Assessment of the Efficacy and Safety of Two Albendazole Regimens for the treatment of hypermicrofilaraemic loiasis in adult populations in Woleu-Ntem Province, Gabon: a Phase IIb single-blind randomised controlled trial
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Background
Loa (L.) loa hypermicrofilaraemia (>8,000 mf/mL) increases the risk of severe adverse events during mass ivermectin administration for onchocerciasis control. Albendazole has been proposed as a potential alternative for reducing microfilariaemia prior to treatment.
Methodology and principal findings
This prospective study was conducted in northern Gabon from November 2021 to April 2022. Individuals infected with L. loa were screened and allocated into three groups: two treatment arms receiving 400 mg or 800 mg of albendazole daily for 30 days among hypermicrofilaremic participants, and a control group with microfilaraemia <8,000 mf/mL. Clinical symptoms and parasitological data were collected on Days 0, 2, 7, 14, and 30. A total of 70 participants were enrolled: 16 in the 400 mg group, 16 in the 800 mg group, and 38 in the control group. Itching was the most common adverse event. By Day 30, no participants in the control group exhibited clinical symptoms. Microfilariaemia significantly decreased in all groups (p< 0.01). After 30 days, over 70.0% of patients treated with albendazole had microfilaraemia ≤8,000 mf/mL. There was no significant difference in efficacy between the two albendazole regimens.
Conclusions/Significance
Daily administration of 400 mg albendazole for 30 days effectively reduces microfilarial loads in patients with L. loa hypermicrofilaraemia and is well tolerated. This pre-treatment regimen may help mitigate the risk of adverse events associated with ivermectin administration. Further research is needed to evaluate the long-term persistence of microfilarial suppression.
Author Summary
Loiasis is a parasitic disease caused by the Loa loa worm and transmitted by the bite of a fly called Chrysops . People living in Central Africa can carry thousands of these microscopic worms in their blood. However, treating this disease is complicated: when the number of parasites in the blood is too high, giving the usual treatments (like ivermectin) can lead to dangerous side effects, including coma or even death. This study tested whether albendazole, a common anti-parasitic drug, could safely reduce the number of worms in heavily infected patients in rural Gabon. We compared two doses—400 mg and 800 mg taken daily for 30 days—and found that both doses were effective in lowering parasite levels below the danger threshold. The lower dose worked just as well and was better tolerated, making it more suitable for use in large-scale treatment campaigns. Our findings suggest that a 400 mg daily regimen of albendazole may help prepare patients for safer treatment with stronger medications and could improve control of this neglected tropical disease in hard-to-reach communities.
