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Lancet Infect Dis. 2017 Apr;17(4):451-458. doi: 10.1016/S1473-3099(16)30467-4. Epub 2016 Dec 22.

Effectiveness of a triple-drug regimen for global elimination of lymphatic filariasis: a modelling study.

Author information

1
School of Life Sciences, University of Warwick, Coventry, UK.
2
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
3
Department of Biological Sciences, University of Notre Dame, Notre Dame, South Bend, IN, USA.
4
Vector Control Research Centre (Indian Council of Medical Research), Indira Nagar, Puducherry, India.
5
Washington University School of Medicine, St Louis, MO, USA.
6
School of Life Sciences, University of Warwick, Coventry, UK; Mathematics Institute, University of Warwick, Coventry, UK. Electronic address: deirdre.hollingsworth@warwick.ac.uk.

Abstract

BACKGROUND:

Lymphatic filariasis is targeted for elimination as a public health problem by 2020. The principal approach used by current programmes is annual mass drug administration with two pairs of drugs with a good safety profile. However, one dose of a triple-drug regimen (ivermectin, diethylcarbamazine, and albendazole) has been shown to clear the transmissible stage of the helminth completely in treated individuals. The aim of this study was to use modelling to assess the potential value of mass drug administration with the triple-drug regimen for accelerating elimination of lymphatic filariasis in different epidemiological settings.

METHODS:

We used three different transmission models to compare the number of rounds of mass drug administration needed to achieve a prevalence of microfilaraemia less than 1% with the triple-drug regimen and with current two-drug regimens.

FINDINGS:

In settings with a low baseline prevalence of lymphatic filariasis (5%), the triple-drug regimen reduced the number of rounds of mass drug administration needed to reach the target prevalence by one or two rounds, compared with the two-drug regimen. For areas with higher baseline prevalence (10-40%), the triple-drug regimen strikingly reduced the number of rounds of mass drug administration needed, by about four or five, but only at moderate-to-high levels of population coverage (>65%) and if systematic non-adherence to mass drug administration was low.

INTERPRETATION:

Simulation modelling suggests that the triple-drug regimen has potential to accelerate the elimination of lymphatic filariasis if high population coverage of mass drug administration can be achieved and if systematic non-adherence with mass drug administration is low. Future work will reassess these estimates in light of more clinical trial data and to understand the effect on an individual country's programme.

FUNDING:

Bill & Melinda Gates Foundation.

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PMID:
28012943
DOI:
10.1016/S1473-3099(16)30467-4
[Indexed for MEDLINE]
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