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Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo

Background: There is anecdotal evidence that ivermectin may decrease seizure frequency in Onchocerca volvulus-infected persons with epilepsy (PWE). Methods: In October 2017, a 12-month clinical trial was initiated in rural Democratic Republic of Congo. PWE with onchocerciasis-associated epilepsy exp...

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Autores principales: Mandro, Michel, Siewe Fodjo, Joseph Nelson, Dusabimana, Alfred, Mukendi, Deby, Haesendonckx, Steven, Lokonda, Richard, Nakato, Swabra, Nyisi, Francoise, Abhafule, Germain, Wonya’rossi, D, Hotterbeekx, An, Abrams, Steven, Colebunders, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7157533/
https://www.ncbi.nlm.nih.gov/pubmed/32164367
http://dx.doi.org/10.3390/pathogens9030205
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author Mandro, Michel
Siewe Fodjo, Joseph Nelson
Dusabimana, Alfred
Mukendi, Deby
Haesendonckx, Steven
Lokonda, Richard
Nakato, Swabra
Nyisi, Francoise
Abhafule, Germain
Wonya’rossi, D
Hotterbeekx, An
Abrams, Steven
Colebunders, Robert
author_facet Mandro, Michel
Siewe Fodjo, Joseph Nelson
Dusabimana, Alfred
Mukendi, Deby
Haesendonckx, Steven
Lokonda, Richard
Nakato, Swabra
Nyisi, Francoise
Abhafule, Germain
Wonya’rossi, D
Hotterbeekx, An
Abrams, Steven
Colebunders, Robert
author_sort Mandro, Michel
collection PubMed
description Background: There is anecdotal evidence that ivermectin may decrease seizure frequency in Onchocerca volvulus-infected persons with epilepsy (PWE). Methods: In October 2017, a 12-month clinical trial was initiated in rural Democratic Republic of Congo. PWE with onchocerciasis-associated epilepsy experiencing ≥2 seizures/month were randomly allocated to receive, over a one-year period, ivermectin once or thrice (group 1), while other onchocerciasis-infected PWE (OIPWE) were randomized to ivermectin twice or thrice (group 2). All participants also received anti-epileptic drugs. Data was analyzed using multiple logistic regression. Results: We enrolled 197 participants. In an intent-to-treat analysis (data from group 1 and 2 combined), seizure freedom was more likely among OIPWE treated with ivermectin thrice (OR: 5.087, 95% CI: 1.378–19.749; p = 0.018) and twice (OR: 2.471, 95% CI: 0.944–6.769; p = 0.075) than in those treated once. Similarly, >50% seizure reduction was more likely among those treated with ivermectin twice (OR: 4.469, 95% CI: 1.250–16.620) and thrice (OR: 2.693, 95% CI: 1.077–6.998). Absence of microfilariae during the last 4 months increased the odds of seizure freedom (p = 0.027). Conclusions: Increasing the number of ivermectin treatments was found to suppress both microfilarial density and seizure frequency in OIPWE, suggesting that O. volvulus infection plays an etiological role in causing seizures.
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spelling pubmed-71575332020-05-01 Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo Mandro, Michel Siewe Fodjo, Joseph Nelson Dusabimana, Alfred Mukendi, Deby Haesendonckx, Steven Lokonda, Richard Nakato, Swabra Nyisi, Francoise Abhafule, Germain Wonya’rossi, D Hotterbeekx, An Abrams, Steven Colebunders, Robert Pathogens Article Background: There is anecdotal evidence that ivermectin may decrease seizure frequency in Onchocerca volvulus-infected persons with epilepsy (PWE). Methods: In October 2017, a 12-month clinical trial was initiated in rural Democratic Republic of Congo. PWE with onchocerciasis-associated epilepsy experiencing ≥2 seizures/month were randomly allocated to receive, over a one-year period, ivermectin once or thrice (group 1), while other onchocerciasis-infected PWE (OIPWE) were randomized to ivermectin twice or thrice (group 2). All participants also received anti-epileptic drugs. Data was analyzed using multiple logistic regression. Results: We enrolled 197 participants. In an intent-to-treat analysis (data from group 1 and 2 combined), seizure freedom was more likely among OIPWE treated with ivermectin thrice (OR: 5.087, 95% CI: 1.378–19.749; p = 0.018) and twice (OR: 2.471, 95% CI: 0.944–6.769; p = 0.075) than in those treated once. Similarly, >50% seizure reduction was more likely among those treated with ivermectin twice (OR: 4.469, 95% CI: 1.250–16.620) and thrice (OR: 2.693, 95% CI: 1.077–6.998). Absence of microfilariae during the last 4 months increased the odds of seizure freedom (p = 0.027). Conclusions: Increasing the number of ivermectin treatments was found to suppress both microfilarial density and seizure frequency in OIPWE, suggesting that O. volvulus infection plays an etiological role in causing seizures. MDPI 2020-03-10 /pmc/articles/PMC7157533/ /pubmed/32164367 http://dx.doi.org/10.3390/pathogens9030205 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mandro, Michel
Siewe Fodjo, Joseph Nelson
Dusabimana, Alfred
Mukendi, Deby
Haesendonckx, Steven
Lokonda, Richard
Nakato, Swabra
Nyisi, Francoise
Abhafule, Germain
Wonya’rossi, D
Hotterbeekx, An
Abrams, Steven
Colebunders, Robert
Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo
title Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo
title_full Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo
title_fullStr Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo
title_full_unstemmed Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo
title_short Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo
title_sort single versus multiple dose ivermectin regimen in onchocerciasis-infected persons with epilepsy treated with phenobarbital: a randomized clinical trial in the democratic republic of congo
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7157533/
https://www.ncbi.nlm.nih.gov/pubmed/32164367
http://dx.doi.org/10.3390/pathogens9030205
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