IHP news 513: infectious diseases & NTDs

By on March 15, 2019

Stat News – Monthly shots control HIV as well as daily pills in two big studies

Stat News;

News from last week in Seattle (CROI conference). “Monthly shots of HIV drugs worked as well as daily pills to control the virus that causes AIDS in two large international tests, researchers reported Thursday.”

Lancet – Efficacy and risk of harms of repeat ivermectin mass drug administrations for control of malaria (RIMDAMAL): a cluster-randomised trial

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32321-3/fulltext

“Ivermectin is widely used in mass drug administrations for controlling neglected parasitic diseases, and can be lethal to malaria vectors that bite treated humans. Therefore, it could be a new tool to reduce plasmodium transmission. We tested the hypothesis that frequently repeated mass administrations of ivermectin to village residents would reduce clinical malaria episodes in children and would be well tolerated with minimal harms.”

From the press release:

“The Lancet: Mosquito-killing drug reduced malaria episodes by a fifth among children, according to randomised trial

First evidence that repeated mass administration of ivermectin can reduce malaria incidence in children aged five or younger without an increase in adverse events for the wider population given the drug.

Childhood malaria episodes could be reduced by 20% — from 2.49 to 2 cases per child — during malaria transmission season if the whole population were given a drug called ivermectin every three weeks, according to the first randomised trial of its kind including 2,700 people including 590 children from eight villages in Burkina Faso, published in The Lancet.  In addition, repeated mass administration of ivermectin showed no obvious drug-related harms among fellow villagers taking the drug….”

See also the related Lancet CommentAdvancing the repurposing of ivermectin for malaria.

“… There is ever-increasing anticipation for the potential of mass drug administration of endectocides (also known as systemic insecticides) to reduce malaria transmission, with ivermectin emerging as the most likely first-in-class endectocide. … …. Ivermectin lays the path for a whole new concept: drug-based vector control.   … … Ivermectin, or indeed any effective endectocide, could be administered to eligible members of the at-risk community as a complementary tool for vector control. It could be administered alone or in combination with partner drugs to allow for integrated management of malaria or neglected tropical diseases, directly responding to residual transmission by targeting malaria and some lymphatic filariasis vectors, regardless of their feeding behavior…”

HPW – Strengthening Supply Chain Security For Essential Antimalarial Drugs

https://www.healthpolicy-watch.org/strengthening-supply-chain-security-for-essential-antimalarial-drugs/

Secure and reliable supply chains for life-saving medicines are essential features of the global health landscape. They ensure that quality approved drugs are manufactured and available in the quantities needed, without interruption. For the fight against malaria, securing supply chains for quality, life-saving antimalarials involves the collective effort of a range of organisations working to mitigate the risk of any shortage of these drugs. A recent success in this area has been the quality approval of a second supplier of injectable artesunate, the drug recommended by the World Health Organization to treat severe malaria….”

NEJM – A Trial of a Shorter Regimen for Rifampin-Resistant Tuberculosis

https://www.nejm.org/doi/full/10.1056/NEJMoa1811867?query=featured_home

“Globally, there are more than 500,000 new infections annually with drug-resistant tb. In this trial involving patients with rifampin-resistant tb, a shorter, more intense course of treatment (9 to 11 months) was found to be noninferior to a standard 20-month regimen. “

For the related NEJM Editorial, see A Short Regimen for Rifampin-Resistant Tuberculosis.

International Health – Gender equity in mass drug administration for neglected tropical diseases: data from 16 countries

https://academic.oup.com/inthealth/advance-article/doi/10.1093/inthealth/ihz012/5371211?searchresult=1

Gender equity in global health is a target of the Sustainable Development Goals and a requirement of just societies. Substantial progress has been made towards control and elimination of neglected tropical diseases (NTDs) via mass drug administration (MDA). However, little is known about whether MDA coverage is equitable. This study assesses the availability of gender-disaggregated data and whether systematic gender differences in MDA coverage exist….”

Some of the results: “Reporting of gender-disaggregated coverage data improved from 32% of districts in 2012 to 90% in 2016. In 2016, median female coverage was 85.5% compared with 79.3% for males. Female coverage was higher than male coverage for all diseases. However, within-country differences exist, with 64 (3.3%) districts reporting male coverage >10 percentage points higher than female coverage….”

Plos NTDs – Resolving “worm wars”: An extended comparison review of findings from key economics and epidemiological studies

https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006940

In this paper, Muhammad Farhan Majid, Su Jin Kang, and Peter J. Hotez critically evaluate the “worm wars” literature, highlighting gaps in the current discourse on deworming, which have been ignored by both economists and epidemiologists.”

Stat –  Sanofi suffers setback as panel recommends against dengue vaccine in adults

Stat News;

(gated) “Sanofi [last week] on Thursday suffered a major setback in its bid to market a controversial dengue vaccine in the United States, as a Food and Drug Administration advisory committee recommended against approval for adults. The drug maker had asked the FDA to approve Dengvaxia for people aged 9 to 45. But the advisory panel recommended the agency license the vaccine only for people ages 9 to less than 17.”

Lancet Neurology (In context) – Sleeping sickness in West and Central Africa: is eradication just skin deep?

https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30082-1/fulltext

Fexinidazole promises to be a breakthrough in the treatment of African sleeping sickness and could help eliminate it. But it might be too early to proclaim victory just yet. There could be a previously unnoticed reservoir of disease. Adrian Burton investigates.”

New treatment brings hope to those bitten by the ‘kissing bug’

https://www.telegraph.co.uk/news/0/new-treatment-brings-hope-bitten-kissing-bug/

Patients suffering from Chagas disease, a debilitating and potentially fatal insect-borne illness, could be cured with a two-week course of drugs instead of the current 60-day regimen, a study has shown. The research, led by the Drugs for Neglected Diseases Initiative (DNDi), found that a shorter course of benznidazole, the drug most commonly used to treat Chagas, was just as effective as the longer treatment course and caused fewer side effects. Some 80 per cent of patients were found to be clear of the disease a year later on both regimens….”

And a quick link:

MIT newsReducing the burden of tuberculosis treatment   A new drug delivery system would allow patients to switch from daily to monthly TB doses.  (cfr: an antibiotic-loaded wire inserted into the stomach )

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