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Ivermectin effective in controlling malaria transmission : Lancet

Ivermectin effective in controlling malaria transmission : Lancet

Ivermectin 300 μg/kg per day for 3 days provided a good balance between efficacy and tolerability and can prove to be a promising drug for malaria elimination, according to a study recently published in the journal THE LANCET Infectious Disease.

Menno R Smit and his associates conducted a study to establish the safety, tolerability, and mosquitocidal efficacy of 3-day courses of high-dose ivermectin, co-administered with a standard malaria treatment.ivermectin is well tolerated up to 2000 μg/kg.

Ivermectin is being considered for mass drug administration for malaria due to its ability to kill mosquitoes feeding on recently treated individuals. However, standard, single doses of 150–200 μg/kg used for onchocerciasis and lymphatic filariasis have a short-lived mosquitocidal effect (<7 days).

The study was a randomized, double-blind, placebo-controlled, superiority trial which included 741 adults (aged 18–50 years) suffering from symptomatic uncomplicated Plasmodium falciparum malaria. Participants were randomly assigned (1:1:1) using sealed envelopes, stratified by sex and body-mass index (men: <21 vs ≥21 kg/m2; women: <23 vs ≥23 kg/m2), with permuted blocks of three, to receive 3 days of ivermectin 300 μg/kg per day, ivermectin 600 μg/kg per day, or placebo, all co-administered with 3 days of dihydroartemisinin-piperaquine. Blood of patients taken on post-treatment days 0, 2 + 4 h, 7, 10, 14, 21, and 28 was checked. Anopheles gambiae sensu stricto mosquitoes and mosquito survival were assessed daily for 28 days after feeding. The primary outcome was 14-day cumulative mortality of mosquitoes fed 7 days after ivermectin treatment (from participants who received at least one dose of study medication).

Out of 741 adults with malaria, 141 were randomly assigned to receive ivermectin 600 μg/kg per day (n=47), ivermectin 300 μg/kg per day (n=48), or placebo (n=46). 128 patients (91%) attended the primary outcome visit 7 days post-treatment.

The study found that compared with placebo, ivermectin was associated with higher 14-day post-feeding mosquito mortality when fed on blood was taken 7 days post-treatment(ivermectin 600 μg/kg per day; ivermectin 300 μg/kg per day). Mosquito mortality remained significantly increased 28 days post-treatment (ivermectin 600 μg/kg per day, and ivermectin 300 μg/kg per day). Five (11%) of 45 patients receiving ivermectin 600 μg/kg per day, two (4%) of 48 patients receiving ivermectin 300 μg/kg per day, and none of 46 patients receiving placebo had one or more treatment-related adverse events.

The study concluded that Ivermectin at both doses assessed was well tolerated and reduced mosquito survival for at least 28 days after treatment. Ivermectin 300 μg/kg per day for 3 days provided a good balance between efficacy and tolerability, and this drug shows promise as a potential new tool for malaria elimination.

In 2016, 91 countries and territories had ongoing malaria transmission and an estimated 3.2 billion people – nearly half the world’s population – were at risk of malaria. The year saw an estimated 216 million cases and 445000 deaths due to malaria worldwide.

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Vinay Singh

Vinay Singh

Vinay Singh joined Medical Dialogue as Desk Editor in 2018. He covers the medical speciality news in different medical categories including Medical guidelines, updates from Medical Journals and Case Reports. He completed his graduation in Biotechnology from AAIDU and did his MBA from IILM Gurgaon. He can be contacted at . Contact no. 011-43720751
Source: With inputs from the journal THE LANCET Infectious Disease

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