アフリカの風土病である寄生虫感染症撲滅への早道(A faster route to eliminating parasitic infection endemic to Africa)

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2025-05-07 ワシントン大学セントルイス校

モキシデクチンの通販 | CiモールStructural formula of moxidectinBall-and-stick model of the moxidectin molecule

ワシントン大学医学部の研究チームは、アフリカで流行する寄生虫疾患であるリンパ系フィラリア症(象皮病)に対して、抗寄生虫薬モキシデクチンが従来の治療薬よりも高い効果を示すことを明らかにしました。この疾患は、蚊を媒介としてフィラリア線虫(Wuchereria bancrofti)に感染することで発症し、慢性的なリンパ浮腫や皮膚の肥厚を引き起こします。モキシデクチンは、これまでオンコセルカ症(河川盲目症)の治療に用いられてきましたが、今回の臨床試験でリンパ系フィラリア症にも有効であることが示されました。特に、これら2つの疾患が同時に流行する地域では、モキシデクチンの使用が両疾患の制圧に貢献する可能性があります。研究成果は、2025年5月6日付で『The Lancet Infectious Diseases』誌に掲載されました。

<関連情報>

リンパ系フィラリア症に対するモキシデクチン併用療法:非盲検、観察者マスク、無作為化比較試験 Moxidectin combination therapies for lymphatic filariasis: an open-label, observer-masked, randomised controlled trial

Prof Guibehi Benjamin Koudou, PhD ∙ Catherine M Bjerum, MD ∙ Foungoye Allassane Ouattara, PhD ∙ Toki Pascal Gabo, MD ∙ Charles W Goss, PhD ∙ Daphne Lew, PhD ∙ et al.
The Lancet Infectious Diseases  Published: May 6, 2025
DOI:https://doi.org/10.1016/S1473-3099(25)00111-2

 

Summary

Background

Lymphatic filariasis caused by Wuchereria bancrofti causes hydroceles and lymphedema in millions of individuals worldwide. Annual mass drug administration of ivermectin plus albendazole (IA) temporarily clears microfilariae from the blood of infected individuals and is used in Africa to reduce W bancrofti transmission. This study aimed to investigate whether moxidectin combination therapies are superior to ivermectin combination therapies for clearance of W bancrofti microfilaremia.

Methods

In this open-label, parallel assignment, masked-observer, randomised, superiority clinical trial in Côte d’Ivoire, we used gender-stratified, block randomisation to sequentially assign adults with bancroftian filariasis (1:1:1:1) to receive annual ivermectin plus albendazole (IA; standard of care) or one of three single-dose regimens: moxidectin plus albendazole (MoxA), ivermectin plus diethylcarbamazine (DEC) plus albendazole (IDA), or moxidectin plus DEC plus albendazole (MoxDA). This trial was conducted at the Filariasis Research Center in Agboville, located at the Centre Hôspitalier Regional, d’Agboville, Côte d’Ivoire. Men and non-pregnant, non-breastfeeding women aged 18–70 years in good general health and with screening microfilaria loads of at least 40 per mL (≥3 microfilariae on 60μL nocturnal thick blood smear) were eligible for enrolment; those found to have at least 40 microfilariae per mL by 1 mL blood filtration at enrolment were eligible for inclusion in the primary, modified intention-to-treat, efficacy analysis. Medicines were administered by an unmasked pharmacist; all other team members were masked to treatment assignment. Primary outcomes were complete microfilaria clearance at 12 months (MoxA vs IA) or 24 months (MoxDA vs IDA) post-treatment. This trial is registered at ClinicalTrials.gov (NCT04410406) and is complete.

Findings

Enrolment occurred from Aug 20, 2020 to July 31, 2021. 190 individuals were predicted to have nocturnal blood microfilariae counts of at least 40 microfilariae per mL, of whom 26 were excluded and 164 were randomly assigned to an intervention (41 to the IA group, 40 to the MoxA group, 41 to the IDA group, and 42 to the MoxDA group). 113 participants met the pre-specified efficacy analysis criteria and completed follow-up. The proportion of participants who were amicrofilaraemic at 12 months was eight of 25 (32% [95% CI 15–54]) among IA recipients versus 18 of 19 (95% [95% CI 74–100]) among MoxA recipients (adjusted risk ratio [RR] 2·79 [95% CI 1·59–4·90]; p=0·0004). The proportion of amicrofilaraemic participants at 24 months was 20 of 22 (91% [95% CI 71–99]) for IDA versus 21 of 23 (91% [72–99]) for MoxDA (adjusted RR 0·98 [95% CI 0·83–1·15]; p=0·78). Most MoxA recipients (14 of 16 [88%; 95% CI 62–98]) remained amicrofilaraemic at 24 months.

Interpretation

In this study, single-dose MoxA was superior to IA for W bancrofti microfilaria clearance at 12 months and provided prolonged microfilaria clearance for most participants. These results suggest that MoxA could be a powerful tool to accelerate the elimination of lymphatic filariasis in Africa.

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