Abstract
Ivermectin remains the drug of choice against Onchocerca volvulus, the filarial parasite that causes onchocerciasis (river blindness). However, due to the paucity of safety data, pregnant women are currently excluded from ivermectin mass drug administration (MDA) campaigns despite reports of high onchocerciasis prevalence (>30%) in pregnant women. Observational studies suggest that gestational onchocerciasis can induce adverse pregnancy outcomes (miscarriage, stillbirth, prematurity) and jeopardize the offspring's well-being during infancy. At the community level, untreated infected pregnant women constitute a parasitic reservoir and hamper the attainment of the 80% MDA coverage threshold that is required annually to achieve elimination.
The IVERPREG project will implement a clinical trial assessing the real-life safety of ivermectin during pregnancy as well as potential benefits for the offspring. In this open-label trial, onchocerciasis-positive pregnant women will be randomized to either a treatment arm (treated with ivermectin at recruitment) or a control arm (no ivermectin treatment during pregnancy, only at 7 days post-partum). The participants will also be tested for confounding conditions in pregnancy such as anemia, malaria, HIV, and helminthiasis. Outcomes will include pregnancy outcome, child onchocerciasis status, vaccine response, and neurodevelopment at 24 months. Our findings could justify intergrating pregnant women in routine MDA and accelerate elimination.
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