TY - JOUR
T1 - Adherence to Hygiene Protocols and Doxycycline Therapy in Ameliorating Lymphatic Filariasis Morbidity in an Endemic Area Post-Interruption of Disease Transmission in Ghana
AU - Debrah, Linda Batsa
AU - Klarmann-Schulz, Ute
AU - Osei-Mensah, Jubin
AU - Kuehlwein, Janina M.
AU - Mubarik, Yusif
AU - Nadal, Jennifer
AU - Ayisi-Boateng, Nana Kwame
AU - Ricchiuto, Arcangelo
AU - Opoku, Vera Serwaa
AU - Sullivan, Sarah M.
AU - Mensah, Derrick Adu
AU - Horton, John
AU - Rahamani, Abu Abudu
AU - Budge, Philip J.
AU - Gbedema, Stephen
AU - Korir, Patricia Jebett
AU - Opoku, John
AU - Pfarr, Kenneth
AU - Kontoh, Derrick Boateng
AU - Kellings, Angelika
AU - Gyasi, Charles
AU - Obeng, Michael Agyemang
AU - Gruetzmacher, Barbara
AU - Fordjour, Fatima Amponsah
AU - Kroidl, Inge
AU - Horn, Sacha
AU - Kuutiero, Eunice Kyaakyile
AU - Wauschkuhn, Caroline
AU - Ngenya, Abdallah
AU - Mackenzie, Charles
AU - Wanji, Samuel
AU - Kalinga, Akili
AU - Ottesen, Eric A.
AU - Hoerauf, Achim
AU - Debrah, Alexander Yaw
N1 - Publisher Copyright:
© 2024 The author(s)
PY - 2024/10
Y1 - 2024/10
N2 - Filarial lymphedema (LE) remains a significant global problem despite the progress made toward elimination of lymphatic filariasis (LF). In Ghana, the main approach to LF is preventive chemotherapy, but this has minimal impact on individuals who have already developed LE. In 2018–2020, a 24-month randomized, double-blind, placebo-controlled trial was conducted to evaluate the efficacy of stringent hygiene measures using the Essential Package of Care with or without additional administration of doxycycline (DOX) to improve filarial leg LE. This study enrolled 356 participants with LE stages 1–3 from two districts in the Upper East Region of Ghana. In addition to regular training on appropriate care for their affected legs, participants were randomized to receive 6 weeks of either 200 mg/day DOX (n 5 117), 100 mg/day DOX (n 5 120), or matching placebo (n 5 119). Participants were seen every 2 months, with clinical measurements done at 6, 12, 18, and 24 months to assess the status of affected legs. There was a trend toward later appearance of acute attacks after DOX, but surprisingly, DOX showed no effect on LE stage progression. In all groups, leg LE improvement was more common (DOX 200 mg: n 5 23 [20%]; DOX 100 mg: n 5 23 [19.5%]; placebo: n 5 32 [27.4%]) than LE worsening (DOX 200 mg: n 5 2 [1.7%]; DOX 100 mg: n 5 3 [2.5%]; placebo: n 5 2 [1.7%]). Overall, these data show a strong benefit from adherence to a strict hygiene protocol, with some added potential benefit for DOX in preventing acute attacks.
AB - Filarial lymphedema (LE) remains a significant global problem despite the progress made toward elimination of lymphatic filariasis (LF). In Ghana, the main approach to LF is preventive chemotherapy, but this has minimal impact on individuals who have already developed LE. In 2018–2020, a 24-month randomized, double-blind, placebo-controlled trial was conducted to evaluate the efficacy of stringent hygiene measures using the Essential Package of Care with or without additional administration of doxycycline (DOX) to improve filarial leg LE. This study enrolled 356 participants with LE stages 1–3 from two districts in the Upper East Region of Ghana. In addition to regular training on appropriate care for their affected legs, participants were randomized to receive 6 weeks of either 200 mg/day DOX (n 5 117), 100 mg/day DOX (n 5 120), or matching placebo (n 5 119). Participants were seen every 2 months, with clinical measurements done at 6, 12, 18, and 24 months to assess the status of affected legs. There was a trend toward later appearance of acute attacks after DOX, but surprisingly, DOX showed no effect on LE stage progression. In all groups, leg LE improvement was more common (DOX 200 mg: n 5 23 [20%]; DOX 100 mg: n 5 23 [19.5%]; placebo: n 5 32 [27.4%]) than LE worsening (DOX 200 mg: n 5 2 [1.7%]; DOX 100 mg: n 5 3 [2.5%]; placebo: n 5 2 [1.7%]). Overall, these data show a strong benefit from adherence to a strict hygiene protocol, with some added potential benefit for DOX in preventing acute attacks.
UR - http://www.scopus.com/inward/record.url?scp=85205605409&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.24-0313
DO - 10.4269/ajtmh.24-0313
M3 - Article
C2 - 39362213
AN - SCOPUS:85205605409
SN - 0002-9637
VL - 111
SP - 66
EP - 82
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 4
ER -