The recommended treatment for elimination of LF in sub-Saharan Africa is annual mass drug
administration (MDA) with single dose Albendazole (ALB) plus Ivermectin (IVM) given for at
least 5-7 years. However, in areas where LF is co-endemic with a related filarial parasite,
Loa loa, co-infection with L. loa represents a serious barrier to LF elimination because IVM
used in LF MDA can result in severe reactions and even death in individuals with high
microfilaria (mf) levels of L. loa. Screening for heavy L. loa infection is problematic. To
overcome this problem, monotherapy with ALB is possible, since this drug has little or no
effect on circulating mf and thus would not cause adverse effects in people with heavy L. loa
infections. Moreover ALB has been shown to have embryostatic or embryocidal effects in female
adult worms resulting in decreased mf levels with time as natural attrition of circulating mf
occurs. Thus this open-label, randomized clinical trial will examine treatment with ALB
monotherapy administered twice per year over a period of 3 years with the primary endpoint
being the proportion of individuals with total clearance of mf at 36 months and Alere antigen
test negativity (a more sensitive circulating antigen test of filarial infection). Two of the
treatment arms will include ALB at two different doses, 400mg or 800mg (fixed dose twice
yearly) as compared to standard treatment of ALB (400 mg) plus IVM (150-200 µg/kg)
administered annually. Observations from an ongoing clinical trial in Papua New Guinea
suggest that a single dose of triple therapy with ALB + IVM + DEC may be highly effective in
sterilizing adult female worms. Therefore to confirm and expand these important preliminary
observations in a different population, a fourth arm will be included in the current clinical
trial in which subjects will receive all three drugs. The clinical trial will be performed in
a region of Cote d'Ivoire where onchocerciasis and loiasis are not endemic.