Discussion
microfilaraemia, encephalopathy, albendazole-based
ENCEPHALOPATHY, LOIASIS, ALCOHOL WITHDRAWAL SYNDROME
Safe and effective treatment regimens that can be used without specific biological monitoring of patients are necessary for the development of drug-based control programs for loiasis. Currently albendazole based drug regimens that are known to be relatively safe in gradually reducing microfilarial load are the only viable options due to safety concerns for the use of DEC and ivermectin when used without detailed biological screening and close follow-up in patients with loiasis [This clinical trial systematically assessed the parasitological outcomes of three different albendazole-based regimens on Overall all treatment regimens proved safe and well tolerated in this relatively small clinical trial. One SAE was retrospectively judged to be associated with an undisclosed alcohol withdrawal syndrome and no other significant safety findings where observed. Various manifestations have been attributed to loiasis including and a probable case of encephalopathy due to loiasis in the absence of any treatment [The transient increase in liver transaminases and increases in relative eosinophil counts paralleled by a modest reduction of haemoglobin during the active treatment period are well-described reversible side effects of high dose albendazole therapy [It is remarkable that the study population was rather old with a median age above 60 years. This finding is at least partly explained by the fact that older individuals are overrepresented in rural Gabonese villages compared to the national average and that the prevalence of loiasis and to a certain extent the level of microfilaraemia increases with age in our setting. In addition, the professional activities of rural populations may have discouraged participation in this clinical trial due to a demanding study schedule and a prolonged follow up period. The main limitation of this study is its descriptive study design with the limited number of participants included precluding formal statistical comparison between treatment groups in this proof of concept trial. Whereas this study systematically describes the effect of the treatment regimens over a 6-month period, no further conclusions may be drawn for a longer duration of the effect beyond the 6-month follow-up period. Similarly, only a fraction of participants has reached the pre-specified threshold of 100mf/ml, which was set as measure to reduce onwards transmission of loiasis. Further epidemiological and experimental data on the infectivity of loiasis at respective microfilarial loads are required to corroborate robust endpoints for clinical trials aiming at reducing loiasis transmission in highly endemic regions [