Brieger W R, Awedoba A K, Eneanya C I, Hagan M, Ogbuagu K F, Okello D O, Ososanya O O, Ovuga E B, Noma M, Kale O O, Burnham G M, Remme J H
Department of Preventive and Social Medicine, University of Ibadan, Nigeria.
Trop Med Int Health. 1998 Dec;3(12):951-61. doi: 10.1046/j.1365-3156.1998.00339.x.
To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onchocercal skin p6isease (OSD) and severe itching.
A multicentre, double-blind placebo controlled trial was conducted among 4072 residents of rural communities in Ghana, Nigeria and Uganda. Baseline clinical examination categorized reactive skin lesions as acute papular onchodermatitis, chronic papular onchodermatitis and lichenified onchodermatitis. Presence and severity of itching was determined by open-ended and probing questions. Clinical examination and interview took place at baseline and each of 5 subsequent 3-monthly follow-up visits.
While prevalence and severity of reactive lesions decreased for all 4 arms, those receiving ivermectin maintained a greater decrease in prevalence and severity over time. The difference between ivermectin and placebo groups was significant for prevalence at 9 months and for severity at 3 months. Differences between placebo and ivermectin groups were much more pronounced for itching. From 6 months onward, the prevalence of severe itching was reduced by 40-50% among those receiving ivermectin compared to the trend in the placebo group.
This is an important effect on disease burden as severe itching is for the affected people the most troubling complication of onchocerciasis. The difference among regimens was not significant, and the recommended regimen of annual treatment for the control of ocular onchocerciasis appears also the most appropriate for onchocerciasis control in areas where the skin manifestations predominate. The final determination of the effect on skin lesions requires a longer period of study.
确定每年、每3个月和每6个月服用一次伊维菌素对盘尾丝虫性皮肤病（OSD）和严重瘙痒的影响。
在加纳、尼日利亚和乌干达的农村社区对4072名居民进行了一项多中心、双盲、安慰剂对照试验。基线临床检查将反应性皮肤病变分类为急性丘疹性盘尾性皮炎、慢性丘疹性盘尾性皮炎和苔藓化盘尾性皮炎。通过开放式和探究性问题确定瘙痒的存在和严重程度。在基线以及随后5次每3个月一次的随访中均进行临床检查和访谈。
虽然所有4组的反应性病变患病率和严重程度均有所下降，但随着时间推移，接受伊维菌素治疗的组在患病率和严重程度方面下降幅度更大。伊维菌素组与安慰剂组在9个月时的患病率差异以及3个月时的严重程度差异具有统计学意义。安慰剂组和伊维菌素组在瘙痒方面的差异更为明显。从6个月起，与安慰剂组的趋势相比，接受伊维菌素治疗的人群中严重瘙痒的患病率降低了40%-50%。
这对疾病负担具有重要影响，因为严重瘙痒是受影响人群盘尾丝虫病最困扰的并发症。不同治疗方案之间的差异不显著，并且推荐的用于控制盘尾丝虫性眼病的年度治疗方案似乎也是皮肤表现为主地区控制盘尾丝虫病最合适的方案。对皮肤病变影响的最终确定需要更长时间的研究。
