A clinical trial is being launched in three African countries of a drug that could eliminate onchocerciasis, or river blindness, one of the leading infectious causes of blindness across Africa. The drug, moxidectin, is being investigated for its potential to kill or sterilize the adult worms of Onchocerca volvulus, which cause onchocerciasis.
“This is a devastating illness that has plagued 30 African countries for centuries, in particular the populations in the most remote areas ‘beyond the end of the road’,” says Dr Uche Amazigo, Director of the African Programme for Onchocerciasis Control (APOC). “Over 100 million people are at risk of infection with onchocerciasis in Africa and a few small areas in the Americas and Yemen.”
Onchocerciasis is also called river blindness because the blackfly which transmits the disease breeds in fast flowing rivers, and blindness is the most incapacitating symptom of the disease which also causes debilitating skin disease.
The development of moxidectin for onchocerciasis is being conducted through a collaboration of the Special Programme for Research and Training in Tropical Diseases, which is executed by the World Health Organization (WHO/TDR), and Wyeth Pharmaceuticals. The work ranges from the development of a formulation for human use and initial studies in healthy volunteers, to clinical studies and community studies in Africa. WHO/TDR, working in partnership with African investigators and institutions, is building the capacity and managing the conduct of the clinical trials conducted in Africa. If the development is successful and results in a positive scientific opinion from the European Medicines Evaluation Agency, Wyeth, with the assistance of WHO, will request approval by national regulatory authorities in the countries where onchocerciasis is endemic.
Dr Henrietta Ukwu, Vice President, Wyeth Pharmaceuticals, says, “Wyeth is committed to improving access to innovative drugs and biologics around the globe including in the developing world. The moxidectin data have been promising so far, and as the programme moves into larger phase III studies, we are hopeful that moxidectin will constitute a significant advance against this devastating disease.”
In conducting this trial, TDR will be working with African investigators and institutions. Fifteen hundred people at 4 sites in Ghana, Liberia and the Democratic Republic of Congo will be enrolled in the study. Preparation has been ongoing since 2007, and included building a clinical research centre in Lofa County, Liberia, and in Nord-Kivu in the Democratic Republic of Congo (DRC). Buildings not used since the war in Ituri, DRC, have been renovated. All centers have been provided with necessary equipment and the research teams trained on how to conduct the trial according to international standards.
Dr Robert Ridley, TDR’s director, says, “We work with national authorities and country partners to build research capacity and infrastructure. The training we provide to researchers and health care professionals and the experience they gather during the TDR sponsored studies enables them to conduct other clinical research later on, strengthening the health research systems in those countries.”
The trial will take place over the next two and a half years. Currently, the disease is controlled by ivermectin, which has been donated for more than 20 years by the pharmaceutical company Merck & Co., Inc., for use in onchocerciasis endemic countries. Treatment with ivermectin has enabled significant progress in the control of onchocerciasis, and currently reaches more than 60 million people in Africa annually. However, ivermectin kills the O. volvulus larvae but not the adult worms, so annual treatments for an extended period of time (at least 11-14 years) are required to ensure disease control. If moxidectin kills not only the larvae but also sterilizes or kills the adult worms, it has the potential to interrupt the disease transmission cycle within around 6 annual rounds of treatment. The drug could be distributed through the community-directed mechanisms set up in collaboration among APOC, African control programmes, and NGOs for the distribution of ivermectin.
Jamie Guth, TDR Communications Manager, Tel. +41 79 441 2289, email: email@example.com
The Special Programme for Research and Training in Tropical Diseases (TDR) is a global programme of scientific collaboration established in 1975, sponsored by the United Nations Children’s Fund, United Nations Development Programme, World Bank and World Health Organization, and administered by WHO in Geneva, Switzerland. Its focus is on working with institutions in low and middle income countries on research into neglected diseases of the poor, with the goal of improving existing approaches and developing new ways to prevent, diagnose, treat and control these diseases. For more information, visit: www.who.int/tdr
The African Programme for Onchocerciasis Control (APOC) is a collaboration between governments, multilateral and bilateral agencies, foundations, non-governmental development organizations (NGDOs), affected communities, the scientific community and the private sector. The objective of the APOC Phase II and Phasing out Period (2008-2015) “is to establish, within a period of 12 to 15 years, effective, self-sustainable, community-directed treatment with ivermectin throughout the endemic areas within the geographic scope of the Programme, develop the evidence base and assist countries to determine when and where ivermectin treatment can be stopped, and, if possible, in selected and isolated foci, to eradicate the vector, by using environmentally safe methods. The World Bank is the fiscal agent and the World Health Organization (WHO) is the executing agency of APOC, providing administrative, technical and operational research support. For more information, visit: www.who.int/apoc
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