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|Title: ||Doxycycline improves filarial lymphedema independent of active filarial infection: a randomized controlled trial|
|Authors: ||Mand, Sabine|
Debrah, Alexander Yaw
|Issue Date: ||1-Sep-2012|
|Publisher: ||Clinical Infectious Diseases|
|Citation: ||Clinical Infectious Diseases,Vol.55 issue 5 pp.621-630|
|Abstract: ||The aim of this study was to determine whether improvement of filarial lymphedema (LE) by
doxycycline is restricted to patients with ongoing infection ( positive for circulating filarial antigen [CFA]), or
whether the majority of CFA-negative patients with LE would also show a reduction in LE severity.
Methods. One hundred sixty-two Ghanaian participants with LE stage 1–5 (Dreyer) were randomized blockwise
into 2 groups (CFA positive or negative) and allocated to 3 treatment arms of 6 weeks: (1) amoxicillin (1000
mg/d), (2) doxycycline (200 mg/d), or (3) placebo matching doxycycline. All groups received standard hygiene
morbidity management. The primary outcome was reduction of LE stages. Secondary outcomes included frequency
of acute attacks and ultrasonographic assessment of skin thickness at the ankles. Parameters were assessed
before treatment and after 3, 12, and 24 months.
Results. Doxycycline-treated patients with LE stage 2–3 showed significant reductions in LE severity after 12 and
24 months, regardless of CFA status. Improvement was observed in 43.9% of doxycycline-treated patients, compared
with only 3.2% and 5.6% in the amoxicillin and placebo arms, respectively. Skin thickness was correlated with LE
stage improvement. Both doxycycline and amoxicillin were able to reduce acute dermatolymphangioadenitis attacks.
Conclusions. Doxycycline treatment improves mild to moderate LE independent of ongoing infection. This
finding expands the benefits of doxycycline to the entire population of patients suffering from LE. Patients with LE
stage 1–3 should benefit from a 6-week course of doxycycline every other year or yearly, which should be considered
as an improved tool to manage morbidity in filarial LE.
Clinical Trials Registration. ISRCTN 90861344.|
|Description: ||Article published in Clinical Infectious Diseases,Vol.55 issue 5 pp.621-630.|
|Appears in Collections:||Publications|
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