Mass chemotherapy with niclosamide for the control of Taenia solium: population-based safety profile and treatment effectiveness

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Americas Pub Date : 2024-08-30 DOI:10.1016/j.lana.2024.100876
Melissa T. Wardle , Samantha E. Allen , Ricardo Gamboa , Percy Vilchez , Seth E. O'Neal , Claudio Muro , Andrés G. Lescano , Luz M. Moyano , Guillermo E. Gonzalvez , Armando E. González , Robert H. Gilman , Héctor H. García
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Abstract

Background

Mass drug administration (MDA) with niclosamide (NSM) can be used to control taeniasis, the cause of neurocysticercosis. NSM is 84.3% effective against taeniasis and is considered safe as it is not absorbed from the intestinal tract. However, information on its safety and effectiveness during MDA is limited. We evaluated the effectiveness of NSM and reported adverse events (AEs) during a cysticercosis elimination program in Tumbes, Peru.

Methods

Three rounds of NSM at 4-month intervals were offered to 77,397 eligible residents. We revisited all participants in their homes 72 h after each round to collect information regarding AEs. We also collected post-treatment stool samples to diagnose taeniasis after the first round, followed by a second sample at 30 days from those infected to evaluate NSM's effectiveness.

Findings

During implementation, 68,751 individuals were administered at least one dose of NSM (mean age 29 years, SD 20; 52% male), and 65,551 (95.3%) were visited post-treatment. 988 (1.5%) reported experiencing at least one AE. Almost all AEs (99.2%) were of mild intensity, with no severe AEs recorded. Of 211 participants diagnosed with taeniasis, 188 provided a follow-up stool sample 30-days after treatment and 141 were cured (treatment effectiveness 75.0%). Older age and higher coproantigen levels were significantly associated with treatment failure.

Interpretation

MDA with NSM is safe in Taenia solium endemic settings. However, the effectiveness following one dose is lower than expected, which suggests additional treatment may be necessary to enhance the infection control efforts.

Funding

The Bill and Melinda Gates Foundation.

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使用烟酰胺进行大规模化疗以控制疟原虫:基于人群的安全性和治疗效果
背景使用尼可刹米(NSM)进行大规模给药可用于控制泰纳丝虫病,泰纳丝虫病是神经囊虫病的病因。尼可刹米对泰纳丝虫病的有效率为84.3%,由于不会被肠道吸收,因此被认为是安全的。然而,有关其在 MDA 期间的安全性和有效性的信息却很有限。我们评估了在秘鲁通贝斯(Tumbes)开展的消除囊尾蚴病计划期间,NSM的有效性和报告的不良事件(AEs)。方法为77397名符合条件的居民提供了三轮NSM,每轮间隔4个月。每轮治疗后 72 小时,我们都会再次访问所有参与者的住所,收集有关不良反应的信息。我们还收集了治疗后的粪便样本,以便在第一轮治疗后诊断taeniasis,并在30天后对感染者进行第二次样本采集,以评估NSM的效果。研究结果在实施期间,68751人至少接受了一剂NSM治疗(平均年龄29岁,SD 20;52%为男性),65551人(95.3%)在治疗后接受了访问。988人(1.5%)报告至少出现过一次AE。几乎所有的不良反应(99.2%)都是轻微的,没有严重不良反应的记录。在 211 名确诊患有泰纳丝虫病的参与者中,188 人在治疗 30 天后提供了粪便样本,141 人治愈(治疗有效率为 75.0%)。年龄较大和共抗原水平较高与治疗失败有明显关系。然而,一次用药后的疗效低于预期,这表明可能需要额外的治疗来加强感染控制工作。
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期刊介绍: The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.
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