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Post-treatment Effects of Ivermectin (IVM) or Diethylcarbamazine (DEC) in Loiasis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01593722
Recruitment Status : Completed
First Posted : May 8, 2012
Results First Posted : November 9, 2016
Last Update Posted : November 9, 2016
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Allergy and Infectious Diseases (NIAID) )

Brief Summary:


  • Loa loa is a small worm that infects people in West and Central Africa. It is spread by the bite of a fly. Adult worms live under the skin and can cause swelling in the arms, legs, and face. Some people have more serious infections in the heart, kidneys, or brain. Most people with Loa loa infection have no symptoms at all. The standard treatment for Loa loa infection is a medicine called diethylcarbamazine (DEC). Some people have bad reactions to DEC, including itching, muscle pains, and in severe cases coma and death.
  • Another drug, ivermectin, is used in mass drug treatment programs to prevent the spread of worm infections that cause blindness and massive swelling (elephantiasis). However, people who also have Loa loa have had serious bad reactions to ivermectin. Researchers want to study both DEC and ivermectin to find out why these reactions occur. If they can be prevented, mass drug treatment programs will be able to be used in areas in Africa where Loa loa exists.


- To study the side effects of DEC and ivermectin treatment for Loa loa infection.


- Individuals who live in 4 villages in Cameroon where Loa loa infection is known to exist, who are between 20 and 60 years of age, not pregnant or breastfeeding and have a low level of Loa loa parasites in the blood, but are otherwise healthy.


  • Participants will be screened with a physical exam and medical history. Blood samples will be collected to check for Loa loa infection. Participants will also have an eye exam and provide skin samples to check for other worm infections that may interfere with the study treatment.
  • Participants will be admitted to the hospital for 4 days (during and after the treatment). They will receive a single dose of either DEC or ivermectin.
  • After treatment, regular blood samples will be collected. Participants will be asked questions about how they feel after treatment. Physical exams will be performed. If side effects develop, participants will be treated at the hospital.
  • After leaving the hospital, participants will have followup visits. These visits will happen on days 5, 7, 9, and 14 after receiving the study medicine. They will involve a short physical exam and collection of blood samples.
  • At the end of the study, participants will be offered a full 21-day DEC treatment to cure the Loa loa infection.

Condition or disease Intervention/treatment Phase
Loiasis Drug: Diethylcarbamazine Drug: Ivermectin Phase 4

Detailed Description:
Ivermectin is currently used for mass drug distribution for the control of onchocerciasis and elimination of lymphatic filariasis in Africa. Due to the occurrence of severe neurologic adverse events in individuals with concomitant Loa loa infection and high levels of circulating microfilariae, drug distribution has been halted in many areas in Cameroon, Democratic Republic of Congo and other Loa-endemic countries. Diethylcarbamazine citrate (DEC) is the treatment of choice for Loa loa infection in the United States and other non-endemic countries, but can also be associated with the development of severe adverse reactions, including fatal encephalopathy, that are correlated with the number of circulating microfilariae in the blood. The cause of these reactions is unknown, and it is not known if post-treatment reactions to DEC and ivermectin both have the same underlying mechanism. Post-treatment reactions to both medications are accompanied by a dramatic interleukin-5 (IL-5)-dependent increase in eosinophilia and evidence of eosinophil activation. Preliminary data suggests that, unlike post-treatment responses in Wolbachia-containing filariae, inflammatory mediators commonly seen in bacterial infections and malaria, including tumor necrosis factor (TNF)-alpha and IL-1-beta, are not increased post-treatment with DEC. The aim of this study is to characterize the immunologic mechanisms of ivermectin and DEC posttreatment reactions so that it can be established whether or not these posttreatment reactions have the same underlying mechanism. An understanding of the pathophysiology of these post-treatment reactions is necessary in order to develop strategies to prevent these reactions in the future. We plan to randomize 20 subjects with low- to- moderate numbers of circulating Loa loa microfilariae to receive a single oral dose of either ivermectin (200 mcg/kg) or DEC (8 mg/kg) in an inpatient setting in Cameroon. Signs and symptoms, blood microfilarial levels, complete blood counts, intracellular and serum cytokine levels and markers of eosinophil activation will be assessed at baseline, 4 and 8 hours, and 1, 2, 3, 5, 7, and 9 and 14 days post-treatment and compared between the two treatment groups. Subjects who received ivermectin will be treated with single dose DEC (8 mg/kg) on day 14. All subjects will then be followed at 6 and 12 months post-hospitalization to determine whether they have experienced Loa-specific symptoms (eyeworm or Calabar swellings). Mf count and complete blood count (CBC) with differential will be obtained at each follow-up visit. Subjects with Loa-specific symptoms or mf counts > 100 mf/mL at the 6 month time point will be offered a full treatment course. If > 50% of subjects meet criteria for full DEC treatment at the 6, month time point, all subjects will be treated and the study will enter a follow-up phase with a visit at 12 months (6 months after the full treatment course ).

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 155 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: Comparison Between the Post-Treatment Reactions After Single-dose Ivermectin or DEC in Subjects With Loa Loa Infection
Study Start Date : April 2012
Actual Primary Completion Date : August 2013
Actual Study Completion Date : January 2014

Resource links provided by the National Library of Medicine

Drug Information available for: Ivermectin

Arm Intervention/treatment
Active Comparator: diethylcarbamazine
diethylcarbamazine 8 mg/kg single oral dose
Drug: Diethylcarbamazine
single dose
Other Name: Hetrazan, Banocide

Active Comparator: ivermectin
ivermectin 200 mcg/kg single oral dose
Drug: Ivermectin
single dose
Other Name: Mectizan, Stromectol

Primary Outcome Measures :
  1. The Peak % of Baseline Eosinophil Count Measured During the First 7 Days Post-treatment. [ Time Frame: 7 days ]

Secondary Outcome Measures :
  1. The Frequency of Adverse Events [ Time Frame: 7 days ]
    Symptoms, signs and laboratory abnormalities occurring in the 7 days post-treatment

  2. Eosinophil Activation [ Time Frame: 3 days ]
    Levels of surface marker expression on eosinophils

  3. Proportion of Subjects Who Clear Microfilaremia [ Time Frame: 14 days ]

Other Outcome Measures:
  1. Treatment Efficacy [ Time Frame: 6 months ]
    Proportion of subjects without signs of infection

Information from the National Library of Medicine

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Ages Eligible for Study:   20 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

A subject will be eligible for participation in the screening portion of this protocol if all of the following criteria apply:

  1. male or non-pregnant and not breastfeeding female subjects,
  2. age 20-60 years (per participant self-report)
  3. resident of Akonolinga
  4. Loa microfilaremia from 20 to 5000 mf/mL from the prior screening in the village or did not participate in the prior screening
  5. consent to a blood draw to screen for infection with Loa loa
  6. must be willing to have blood samples stored


A subject will not be eligible for participation in the screening portion of this study if any of the following conditions apply:

  1. Known to be pregnant (by history) or breastfeeding
  2. Chronic medical conditions, including but not limited to diabetes, renal or hepatic insufficiency, immunodeficiency, psychiatric disorder, seizure, that in the investigators judgments are deemed to be clinically significant
  3. History of hypersensitivity reaction to DEC or IVM


A subject will be eligible for participation in the interventional portion of the study only if all of the following additional inclusion criteria apply:

  1. Loa loa microfilaremia between 20 and 2,000 mf/mL blood drawn between 11:30 am and 2:30 pm measured within 30 days prior to the baseline visit
  2. The subject agrees to storage of samples for study


A subject will not be eligible to participate in the interventional portion of the study if any of the following conditions are fulfilled at the time of enrollment:

  1. Pregnancy (by serum or urine beta-HCG) or breastfeeding
  2. Chronic kidney or liver disease
  3. Hgb < 10 gm/dL
  4. Filarial infection other than Loa loa or M. perstans (O. volvulus, or W. bancrofti)
  5. Use of DEC or IVM within the past 6 months
  6. Use of immunosuppressive therapies, including steroids, within the past month
  7. Any condition that in the investigator s opinion places the subject at undue risk by participating in the study


Pregnant women and children (the age of consent in Cameroon is 20 years of age) will be excluded from this study since it involves administration of medications contraindicated in pregnancy and more than minimal risk with no prospect of direct benefit, respectively.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01593722

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Filariasis and other Tropical Diseases Research Center
Yaounde, Cameroon
Sponsors and Collaborators
National Institute of Allergy and Infectious Diseases (NIAID)
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Principal Investigator: Amy D Klion, M.D. National Institute of Allergy and Infectious Diseases (NIAID)
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID) Identifier: NCT01593722    
Other Study ID Numbers: 999912117
12-I-N117 ( Other Identifier: NIAID IRB )
First Posted: May 8, 2012    Key Record Dates
Results First Posted: November 9, 2016
Last Update Posted: November 9, 2016
Last Verified: September 2016
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Allergy and Infectious Diseases (NIAID) ):
Loa loa
Immune Response
Additional relevant MeSH terms:
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Spirurida Infections
Secernentea Infections
Nematode Infections
Parasitic Diseases
Antiparasitic Agents
Anti-Infective Agents
Antinematodal Agents
Lipoxygenase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action