@article{fdi:010048258,
  title = {{I}dentifying sub-optimal responses to ivermectin in the treatment of {R}iver {B}lindness},
  author = {{C}hurcher, {T}. {S}. and {P}ion, {S}{\'e}bastien and {O}sei-{A}tweneboana, {M}. {Y}. and {P}richard, {R}. {K}. and {A}wadzi, {K}. and {B}oussinesq, {M}ichel and {C}ollins, {R}. {C}. and {W}hitworth, {J}. {A}. and {B}asanez, {M}. {G}.},
  editor = {},
  language = {{ENG}},
  abstract = {{I}dentification of drug resistance before it becomes a public health concern requires a clear distinction between what constitutes a normal and a suboptimal treatment response. {A} novel method of analyzing drug efficacy studies in human helminthiases is proposed and used to investigate recent claims of atypical responses to ivermectin in the treatment of {R}iver {B}lindness. {T}he variability in the rate at which {O}nchocerca volvulus microfilariae repopulate host's skin following ivermectin treatment is quantified using an individual-based onchocerciasis mathematical model. {T}he model estimates a single skin repopulation rate for every host sampled, allowing reports of suboptimal responses to be statistically compared with responses from populations with no prior exposure to ivermectin. {S}tatistically faster rates of skin repopulation were observed in 3 {G}hanaian villages (treated 12-17 times), despite the wide variability in repopulation rates observed in ivermectin-naive populations. {A}nother village previously thought to have high rates of skin repopulation was shown to be indistinguishable from the normal treatment response. {T}he model is used to generate testable hypotheses to identify whether atypical rates of skin repopulation by microfilariae could result from low treatment coverage alone or provide evidence of decreased ivermectin efficacy. {F}urther work linking phenotypic poor responses to treatment with parasite molecular genetics markers will be required to confirm drug resistance. {L}imitations of the skin-snipping method for estimating parasite load indicates that changes in the distribution of microfilarial repopulation rates, rather than their absolute values, maybe a more sensitive indicator of emerging ivermectin resistance.},
  keywords = {drug resistance ; helminth parasites ; {O}nchocerca volvulus ; overdispersion},
  booktitle = {},
  journal = {{P}roceedings of the {N}ational {A}cademy of {S}ciences of the {U}nited {S}tates of {A}merica},
  volume = {106},
  numero = {39},
  pages = {16716--16721},
  ISSN = {0027-8424},
  year = {2009},
  DOI = {10.1073/pnas.0906176106},
  URL = {https://www.documentation.ird.fr/hor/fdi:010048258},
}