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Doxycycline improves filarial lymphedema independent of active filarial infection: a randomized controlled trial

Mand, Sabine, Debrah, Alexander Yaw, Klarmann, Ute, Batsa, Linda, Marfo-Debrekyei, Yeboah, Kwarteng, Alexander, Specht, Sabine, Belda-Domene, Aurea, Fimmers, Rolf, Taylor, Mark, Adjei, Ohene and Hoerauf, Achim (2012) 'Doxycycline improves filarial lymphedema independent of active filarial infection: a randomized controlled trial'. Clinical Infectious Diseases, Vol 55, Issue 5, pp. 621-630.

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Abstract

BACKGROUND
The aim of this study was to determine whether improvement of filarial lymphedema (LE) by doxycycline is restricted to patients with ongoing infection (positive for circulating filarial antigen [CFA]), or whether the majority of CFA-negative patients with LE would also show a reduction in LE severity.

METHODS
One hundred sixty-two Ghanaian participants with LE stage 1-5 (Dreyer) were randomized blockwise into 2 groups (CFA positive or negative) and allocated to 3 treatment arms of 6 weeks: (1) amoxicillin (1000 mg/d), (2) doxycycline (200 mg/d), or (3) placebo matching doxycycline. All groups received standard hygiene morbidity management. The primary outcome was reduction of LE stages. Secondary outcomes included frequency of acute attacks and ultrasonographic assessment of skin thickness at the ankles. Parameters were assessed before treatment and after 3, 12, and 24 months.

RESULTS
Doxycycline-treated patients with LE stage 2-3 showed significant reductions in LE severity after 12 and 24 months, regardless of CFA status. Improvement was observed in 43.9% of doxycycline-treated patients, compared with only 3.2% and 5.6% in the amoxicillin and placebo arms, respectively. Skin thickness was correlated with LE stage improvement. Both doxycycline and amoxicillin were able to reduce acute dermatolymphangioadenitis attacks.

CONCLUSIONS
Doxycycline treatment improves mild to moderate LE independent of ongoing infection. This finding expands the benefits of doxycycline to the entire population of patients suffering from LE. Patients with LE stage 1-3 should benefit from a 6-week course of doxycycline every other year or yearly, which should be considered as an improved tool to manage morbidity in filarial LE.

Item Type: Article
Subjects: QV Pharmacology > QV 38 Drug action.
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 880 Filariasis and related conditions (General)
WH Hemic and Lymphatic Systems > Lymphatic System > WH 700 Lymphatic system. Lymphatic diseases (General)
Digital Object Identifer (DOI): https://doi.org/10.1093/cid/cis486
Depositing User: Mary Creegan
Date Deposited: 14 Feb 2013 16:48
Last Modified: 15 Jun 2018 14:44
URI: https://archive.lstmed.ac.uk/id/eprint/3297

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