LymphedemaV1, Main, Exploration, bibRecord, 004946

Doxycycline Improves Filarial Lymphedema Independent of Active Filarial Infection: A Randomized Controlled Trial

Identifieur interne : 004946 ( Main/Exploration ); précédent : 004945; suivant : 004947

Doxycycline Improves Filarial Lymphedema Independent of Active Filarial Infection: A Randomized Controlled Trial

Auteurs : Sabine Mand [Allemagne] ; Alexander Yaw Debrah [Ghana] ; Ute Klarmann [Allemagne] ; Linda Batsa [Ghana] ; Yeboah Marfo-Debrekyei [Ghana] ; Alexander Kwarteng [Ghana] ; Sabine Specht [Allemagne] ; Aurea Belda-Domene [Allemagne] ; Rolf Fimmers [Allemagne] ; Mark Taylor [Royaume-Uni] ; Ohene Adjei ; Achim Hoerauf [Allemagne]

Source :

Clinical infectious diseases [ 1058-4838 ] ; 2012.

RBID : Pascal:12-0347326

Descripteurs français

KwdFr :
- Adolescent, Adulte, Adulte d'âge moyen, Amoxicilline (usage thérapeutique), Cheville (anatomopathologie), Cheville (imagerie diagnostique), Doxycycline (usage thérapeutique), Estimation de Kaplan-Meier, Femelle, Filaricides (usage thérapeutique), Filarioses (anatomopathologie), Filarioses (sang), Filarioses (traitement médicamenteux), Ghana, Humains, Jambe (anatomopathologie), Lymphoedème (anatomopathologie), Lymphoedème (parasitologie), Lymphoedème (sang), Lymphoedème (traitement médicamenteux), Mâle, Peau (anatomopathologie), Peau (imagerie diagnostique), Récepteur-3 au facteur croissance endothéliale vasculaire (sang), Statistique non paramétrique, Échographie.
MESH :
- anatomopathologie : Cheville, Filarioses, Jambe, Lymphoedème, Peau.
- imagerie diagnostique : Cheville, Peau.
- parasitologie : Lymphoedème.
- sang : Filarioses, Lymphoedème, Récepteur-3 au facteur croissance endothéliale vasculaire.
- traitement médicamenteux : Filarioses, Lymphoedème.
- usage thérapeutique : Amoxicilline, Doxycycline, Filaricides.
Pascal (Inist)
- Adolescent, Adulte, Adulte d'âge moyen, Estimation de Kaplan-Meier, Femelle, Ghana, Humains, Lymphoedème, Filariose lymphatique, Doxycycline, Antibactérien, Antibiotique, Mâle, Statistique non paramétrique, Échographie.
Wicri :
- topic : Antibiotique.

English descriptors

KwdEn :
- Adolescent, Adult, Amoxicillin (therapeutic use), Ankle (diagnostic imaging), Ankle (pathology), Antibacterial agent, Antibiotic, Doxycycline, Doxycycline (therapeutic use), Female, Filariasis (blood), Filariasis (drug therapy), Filariasis (pathology), Filaricides (therapeutic use), Ghana, Humans, Kaplan-Meier Estimate, Leg (pathology), Lymphatic filariasis, Lymphedema, Lymphedema (blood), Lymphedema (drug therapy), Lymphedema (parasitology), Lymphedema (pathology), Male, Middle Aged, Skin (diagnostic imaging), Skin (pathology), Statistics, Nonparametric, Ultrasonography, Vascular Endothelial Growth Factor Receptor-3 (blood).
MESH :
- chemical , blood : Vascular Endothelial Growth Factor Receptor-3.
- chemical , therapeutic use : Amoxicillin, Doxycycline, Filaricides.
- blood : Filariasis, Lymphedema.
- diagnostic imaging : Ankle, Skin.
- drug therapy : Filariasis, Lymphedema.
- parasitology : Lymphedema.
- pathology : Ankle, Filariasis, Leg, Lymphedema, Skin.
- Adolescent, Adult, Female, Ghana, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Statistics, Nonparametric, Ultrasonography.

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 block-wise 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. Clinical Trials Registration. ISRCTN 90861344.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412691

Affiliations:

Allemagne, Ghana, Royaume-Uni

Le document en format XML

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<author><name sortKey="Taylor, Mark" sort="Taylor, Mark" uniqKey="Taylor M" first="Mark" last="Taylor">Mark Taylor</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Liverpool School of Tropical Medicine</s1>
<s3>GBR</s3>
<sZ>10 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<wicri:noRegion>Liverpool School of Tropical Medicine</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Adjei, Ohene" sort="Adjei, Ohene" uniqKey="Adjei O" first="Ohene" last="Adjei">Ohene Adjei</name>
<affiliation><inist:fA14 i1="04"><s1>Komfo Anokye Teaching Hospital, School of Medical Sciences, Kwame Nkrumah University of Science and Technology</s1>
<s3>INC</s3>
<sZ>11 aut.</sZ>
</inist:fA14>
<wicri:noCountry>INC</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Hoerauf, Achim" sort="Hoerauf, Achim" uniqKey="Hoerauf A" first="Achim" last="Hoerauf">Achim Hoerauf</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Institute for Medical Microbiology, Immunology and Parasitology, Informatics and Epidemiology, University Hospital Bonn</s1>
<s3>DEU</s3>
<sZ>1 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>7 aut.</sZ>
<sZ>8 aut.</sZ>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<wicri:noRegion>University Hospital Bonn</wicri:noRegion>
<wicri:noRegion>Institute for Medical Microbiology, Immunology and Parasitology, Informatics and Epidemiology, University Hospital Bonn</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j" type="main">Clinical infectious diseases</title>
<title level="j" type="abbreviated">Clin. infect. dis.</title>
<idno type="ISSN">1058-4838</idno>
<imprint><date when="2012">2012</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">Clinical infectious diseases</title>
<title level="j" type="abbreviated">Clin. infect. dis.</title>
<idno type="ISSN">1058-4838</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term>
<term>Adult</term>
<term>Amoxicillin (therapeutic use)</term>
<term>Ankle (diagnostic imaging)</term>
<term>Ankle (pathology)</term>
<term>Antibacterial agent</term>
<term>Antibiotic</term>
<term>Doxycycline</term>
<term>Doxycycline (therapeutic use)</term>
<term>Female</term>
<term>Filariasis (blood)</term>
<term>Filariasis (drug therapy)</term>
<term>Filariasis (pathology)</term>
<term>Filaricides (therapeutic use)</term>
<term>Ghana</term>
<term>Humans</term>
<term>Kaplan-Meier Estimate</term>
<term>Leg (pathology)</term>
<term>Lymphatic filariasis</term>
<term>Lymphedema</term>
<term>Lymphedema (blood)</term>
<term>Lymphedema (drug therapy)</term>
<term>Lymphedema (parasitology)</term>
<term>Lymphedema (pathology)</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Skin (diagnostic imaging)</term>
<term>Skin (pathology)</term>
<term>Statistics, Nonparametric</term>
<term>Ultrasonography</term>
<term>Vascular Endothelial Growth Factor Receptor-3 (blood)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term>
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Amoxicilline (usage thérapeutique)</term>
<term>Cheville (anatomopathologie)</term>
<term>Cheville (imagerie diagnostique)</term>
<term>Doxycycline (usage thérapeutique)</term>
<term>Estimation de Kaplan-Meier</term>
<term>Femelle</term>
<term>Filaricides (usage thérapeutique)</term>
<term>Filarioses (anatomopathologie)</term>
<term>Filarioses (sang)</term>
<term>Filarioses (traitement médicamenteux)</term>
<term>Ghana</term>
<term>Humains</term>
<term>Jambe (anatomopathologie)</term>
<term>Lymphoedème (anatomopathologie)</term>
<term>Lymphoedème (parasitologie)</term>
<term>Lymphoedème (sang)</term>
<term>Lymphoedème (traitement médicamenteux)</term>
<term>Mâle</term>
<term>Peau (anatomopathologie)</term>
<term>Peau (imagerie diagnostique)</term>
<term>Récepteur-3 au facteur croissance endothéliale vasculaire (sang)</term>
<term>Statistique non paramétrique</term>
<term>Échographie</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Vascular Endothelial Growth Factor Receptor-3</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Amoxicillin</term>
<term>Doxycycline</term>
<term>Filaricides</term>
</keywords>
<keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Cheville</term>
<term>Filarioses</term>
<term>Jambe</term>
<term>Lymphoedème</term>
<term>Peau</term>
</keywords>
<keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Filariasis</term>
<term>Lymphedema</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Ankle</term>
<term>Skin</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Filariasis</term>
<term>Lymphedema</term>
</keywords>
<keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Cheville</term>
<term>Peau</term>
</keywords>
<keywords scheme="MESH" qualifier="parasitologie" xml:lang="fr"><term>Lymphoedème</term>
</keywords>
<keywords scheme="MESH" qualifier="parasitology" xml:lang="en"><term>Lymphedema</term>
</keywords>
<keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Ankle</term>
<term>Filariasis</term>
<term>Leg</term>
<term>Lymphedema</term>
<term>Skin</term>
</keywords>
<keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Filarioses</term>
<term>Lymphoedème</term>
<term>Récepteur-3 au facteur croissance endothéliale vasculaire</term>
</keywords>
<keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Filarioses</term>
<term>Lymphoedème</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Amoxicilline</term>
<term>Doxycycline</term>
<term>Filaricides</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adolescent</term>
<term>Adult</term>
<term>Female</term>
<term>Ghana</term>
<term>Humans</term>
<term>Kaplan-Meier Estimate</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Statistics, Nonparametric</term>
<term>Ultrasonography</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Adolescent</term>
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Estimation de Kaplan-Meier</term>
<term>Femelle</term>
<term>Ghana</term>
<term>Humains</term>
<term>Lymphoedème</term>
<term>Filariose lymphatique</term>
<term>Doxycycline</term>
<term>Antibactérien</term>
<term>Antibiotique</term>
<term>Mâle</term>
<term>Statistique non paramétrique</term>
<term>Échographie</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Antibiotique</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">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 block-wise 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. Clinical Trials Registration. ISRCTN 90861344.</div>
</front>
</TEI>
<affiliations><list><country><li>Allemagne</li>
<li>Ghana</li>
<li>Royaume-Uni</li>
</country>
</list>
<tree><noCountry><name sortKey="Adjei, Ohene" sort="Adjei, Ohene" uniqKey="Adjei O" first="Ohene" last="Adjei">Ohene Adjei</name>
</noCountry>
<country name="Allemagne"><noRegion><name sortKey="Mand, Sabine" sort="Mand, Sabine" uniqKey="Mand S" first="Sabine" last="Mand">Sabine Mand</name>
</noRegion>
<name sortKey="Belda Domene, Aurea" sort="Belda Domene, Aurea" uniqKey="Belda Domene A" first="Aurea" last="Belda-Domene">Aurea Belda-Domene</name>
<name sortKey="Fimmers, Rolf" sort="Fimmers, Rolf" uniqKey="Fimmers R" first="Rolf" last="Fimmers">Rolf Fimmers</name>
<name sortKey="Hoerauf, Achim" sort="Hoerauf, Achim" uniqKey="Hoerauf A" first="Achim" last="Hoerauf">Achim Hoerauf</name>
<name sortKey="Klarmann, Ute" sort="Klarmann, Ute" uniqKey="Klarmann U" first="Ute" last="Klarmann">Ute Klarmann</name>
<name sortKey="Klarmann, Ute" sort="Klarmann, Ute" uniqKey="Klarmann U" first="Ute" last="Klarmann">Ute Klarmann</name>
<name sortKey="Specht, Sabine" sort="Specht, Sabine" uniqKey="Specht S" first="Sabine" last="Specht">Sabine Specht</name>
</country>
<country name="Ghana"><noRegion><name sortKey="Yaw Debrah, Alexander" sort="Yaw Debrah, Alexander" uniqKey="Yaw Debrah A" first="Alexander" last="Yaw Debrah">Alexander Yaw Debrah</name>
</noRegion>
<name sortKey="Batsa, Linda" sort="Batsa, Linda" uniqKey="Batsa L" first="Linda" last="Batsa">Linda Batsa</name>
<name sortKey="Kwarteng, Alexander" sort="Kwarteng, Alexander" uniqKey="Kwarteng A" first="Alexander" last="Kwarteng">Alexander Kwarteng</name>
<name sortKey="Marfo Debrekyei, Yeboah" sort="Marfo Debrekyei, Yeboah" uniqKey="Marfo Debrekyei Y" first="Yeboah" last="Marfo-Debrekyei">Yeboah Marfo-Debrekyei</name>
</country>
<country name="Royaume-Uni"><noRegion><name sortKey="Taylor, Mark" sort="Taylor, Mark" uniqKey="Taylor M" first="Mark" last="Taylor">Mark Taylor</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

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Doxycycline Improves Filarial Lymphedema Independent of Active Filarial Infection: A Randomized Controlled Trial

Doxycycline Improves Filarial Lymphedema Independent of Active Filarial Infection: A Randomized Controlled Trial

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