Drug Combo to Hasten Elimination of Elephantiasis by 2020 ― study

ANOTHER DISABLING DISEASE, ELEPHANTIASIS which is also known as lymphatic filariasis is being targeted as one tropical disease for global elimination by 2020.

The determination to ensure the plausibility of its elimination has been proven by the latest outcome of a medical research by a team of tropical diseases expert from University of Warwick, England.

Elephantiasis is one of the age-long Neglected Tropical Diseases (NTDs) caused by parasitic infection, filarial worm, transmitted from human to human by female mosquito when it takes a blood meal.

The parasite grows into an adult worm that lives in the lymphatic system of humans. The effect causes extreme swelling in the arms and legs.

The research outcome published in the Lancet on Infectious Disease revealed that the disease which threatens about a billion people in 54 countries faces a possible fast elimination if a recently proposed combination of three particular drugs is used together.

The study leader, Dr Deirdre Hollingsworth reportedly observed that the disease can be prevented or treated rapidly, in a maximum amount of people, using fewer rounds of drugs.

At present, people with Lymphatic filariasis require multiple rounds of treatment – but if the drugs ivermectin, diethylcarbamazine, and albendazole are used together recent clinical studies have shown that the drugs are more effective at killing the worms.

The new modelling work shows that this meant that the number of rounds of mass drug administration needed to treat the disease may fall from many rounds to only two or three.

Many people with the disease develop elephantiasis or lymphoedema, causing pain and profound disfigurement – such as large swelling of the arms, legs or genitals – and leading to permanent disability.

The World Health Organisation has targeted the year 2020 for the elimination of the disease and the new research outcome is seen as an effort in hastening the process.

A large proportion of the billion people living with the threat of transmission are said to live in India, Indonesia and Myanmar where the triple drug combination could be used.

Initial studies show the triple drug regimen is far more effective at clearing the parasite from its human host and that is has a good safety profile. However, experts note that campaigns can run into trouble when they go on for too long because populations can lose interest in taking the drug when the disease is not very common. At this stage the researchers can’t predict how fast this new regimen will speed up elimination, and if so, in which countries.

According to Hollingsworth, “This more effective treatment has the potential to revolutionise the control of this disease, but it will require that in over a few rounds of treatment the programs are able to treat almost the whole population, even the most inaccessible.

The lead author of the paper, Dr Mike Irvine, University of British Columbia in Canada, said: “Our results show that this regimen could potentially overcome important issues plagued by elimination campaigns, by making elimination as a public health problem achievable in a few years.”

Dr Wilma Stolk, from Erasmus Medical Centre, added: “We use very different approaches, but our models all have the same message. This new drug regimen can reduce the number of rounds, but it still depends on the programs being well-run. Even with the best possible regimen elimination is difficult to achieve if many people repeatedly don’t participate in mass drug administration.”

Professor Edwin Michael, from Notre Dame University said: “This study demonstrates the power of using multiple models, an important trend in complex systems modelling and use of models for policy making. It allows us to be sure that our insights are robust.”

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