Treatment of onchocerciasis. The ocular effects of ivermectin and diethylcarbamazine
H. R. Taylor, R. P. Murphy, H. S. Newland, A. T. White, S. A. D'Anna, E. Keyvan-Larijani, M. A. Aziz, E. W. Cupp and B. M. Greene
The ocular changes that occur with diethylcarbamazine treatment of
onchocerciasis seriously restrict its usefulness. Ivermectin, a newly
developed antifilarial drug, was compared with diethylcarbamazine for
treatment of onchocerciasis in a double-masked, placebo-controlled trial.
Thirty men with moderate to severe infection and ocular involvement were
randomly assigned to receive ivermectin as a single oral dose (200
micrograms/kg), diethylcarbamazine (administered for eight days), or
placebo. Detailed ocular examinations were performed serially over a
12-month period. Diethylcarbamazine treatment caused a marked increase in
living and dead microfilariae in the cornea, punctate opacities, and
limbitis during the first week of therapy. Ivermectin had no such effect.
However, ivermectin therapy resulted in a long-term reduction in
intraocular microfilariae comparable to that seen with diethylcarbamazine.
Ivermectin appears to have few ocular complications and be a
better-tolerated and more effective microfilaricidal agent than
diethylcarbamazine for the treatment of onchocerciasis.