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Please use this identifier to cite or link to this item: http://hdl.handle.net/123456789/12713

Title: Doxycycline leads to sterility and enhanced killing of female onchocerca volvulus worms inan area with persistent microfilaridermia after repeated ivermectin treatment: A randomized, placebo-controlled, double-blind trial
Authors: Debrah, Alexander Yaw
Specht, Sabine
Klarmann-Schulz, Ute
Batsa, Linda
Kwarteng, Alexander
et. al
Keywords: doxycycline
Onchocerca volvulus
suboptimal response
ivermectin
Wolbachia
Issue Date: 15-Aug-2015
Publisher: Oxford University Press
Abstract: Background.Ivermectin (IVM) has been the drug of choice for the treatment of onchocerciasis. However, therehave been reports of persistent microfilaridermia in individuals from an endemic area in Ghana after many rounds ofIVM, raising concerns of suboptimal response or even the emergence of drug resistance. Because it is consideredrisky to continue relying only on IVM to combat this phenomenon, we assessed the effect of targeting theOncho-cerca volvulus Wolbachiaendosymbionts with doxycycline for these individuals with suboptimal response.Methods.One hundred sixty-seven patients, most of them with multiple rounds of IVM, were recruited in areaswith IVM suboptimal response and treated with 100 mg/day doxycycline for 6 weeks. Three and 12 months afterdoxycycline treatment, patients took part in standard IVM treatment.Results.At 20 months after treatment, 80% of living female worms from the placebo group wereWolbachiapositive, whereas only 5.1% in the doxycycline-treated group contained bacteria. Consistent with interruption ofembryogenesis, none of the nodules removed from doxycycline-treated patients contained microfilariae, and 97%of those patients were without microfilaridermia, in contrast to placebo patients who remained at pretreatment levels(P< .001). Moreover, a significantly enhanced number of dead worms were observed after doxycycline.Conclusions.Targeting theWolbachiainO. volvulusis effective in clearing microfilariae in the skin ofonchocerciasis patients with persistent microfilaridermia and in enhanced killing of adult worms after repeated stan-dard IVM treatment. Strategies can now be developed that include doxycycline to control onchocerciasis in areaswhere infections persist despite the frequent use of IVM.Clinical Trials Registration.ISRCTN 66649839.
Description: An article published by Oxford University Press and also available at DOI: 10.1093/cid/civ363
URI: http://hdl.handle.net/123456789/12713
Appears in Collections:College of Science

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