Cargando…
Dosing pole recommendations for lymphatic filariasis elimination: A height-weight quantile regression modeling approach
BACKGROUND: The World Health Organization (WHO) currently recommends height or age-based dosing as alternatives to weight-based dosing for mass drug administration lymphatic filariasis (LF) elimination programs. The goals of our study were to compare these alternative dosing strategies to weight-bas...
Autores principales: | , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6663033/ https://www.ncbi.nlm.nih.gov/pubmed/31314753 http://dx.doi.org/10.1371/journal.pntd.0007541 |
_version_ | 1783439755301617664 |
---|---|
author | Goss, Charles W. O’Brian, Katiuscia Dubray, Christine Fischer, Peter U. Hardy, Myra Jambulingam, Purushothaman King, Christopher L. Laman, Moses Lemoine, Jean Frantz Robinson, Leanne J. Samuela, Josaia Subramanian, Swaminathan Supali, Taniawati Weil, Gary J. Schechtman, Kenneth B. |
author_facet | Goss, Charles W. O’Brian, Katiuscia Dubray, Christine Fischer, Peter U. Hardy, Myra Jambulingam, Purushothaman King, Christopher L. Laman, Moses Lemoine, Jean Frantz Robinson, Leanne J. Samuela, Josaia Subramanian, Swaminathan Supali, Taniawati Weil, Gary J. Schechtman, Kenneth B. |
author_sort | Goss, Charles W. |
collection | PubMed |
description | BACKGROUND: The World Health Organization (WHO) currently recommends height or age-based dosing as alternatives to weight-based dosing for mass drug administration lymphatic filariasis (LF) elimination programs. The goals of our study were to compare these alternative dosing strategies to weight-based dosing and to develop and evaluate new height-based dosing pole scenarios. METHODOLOGY/PRINCIPAL FINDINGS: Age, height and weight data were collected from >26,000 individuals in five countries during a cluster randomized LF clinical trial. Weight-based dosing for diethylcarbamazine (DEC; 6 mg/kg) and ivermectin (IVM; 200 ug/kg) with tablet numbers derived from a table of weight intervals was treated as the “gold standard” for this study. Following WHO recommended age-based dosing of DEC and height-based dosing of IVM would have resulted in 32% and 27% of individuals receiving treatment doses below those recommended by weight-based dosing for DEC and IVM, respectively. Underdosing would have been especially common in adult males, who tend to have the highest LF prevalence in many endemic areas. We used a 3-step modeling approach to develop and evaluate new dosing pole cutoffs. First, we analyzed the clinical trial data using quantile regression to predict weight from height. We then used weight predictions to develop new dosing pole cutoff values. Finally, we compared different dosing pole cutoffs and age and height-based WHO dosing recommendations to weight-based dosing. We considered hundreds of scenarios including country- and sex-specific dosing poles. A simple dosing pole with a 6-tablet maximum for both DEC and IVM reduced the underdosing rate by 30% and 21%, respectively, and was nearly as effective as more complex pole combinations for reducing underdosing. CONCLUSIONS/SIGNIFICANCE: Using a novel modeling approach, we developed a simple dosing pole that would markedly reduce underdosing for DEC and IVM in MDA programs compared to current WHO recommended height or age-based dosing. |
format | Online Article Text |
id | pubmed-6663033 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-66630332019-08-05 Dosing pole recommendations for lymphatic filariasis elimination: A height-weight quantile regression modeling approach Goss, Charles W. O’Brian, Katiuscia Dubray, Christine Fischer, Peter U. Hardy, Myra Jambulingam, Purushothaman King, Christopher L. Laman, Moses Lemoine, Jean Frantz Robinson, Leanne J. Samuela, Josaia Subramanian, Swaminathan Supali, Taniawati Weil, Gary J. Schechtman, Kenneth B. PLoS Negl Trop Dis Research Article BACKGROUND: The World Health Organization (WHO) currently recommends height or age-based dosing as alternatives to weight-based dosing for mass drug administration lymphatic filariasis (LF) elimination programs. The goals of our study were to compare these alternative dosing strategies to weight-based dosing and to develop and evaluate new height-based dosing pole scenarios. METHODOLOGY/PRINCIPAL FINDINGS: Age, height and weight data were collected from >26,000 individuals in five countries during a cluster randomized LF clinical trial. Weight-based dosing for diethylcarbamazine (DEC; 6 mg/kg) and ivermectin (IVM; 200 ug/kg) with tablet numbers derived from a table of weight intervals was treated as the “gold standard” for this study. Following WHO recommended age-based dosing of DEC and height-based dosing of IVM would have resulted in 32% and 27% of individuals receiving treatment doses below those recommended by weight-based dosing for DEC and IVM, respectively. Underdosing would have been especially common in adult males, who tend to have the highest LF prevalence in many endemic areas. We used a 3-step modeling approach to develop and evaluate new dosing pole cutoffs. First, we analyzed the clinical trial data using quantile regression to predict weight from height. We then used weight predictions to develop new dosing pole cutoff values. Finally, we compared different dosing pole cutoffs and age and height-based WHO dosing recommendations to weight-based dosing. We considered hundreds of scenarios including country- and sex-specific dosing poles. A simple dosing pole with a 6-tablet maximum for both DEC and IVM reduced the underdosing rate by 30% and 21%, respectively, and was nearly as effective as more complex pole combinations for reducing underdosing. CONCLUSIONS/SIGNIFICANCE: Using a novel modeling approach, we developed a simple dosing pole that would markedly reduce underdosing for DEC and IVM in MDA programs compared to current WHO recommended height or age-based dosing. Public Library of Science 2019-07-17 /pmc/articles/PMC6663033/ /pubmed/31314753 http://dx.doi.org/10.1371/journal.pntd.0007541 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication. |
spellingShingle | Research Article Goss, Charles W. O’Brian, Katiuscia Dubray, Christine Fischer, Peter U. Hardy, Myra Jambulingam, Purushothaman King, Christopher L. Laman, Moses Lemoine, Jean Frantz Robinson, Leanne J. Samuela, Josaia Subramanian, Swaminathan Supali, Taniawati Weil, Gary J. Schechtman, Kenneth B. Dosing pole recommendations for lymphatic filariasis elimination: A height-weight quantile regression modeling approach |
title | Dosing pole recommendations for lymphatic filariasis elimination: A height-weight quantile regression modeling approach |
title_full | Dosing pole recommendations for lymphatic filariasis elimination: A height-weight quantile regression modeling approach |
title_fullStr | Dosing pole recommendations for lymphatic filariasis elimination: A height-weight quantile regression modeling approach |
title_full_unstemmed | Dosing pole recommendations for lymphatic filariasis elimination: A height-weight quantile regression modeling approach |
title_short | Dosing pole recommendations for lymphatic filariasis elimination: A height-weight quantile regression modeling approach |
title_sort | dosing pole recommendations for lymphatic filariasis elimination: a height-weight quantile regression modeling approach |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6663033/ https://www.ncbi.nlm.nih.gov/pubmed/31314753 http://dx.doi.org/10.1371/journal.pntd.0007541 |
work_keys_str_mv | AT gosscharlesw dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT obriankatiuscia dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT dubraychristine dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT fischerpeteru dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT hardymyra dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT jambulingampurushothaman dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT kingchristopherl dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT lamanmoses dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT lemoinejeanfrantz dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT robinsonleannej dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT samuelajosaia dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT subramanianswaminathan dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT supalitaniawati dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT weilgaryj dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach AT schechtmankennethb dosingpolerecommendationsforlymphaticfilariasiseliminationaheightweightquantileregressionmodelingapproach |