CLINICAL AND THERAPEUTIC STUDIES IN HUMAN FILARIASIS

伊维菌素在南印度的试验中被证明对 清除班氏丝虫病患者的微丝虫病。一个 伊维菌素和目前使用的药物的安慰剂对照试验， 二乙基氨基马津(DEC)，已显示出与伊维菌素和 12月为3个月，但到6个月时(约)18%-20%的微丝虫病 接受伊维菌素治疗的患者复发率显著 高于DEC组(约)6%的复发率。侧面 两组的效果基本相同。因此，尽管伊维菌素 在6个月时，其单次口服剂量显示出比DEC更差的效果 给药方式和毒性不超过DEC意味着 这种药物应该会产生更大的患者依从性，因此 在大规模治疗丝虫病方面有可能更有效 控制程序比DEC。目前在南印度和巴西的试验 (与世界其他地方的试验相协调)表明这一比例非常低 剂量伊维菌素(10微克/公斤)清除微丝虫病的侧数更少 反应，当第二次更高的剂量时，可能会导致极端 长期清除微丝虫病。 到疫区的外籍游客感染的肺吸虫病已经 在NIH的早期研究中表现出明显的临床和 对丝虫的免疫高反应性。假说 这种高反应综合症与低反应综合征形成对比 (耐受性)状态，临床和免疫学都出现在这些 来自流行区的感染者已被临床证实 以及西非贝宁的实验室研究。

Ivermectin has been shown in trials in South India to be effective in clearing microfilaremia in patients with bancroftian filariasis. A placebo-controlled trial of ivermectin and the currently used drug, diethylcarbamazine (DEC), has shown equivalent efficacy for ivermectin and DEC for 3 months, but by 6 months the (approximately) 18-20% microfilarial recurrence rate in the ivermectin-treated patients was significantly greater than the (approximately) 6% recurrence rate in the DEC group. Side effects were essentially identical for both groups. Thus, though ivermectin appeared somewhat less effective than DEC at 6 months, its single-oral-dose mode of administration and toxicity no greater than that of DEC means that this drug should engender greater patient compliance and, therefore, have the potential to be much more effective in mass-treatment filariasis control programs than DEC. Current trials in South India and Brazil (coordinated with trials elsewhere in the world) indicate that very low doses of ivermectin (10 mcg/kg) clear microfilariae with even fewer side reactions and, when followed by a second higher dose, may lead to extremely prolonged microfilarial clearance. Loiasis acquired by expatriate visitors to endemic areas has been characterized in earlier studies at NIH as showing marked clinical and immunologic hyperresponsiveness to the filarial parasite. The hypothesis that this hyperresponsive syndrome contrasted with a hyporesponsive ('tolerized') state, both clinical and immunologic that appeared in those infected individuals native to the endemic regions was proven by clinical and laboratory studies in Benin, West Africa.