Effects of Ivermectin with and without doxycycline on clinical symptoms of onchocerciasis.

OBJECTIVE To compare and analyze the effects of ivermectin with combined therapy of doxycycline and ivermectin on clinical symptoms of onchocerciasis. STUDY DESIGN Randomized, comparative trial without blinding, a quasi-experimental study. PLACE AND DURATION OF STUDY Tubmenburg City (Bomy County) of Liberia, from March to December 2005. METHODOLOGY Two hundred and forty black local patients were included in clinical trial after recording their informed consent. Inclusion criteria was history of exposure to black fly in endemic area, symptoms of generalized and ocular itching, visual impairment associated with pannus and perilimbal pigmentation, punctuate/sclerosing keratitis, iridocyclitis, chorioretinitis, optic atrophy, lesions suggestive of onchodermatitis and subcutaneous nodules. Patients suffering from allergic conjunctivitis, history of measles and rubella, pregnant / breast-feeding women and children under 16 years of age were excluded from the study. The patients were randomly placed into two groups. Group I (120 patients) was treated with ivermectin in a single dose of 150 microg/kg orally. Group II (120 patients) was treated with combined therapy of doxycycline 100 mg/day for 6 weeks followed by ivermectin in a single dose of 150 microg/kg orally. Topical steroid-antibiotic combination was given to patients of both groups where indicated. Follow-up was carried out for 6 months. Improvement or progression of clinical features was recorded on each visit. Results were compiled and analysed by SPSS 10.0 using Chi-square test. RESULTS Eighty four patients (70%) of group I and 117 (98%) patients of group II responded to treatment, with improvement in onchocerciasis clinical symptoms (p < 0.05). Pannus, punctuate keratitis and iridocyclitis healed in all patients, whereas irreversible eye lesions like sclerosing keratitis and optic atrophy did not respond to treatment in either group. CONCLUSION There was a significantly greater relief in patients of group II treated with a combination of doxycycline and ivermectin as compared to those patients who were treated with ivermectin alone.