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Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled trial.
Lancet. 2005 Jun 18-24; 365(9477):2116-21.Lct

Abstract

BACKGROUND

Wolbachia endosymbionts of filarial nematodes are vital for larval development and adult-worm fertility and viability. This essential dependency on the bacterium for survival of the parasites has provided a new approach to treat filariasis with antibiotics. We used this strategy to investigate the effects of doxycycline treatment on the major cause of lymphatic filariasis, Wuchereria bancrofti.

METHODS

We undertook a double-blind, randomised, placebo-controlled field trial of doxycycline (200 mg per day) for 8 weeks in 72 individuals infected with W bancrofti from Kimang'a village, Pangani, Tanzania. Participants were randomly assigned by block randomisation to receive capsules of doxycycline (n=34) or placebo (n=38). We assessed treatment efficacy by monitoring microfilaraemia, antigenaemia, and ultrasound detection of adult worms. Follow-up assessments were done at 5, 8, 11, and 14 months after the start of treatment. Analysis was per protocol.

FINDINGS

One person from the doxycycline group died from HIV infection. Five (doxycycline) and 11 (placebo) individuals were absent at the time of ultrasound analysis. Doxycycline treatment almost completely eliminated microfilaraemia at 8-14 months' follow-up (for all timepoints p<0.001). Ultrasonography detected adult worms in only six (22%) of 27 individuals treated with doxycycline compared with 24 (88%) of 27 with placebo at 14 months after the start of treatment (p<0.0001). At the same timepoint, filarial antigenaemia in the doxycycline group fell to about half of that before treatment (p=0.015). Adverse events were few and mild.

INTERPRETATION

An 8-week course of doxycycline is a safe and well-tolerated treatment for lymphatic filariasis with significant activity against adult worms and microfilaraemia.

Authors+Show Affiliations

Filariasis Research Group, Molecular and Biochemical Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK. mark.taylor@liv.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15964448

Citation

Taylor, Mark J., et al. "Macrofilaricidal Activity After Doxycycline Treatment of Wuchereria Bancrofti: a Double-blind, Randomised Placebo-controlled Trial." Lancet (London, England), vol. 365, no. 9477, 2005, pp. 2116-21.
Taylor MJ, Makunde WH, McGarry HF, et al. Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled trial. Lancet. 2005;365(9477):2116-21.
Taylor, M. J., Makunde, W. H., McGarry, H. F., Turner, J. D., Mand, S., & Hoerauf, A. (2005). Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled trial. Lancet (London, England), 365(9477), 2116-21.
Taylor MJ, et al. Macrofilaricidal Activity After Doxycycline Treatment of Wuchereria Bancrofti: a Double-blind, Randomised Placebo-controlled Trial. Lancet. 2005;365(9477):2116-21. PubMed PMID: 15964448.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled trial. AU - Taylor,Mark J, AU - Makunde,Williams H, AU - McGarry,Helen F, AU - Turner,Joseph D, AU - Mand,Sabine, AU - Hoerauf,Achim, PY - 2005/6/21/pubmed PY - 2005/9/7/medline PY - 2005/6/21/entrez SP - 2116 EP - 21 JF - Lancet (London, England) JO - Lancet VL - 365 IS - 9477 N2 - BACKGROUND: Wolbachia endosymbionts of filarial nematodes are vital for larval development and adult-worm fertility and viability. This essential dependency on the bacterium for survival of the parasites has provided a new approach to treat filariasis with antibiotics. We used this strategy to investigate the effects of doxycycline treatment on the major cause of lymphatic filariasis, Wuchereria bancrofti. METHODS: We undertook a double-blind, randomised, placebo-controlled field trial of doxycycline (200 mg per day) for 8 weeks in 72 individuals infected with W bancrofti from Kimang'a village, Pangani, Tanzania. Participants were randomly assigned by block randomisation to receive capsules of doxycycline (n=34) or placebo (n=38). We assessed treatment efficacy by monitoring microfilaraemia, antigenaemia, and ultrasound detection of adult worms. Follow-up assessments were done at 5, 8, 11, and 14 months after the start of treatment. Analysis was per protocol. FINDINGS: One person from the doxycycline group died from HIV infection. Five (doxycycline) and 11 (placebo) individuals were absent at the time of ultrasound analysis. Doxycycline treatment almost completely eliminated microfilaraemia at 8-14 months' follow-up (for all timepoints p<0.001). Ultrasonography detected adult worms in only six (22%) of 27 individuals treated with doxycycline compared with 24 (88%) of 27 with placebo at 14 months after the start of treatment (p<0.0001). At the same timepoint, filarial antigenaemia in the doxycycline group fell to about half of that before treatment (p=0.015). Adverse events were few and mild. INTERPRETATION: An 8-week course of doxycycline is a safe and well-tolerated treatment for lymphatic filariasis with significant activity against adult worms and microfilaraemia. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/15964448/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(05)66591-9 DB - PRIME DP - Unbound Medicine ER -