng/mL of moxidectin. The simple and practical capillary procedure using Mitra® microsampling has been demonstrated to be suitable for PK studies of moxidectin and will pave the way for future PK studies.
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Affiliation(s)
- Daniela Hofmann
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Somphou Sayasone
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; University of Basel, Basel, Switzerland; Lao Tropical and Public Health Institute, Vientiane, Lao Democratic People's Republic
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
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