[e-drug] Oral drug therapy for multiple neglected tropical diseases

["E-Drug" <e-drug@healthnet.org>]

E-DRUG: Oral drug therapy for multiple neglected tropical diseases
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Madhuri Reddy, MD, MSc; Sudeep S. Gill, MD, MSc; Sunila R. Kalkar, MBBS,
MD; Wei Wu, MSc; Peter J. Anderson, BA; Paula A. Rochon, MD, MPH. Oral
Drug Therapy for Multiple Neglected Tropical Diseases. A Systematic
Review. JAMA. 2007;298:1911-1924.

Context.  The neglected tropical diseases include 13 conditions that
occur in areas of extreme poverty and are poverty promoting. The
neglected tropical diseases produce a disease burden almost as great as
that associated with human immunodeficiency virus/AIDS, tuberculosis, or
malaria, yet are virtually unknown by health care workers in North
America, because they occur almost exclusively in the poorest regions of
the world. Seven of the most prevalent diseases have existing oral drug
treatments. Identifying treatments that are effective against more than
1 disease could facilitate efficient and inexpensive treatment.

Objectives.  To systematically review the evidence for drug treatments
and to increase awareness that neglected tropical diseases exist and
that treatments are available.

Data Sources and Study Selection.  Using a MEDLINE search (1966 through
June 2007), randomized controlled trials (RCTs) were reviewed that
examined simultaneous treatment of 2 or more of the 7 most prevalent
neglected tropical diseases using oral drug therapy.

Data Synthesis.  Twenty-nine RCTs were identified, of which 3 targeted 4
diseases simultaneously, 20 targeted 3 diseases, and 6 targeted 2
diseases. Trials were published between 1972 and 2005 and baseline
prevalence of individual diseases varied among RCTs. Albendazole plus
diethylcarbamazine significantly reduced prevalence of elephantiasis
(16.7% to 5.3%), hookworm (10.3% to 1.9%), roundworm (34.5% to 2.3%),
and whipworm (55.5% to 40.3%). Albendazole plus ivermectin significantly
reduced prevalence of elephantiasis (12.6% to 4.6%), hookworm (7.8% to
0%), roundworm (33.5% to 6.1%), and whipworm (42.7% to 8.9%). Levamisole
plus mebendazole significantly reduced prevalence of hookworm (94.0% to
71.8%), roundworm (62.0% to 1.4%), and whipworm (93.1% to 74.5%).
Pyrantel-oxantel significantly reduced hookworm (93.4% to 85.2%),
roundworm (22.8% to 1.4%), and whipworm (86.8% to 59.5%), while
albendazole alone significantly reduced prevalence of hookworm (8.1% to
1.3%), roundworm (28.4% to 0.9%), and whipworm (51.9% to 31.9%). No RCT
examined treatment of river blindness or trachoma as part of an
intervention to target 2 or more neglected tropical diseases. Adverse
events were generally inadequately reported.

Conclusions.  At least 2 of the most prevalent neglected tropical
diseases can be treated simultaneously with existing oral drug
treatments, facilitating effective and efficient treatment. Increasing
awareness about neglected tropical diseases, their global impact, and
the availability of oral drug treatments is an essential step in
controlling these diseases.

Author Affiliations: Department of Medicine, Hebrew Rehabilitation
Center and Division of Gerontology, Beth Israel Deaconess Medical
Center, Boston, Massachusetts (Dr Reddy); Departments of Medicine and
Community Health and Epidemiology, Queen's University, Kingston,
Ontario, Canada (Dr Gill); Baycrest-Kunin Lunenfeld Applied Research
Unit, Toronto, Ontario, Canada (Dr Kalkar and Messrs Wu and Anderson);
and Department of Medicine, University of Toronto, Baycrest