Post by Niels on Dec 14, 2008 2:08:21 GMT -5
Available OTC veterinary use in canada and australia (and at least one US supplier) as Dimmitrol: www.mavlab.com.au/v_tablets/04.html
DEC used for treating filiarisis in humans:
www.who.int/mediacentre/factsheets/fs102/en/
...
Communities where filariasis is endemic. The primary goal of treating
the affected community is to eliminate microfilariae from the blood of
infected individuals so that transmission of the infection by the
mosquito can be interrupted. Recent studies have shown that single
doses of diethylcarbamazine (DEC) have the same long-term (1-year)
effect in decreasing microfilaraemia as the formerly-recommended
12-day regimens of DEC and, even more importantly, that the use of
single doses of 2 drugs administered concurrently (optimally
albendazole with DEC or ivermectin) is 99% effective in removing
microfilariae from the blood for a full year after treatment. It is
this level of treatment effectiveness that has made feasible the new
efforts to eliminate lymphatic filariasis.
Treating the individual. Both albendazole and DEC have been shown to
be effective in killing the adult-stage filarial parasites (necessary
for complete cure of infection), but ideal treatment regimens still
need to be defined. It is clear that this anti-parasite treatment can
result in improvement of patients' elephantiasis and hydrocoele
(especially in the early stages of disease), but the most significant
treatment advance to alleviate the suffering of those with
elephantiasis has come from recognizing that much of the progression
in pathology results from bacterial and fungal "superinfection" of
tissues with compromised lymphatic function caused by earlier filarial
infection. Thus, rigorous hygiene to the affected limbs, with
accompanying adjunctive measures to minimize infection and promote
lymph flow, results both in a dramatic reduction in frequency of acute
episodes of inflammation ("filarial fevers") and in an astonishing
degree of improvement of the elephantiasis itself.
............
I came across this:
www.who.int/tdr/research/progress9900/tools/drug-onchofil.htm
New and Improved Tools TDR Fifteenth Programme Report
NEW CANDIDATES IN DEVELOPMENT
Drug development: ONCHOCERCIASIS and LYMPHATIC FILARIASIS
Studies are ongoing on the use of albendazole in combination with ivermectin,
DEC or levamisole for the treatment of onchocerciasis, lymphatic filariasis and
geohelminths, while trials in animals have shown moxidectin to be a potential
macrofilaricide
Two types of drug are described for treatment of onchocerciasis and lymphatic
filariasis:
* microfilaricides, which kill immature worms
* macrofilaricides, which kill adult worms.
Existing microfilaricides are effective, but there is no suitable
macrofilaricide currently available. Because treatment with microfilaricides
must be maintained for a number of years, in fact for the length of life of the
adult worm in the human host (more than 10 years in the case of onchocerciasis),
a suitable, safe and effective macrofilaricide would allow more impact to be
made on controlling filarial diseases than is currently possible using
microfilaricidal treatment.
Albendazole combinations
Levamisol trial in Ghana
Levamisol trial in Ghana
TDR, through its network of clinical researchers, is supporting studies to
evaluate albendazole in combination with either ivermectin or levamisole as
potential macrofilaricidal treatment for O. volvulus patients, and albendazole
co-administered with either ivermectin or diethylcarbamazine (DEC) for treatment
of lymphatic filariasis patients.
The studies in onchocerciasis patients are being conducted at the Onchocerciasis
Clinical Research Center in Hohoe, Ghana. The effects of single-dose
co-administration of ivermectin (Mectizan) with albendazole, of albendazole with
levamisole, or of ivermectin with levamisole, are being evaluated, the primary
end points being safety, pharmacokinetics and effect on microfilaria and
macrofilaria. Preliminary results suggest that, although safe, none of the
combinations is more effective on adult worms than ivermectin alone. Also, so
far, no pharmacokinetic drug interactions have been detected.
partnersThe studies in lymphatic filariasis patients are being conducted in
light of the WHO/SmithKlineBeecham (now GlaxoSmithKline) / Merck recommendations
on use of co-administration of albendazole with ivermectin or DEC for
elimination of lymphatic filariasis. Three studies are in progress:
1. On the Island of Pemba, Tanzania, a randomized, double blind study in
1000 subjects is under way to compare single-dose ivermectin + albendazole with
single-dose ivermectin alone. This study will define:
a) unacceptable adverse drug reactions occurring within 7 days of
treatment
b) the proportion of microfilaria positive subjects that, one year
after treatment, remain microfilaria negative – the primary endpoints being 80%
reduction in prevalence for ivermectin alone and 90% reduction in prevalence for
albendazole + ivermectin.
As secondary end-points, the study will assess:
a) prevalence of microfilaremic subjects 3 and 6 months after
treatment, and reduction in microfilaremia 3 and 6 months after treatment
b) the cure rate (proportion of patients with clearance of eggs from
stools) of Trichuris trichiura (human whipworm) infections 21 days after
treatment, and reduction in the T. trichiura egg count 21 days after treatment
compared to before treatment
c) cure of other soil transmitted helminths.
The results are expected during the 3rd quarter 2002.
2. In Alleppey, India, a study in lymphatic filariasis infected vs.
uninfected individuals is under way to evaluate the pharmackokinetic profiles of
albendazole and DEC when administered as single drugs or when co-administered as
in lymphatic filariasis elimination programmes. Besides assessing safety and
laboratory parameters, this study will, for the first time, determine if there
is any adverse pharmacokinetic drug interaction. Determination of drug plasma
levels will be carried out at the University of Iowa, US. Results of the study
are expected to be available during the 4th quarter of 2001.
3. In Wardha, India, a study in 1347 subjects is ongoing to assess the
safety, tolerability, efficacy and population pharmacokinetics of DEC
co-administered with albendazole as compared to DEC administered alone. The
primary end-points will be information on the number of patients without
microfilaraemia at 3, 6 and 12 months after treatment, and on the clinical signs
and symptoms and adverse events in the two arms of the study. The results are
expected to be available during the 4th quarter 2002.
DEC used for treating filiarisis in humans:
www.who.int/mediacentre/factsheets/fs102/en/
...
Communities where filariasis is endemic. The primary goal of treating
the affected community is to eliminate microfilariae from the blood of
infected individuals so that transmission of the infection by the
mosquito can be interrupted. Recent studies have shown that single
doses of diethylcarbamazine (DEC) have the same long-term (1-year)
effect in decreasing microfilaraemia as the formerly-recommended
12-day regimens of DEC and, even more importantly, that the use of
single doses of 2 drugs administered concurrently (optimally
albendazole with DEC or ivermectin) is 99% effective in removing
microfilariae from the blood for a full year after treatment. It is
this level of treatment effectiveness that has made feasible the new
efforts to eliminate lymphatic filariasis.
Treating the individual. Both albendazole and DEC have been shown to
be effective in killing the adult-stage filarial parasites (necessary
for complete cure of infection), but ideal treatment regimens still
need to be defined. It is clear that this anti-parasite treatment can
result in improvement of patients' elephantiasis and hydrocoele
(especially in the early stages of disease), but the most significant
treatment advance to alleviate the suffering of those with
elephantiasis has come from recognizing that much of the progression
in pathology results from bacterial and fungal "superinfection" of
tissues with compromised lymphatic function caused by earlier filarial
infection. Thus, rigorous hygiene to the affected limbs, with
accompanying adjunctive measures to minimize infection and promote
lymph flow, results both in a dramatic reduction in frequency of acute
episodes of inflammation ("filarial fevers") and in an astonishing
degree of improvement of the elephantiasis itself.
............
I came across this:
www.who.int/tdr/research/progress9900/tools/drug-onchofil.htm
New and Improved Tools TDR Fifteenth Programme Report
NEW CANDIDATES IN DEVELOPMENT
Drug development: ONCHOCERCIASIS and LYMPHATIC FILARIASIS
Studies are ongoing on the use of albendazole in combination with ivermectin,
DEC or levamisole for the treatment of onchocerciasis, lymphatic filariasis and
geohelminths, while trials in animals have shown moxidectin to be a potential
macrofilaricide
Two types of drug are described for treatment of onchocerciasis and lymphatic
filariasis:
* microfilaricides, which kill immature worms
* macrofilaricides, which kill adult worms.
Existing microfilaricides are effective, but there is no suitable
macrofilaricide currently available. Because treatment with microfilaricides
must be maintained for a number of years, in fact for the length of life of the
adult worm in the human host (more than 10 years in the case of onchocerciasis),
a suitable, safe and effective macrofilaricide would allow more impact to be
made on controlling filarial diseases than is currently possible using
microfilaricidal treatment.
Albendazole combinations
Levamisol trial in Ghana
Levamisol trial in Ghana
TDR, through its network of clinical researchers, is supporting studies to
evaluate albendazole in combination with either ivermectin or levamisole as
potential macrofilaricidal treatment for O. volvulus patients, and albendazole
co-administered with either ivermectin or diethylcarbamazine (DEC) for treatment
of lymphatic filariasis patients.
The studies in onchocerciasis patients are being conducted at the Onchocerciasis
Clinical Research Center in Hohoe, Ghana. The effects of single-dose
co-administration of ivermectin (Mectizan) with albendazole, of albendazole with
levamisole, or of ivermectin with levamisole, are being evaluated, the primary
end points being safety, pharmacokinetics and effect on microfilaria and
macrofilaria. Preliminary results suggest that, although safe, none of the
combinations is more effective on adult worms than ivermectin alone. Also, so
far, no pharmacokinetic drug interactions have been detected.
partnersThe studies in lymphatic filariasis patients are being conducted in
light of the WHO/SmithKlineBeecham (now GlaxoSmithKline) / Merck recommendations
on use of co-administration of albendazole with ivermectin or DEC for
elimination of lymphatic filariasis. Three studies are in progress:
1. On the Island of Pemba, Tanzania, a randomized, double blind study in
1000 subjects is under way to compare single-dose ivermectin + albendazole with
single-dose ivermectin alone. This study will define:
a) unacceptable adverse drug reactions occurring within 7 days of
treatment
b) the proportion of microfilaria positive subjects that, one year
after treatment, remain microfilaria negative – the primary endpoints being 80%
reduction in prevalence for ivermectin alone and 90% reduction in prevalence for
albendazole + ivermectin.
As secondary end-points, the study will assess:
a) prevalence of microfilaremic subjects 3 and 6 months after
treatment, and reduction in microfilaremia 3 and 6 months after treatment
b) the cure rate (proportion of patients with clearance of eggs from
stools) of Trichuris trichiura (human whipworm) infections 21 days after
treatment, and reduction in the T. trichiura egg count 21 days after treatment
compared to before treatment
c) cure of other soil transmitted helminths.
The results are expected during the 3rd quarter 2002.
2. In Alleppey, India, a study in lymphatic filariasis infected vs.
uninfected individuals is under way to evaluate the pharmackokinetic profiles of
albendazole and DEC when administered as single drugs or when co-administered as
in lymphatic filariasis elimination programmes. Besides assessing safety and
laboratory parameters, this study will, for the first time, determine if there
is any adverse pharmacokinetic drug interaction. Determination of drug plasma
levels will be carried out at the University of Iowa, US. Results of the study
are expected to be available during the 4th quarter of 2001.
3. In Wardha, India, a study in 1347 subjects is ongoing to assess the
safety, tolerability, efficacy and population pharmacokinetics of DEC
co-administered with albendazole as compared to DEC administered alone. The
primary end-points will be information on the number of patients without
microfilaraemia at 3, 6 and 12 months after treatment, and on the clinical signs
and symptoms and adverse events in the two arms of the study. The results are
expected to be available during the 4th quarter 2002.