School of Life Sciences, University of Warwick, Coventry, UK.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
Lancet Infect Dis. 2017 Apr;17(4):451-458. doi: 10.1016/S1473-3099(16)30467-4. Epub 2016 Dec 22.
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.
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.
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.
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.
Bill & Melinda Gates Foundation.
淋巴丝虫病的目标是在 2020 年消除这一公共卫生问题。当前规划采用的主要方法是每年用具有良好安全性的两种药物组合进行大规模药物治疗。然而，一剂三药方案（伊维菌素、乙胺嗪和阿苯达唑）已被证明可在接受治疗的个体中完全清除寄生虫的传染性阶段。本研究旨在使用建模来评估大规模药物治疗用三药方案在不同流行环境下加速消除淋巴丝虫病的潜在价值。
我们使用三种不同的传播模型来比较用三药方案和当前的两药方案达到微丝蚴血症患病率低于 1%所需的大规模药物治疗轮数。
在淋巴丝虫病基线患病率较低（5%）的环境中，与两药方案相比，三药方案可减少达到目标患病率所需的大规模药物治疗轮数一轮或两轮。对于基线患病率较高（10-40%）的地区，三药方案可显著减少所需的大规模药物治疗轮数，约为四轮或五轮，但前提是人群覆盖率较高（>65%）且大规模药物治疗的系统性不依从率较低。
模拟模型表明，如果可以实现大规模药物治疗的高人群覆盖率，并且如果大规模药物治疗的系统性不依从率较低，三药方案有可能加速淋巴丝虫病的消除。未来的工作将根据更多的临床试验数据重新评估这些估计值，并了解其对个别国家规划的影响。
比尔及梅琳达·盖茨基金会。
