Doxycycline to improve filarial lymphedema (LEDoxy Ghana)
| ISRCTN | ISRCTN14042737 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN14042737 |
| Protocol serial number | TAKeOFF-4-0117 |
| Sponsor | Kumasi Centre for Collaborative Research (KCCR) |
| Funder | Research Networks for Health Innovations in Sub-Saharan Africa sponsored by the Federal Ministry of Education and Research (BMBF), Germany |
- Submission date
- 10/07/2017
- Registration date
- 17/07/2017
- Last edited
- 03/12/2024
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Infections and Infestations
Plain English summary of protocol
Current plain English summary as of 25/11/2021:
Background and study aims
Lymphatic filariasis is a parasitic disease caused by microscopic, thread-like worms that infect the lymph system, resulting in fluid collection and swelling (lymphedema). Current lymphedema treatment is based on the use of simple measures of hygiene (regular washing with soap and water, skin and nail care), use of topical antibiotics or antifungal agents, exercise and footwear. This is considered the "standard of care" and has been shown to reduce the frequency of acute attacks that drive the progression of lymphedema. In two previous studies doxycycline 200 mg was given to patients with lymphedema for 6 weeks. This oral antibiotic treatment led to improvement or halt of the progression of the lymphedema in most of the treated patients despite active infection with worms that cause lymphatic filariasis. In order to expand the benefits of this observation to more people affected by this disease, similar studies are needed to confirm the earlier results so that doxycycline treatment can be introduced into current treatment programmes. This study takes place in Ghana and is one of five studies that have the aim to confirm the effect of doxycycline 200 mg for 6 weeks. The other four studies are carried out in Mali, Sri Lanka, India and Tanzania. While the three studies in Mali, Sri Lanka and India compare doxycycline 200 mg for 6 weeks versus a placebo (dummy drug) matching doxycycline (both treatments on top of standard methods of hygiene), the two studies in Ghana and Tanzania have the additional aim to find out whether a lower dose of doxycycline of 100 mg is equally beneficial.
Who can participate?
Patients aged 14 – 65 with a lymphedema of the leg
What does the study involve?
Participants with lymphedema stage 1-3 are randomly allocated to be treated with either doxycycline 200 mg, doxycycline 100 mg or a placebo for 6 weeks, and participants with lymphedema stage 4-6 are randomly allocated to receive doxycycline 200 mg or a placebo for 6 weeks. All treatments are given in addition to the standard methods of hygiene and mass drug administration (ivermectin 200 µg/kg plus albendazole 400 mg) in areas where this is still ongoing. At the start of the study and 6, 12, 18 and 24 months later, participants undergo measurements of the leg. A questionnaire about the occurrence of acute attacks is carried out every 2 months after treatment onset. Participants also undergo lymphedema management training at the start of the study and after 4, 6, 12, 18 and 24 months.
All people who were were seen by the team at study start (those who received treatment and those who had to be excluded) will be asked to consent to an additional follow-up around three years after treatment start which will consist of similar procedures as the follow-up after 24 months. In addition, we will ask some questions related to COVID-19. All participants will receive another round of lymphedema management training including the necessary supplies.
What are the possible benefits and risks of participating?
Benefits to the participant include thorough medical evaluation, intensified hygiene training, free supplies for local care of lymphedema and free medical treatment for common illnesses during the treatment period and follow-up. The risks to participants are side effects caused by the licensed study drug doxycycline and infection during blood sampling. In the event of side effects caused by the study drugs or treatments, participants are treated and followed up by the research team until they are resolved.
Where is the study run from?
Kumasi Centre for Collaborative Research (KCCR) (Ghana)
When is the study starting and how long is it expected to run for?
January 2017 to August 2020
Who is funding the study?
Research Networks for Health Innovations in Sub-Saharan Africa sponsored by the Federal Ministry of Education and Research (BMBF) (Germany)
Who is the main contact?
Dr Alexander Yaw Debrah
yadebrah@yahoo.com
Previous plain English summary:
Background and study aims
Lymphatic filariasis is a parasitic disease caused by microscopic, thread-like worms that infect the lymph system, resulting in fluid collection and swelling (lymphedema). Current lymphedema treatment is based on the use of simple measures of hygiene (regular washing with soap and water, skin and nail care), use of topical antibiotics or antifungal agents, exercise and footwear. This is considered the "standard of care" and has been shown to reduce the frequency of acute attacks that drive the progression of lymphedema. In two previous studies doxycycline 200 mg was given to patients with lymphedema for 6 weeks. This oral antibiotic treatment led to improvement or halt of the progression of the lymphedema in most of the treated patients despite active infection with worms that cause lymphatic filariasis. In order to expand the benefits of this observation to more people affected by this disease, similar studies are needed to confirm the earlier results so that doxycycline treatment can be introduced into current treatment programmes. This study takes place in Ghana and is one of five studies that have the aim to confirm the effect of doxycycline 200 mg for 6 weeks. The other four studies are carried out in Mali, Sri Lanka, India and Tanzania. While the three studies in Mali, Sri Lanka and India compare doxycycline 200 mg for 6 weeks versus a placebo (dummy drug) matching doxycycline (both treatments on top of standard methods of hygiene), the two studies in Ghana and Tanzania have the additional aim to find out whether a lower dose of doxycycline of 100 mg is equally beneficial.
Who can participate?
Patients aged 14 – 65 with a lymphedema of the leg
What does the study involve?
Participants with lymphedema stage 1-3 are randomly allocated to be treated with either doxycycline 200 mg, doxycycline 100 mg or a placebo for 6 weeks, and participants with lymphedema stage 4-6 are randomly allocated to receive doxycycline 200 mg or a placebo for 6 weeks. All treatments are given in addition to the standard methods of hygiene and mass drug administration (ivermectin 200 µg/kg plus albendazole 400 mg) in areas where this is still ongoing. At the start of the study and 6, 12, 18 and 24 months later, participants undergo measurements of the leg. A questionnaire about the occurrence of acute attacks is carried out every 2 months after treatment onset. Participants also undergo lymphedema management training at the start of the study and after 4, 6, 12, 18 and 24 months.
What are the possible benefits and risks of participating?
Benefits to the participant include thorough medical evaluation, intensified hygiene training, free supplies for local care of lymphedema and free medical treatment for common illnesses during the treatment period and follow-up. The risks to participants are side effects caused by the licensed study drug doxycycline and infection during blood sampling. In the event of side effects caused by the study drugs or treatments, participants are treated and followed up by the research team until they are resolved.
Where is the study run from?
Kumasi Centre for Collaborative Research (KCCR) (Ghana)
When is the study starting and how long is it expected to run for?
January 2017 to August 2020
Who is funding the study?
Research Networks for Health Innovations in Sub-Saharan Africa sponsored by the Federal Ministry of Education and Research (BMBF) (Germany)
Who is the main contact?
Dr Alexander Yaw Debrah
yadebrah@yahoo.com
Contact information
Public
Faculty of Allied Health Sciences
Kwame Nkrumah University of Science and Technology
Kumasi
00000
Ghana
| Phone | +233 (0)3220 60351 |
|---|---|
| yadebrah@yahoo.com |
Scientific
Institute for Medical Microbiology, Immunology and Parasitology
University Hospital of Bonn
Sigmund-Freud-Str. 25
Bonn
53105
Germany
| Phone | +49 (0)228 28715673 |
|---|---|
| achim.hoerauf@ukbonn.de |
Study information
| Primary study design | Interventional |
|---|---|
| Study design | Multi-national interventional randomized double-blind placebo-controlled phase II trial |
| Secondary study design | Randomised controlled trial |
| Study type | Participant information sheet |
| Scientific title | Doxycycline 200 mg/d vs 100 mg/d for 6 weeks to improve filarial lymphedema: a multi-national, double-blind, randomized, placebo-controlled trial |
| Study acronym | TAKeOFF - LEDoxy |
| Study objectives | Group A (LE stage 1-3): 1. To confirm the efficacy of a 6-week course of daily doxycycline 200 mg on lack of progression of filarial lymphedema (LE) 2. To reduce the dosage of doxycycline from 200 mg/d to 100 mg/d for 6 weeks for the treatment of filarial LE Group B (LE stage 4-6): 1. To show efficacy of a 6-week course of daily doxycycline 200 mg on lack of progression of filarial LE |
| Ethics approval(s) | Current ethics approval as of 25/11/2021: 1. Approved 24/10/2017; approval for first amendment: 13/04/2018; approval for 3 year-follow up 10/11/2021; The Committee for Human Research, Publication and Ethics (CHRPE) of the Kwame Nkrumah University of Science and Technology (KNUST) (Kumasi, Ghana), ref: CHRPE/AP/535/21 2. Approved 13/12/2017; approval for first amendment: 31/05/2018; The Ghana Health Service Ethics Review Committee (GHS-ERC), Accra, Ghana 3. Approved 15/02/2018; approval for first amendment: 18/06/2018; The Ghana Food and Drug Authority (Ghana FDA), Accra, Ghana 4. Approved 06/12/2017; approval for first amendment: 08/05/2018; approval for 3 year-follow up 05/11/2021; The Ethikkommission an der Medizinischen Fakultät der Rheinischen Friedrich-Wilhelms-Universität Bonn (Bonn, Germany), ref: 325/21 Previous ethics approval: 1. The Committee for Human Research, Publication and Ethics (CHRPE) of the Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana: approval for first submission: 24/10/2017; approval for first amendment: 13/04/2018 2. The Ghana Health Service Ethics Review Committee (GHS-ERC), Accra, Ghana: approval for first submission: 13/12/2017; approval for first amendment: 31/05/2018 3. The Ghana Food and Drug Authority (Ghana FDA), Accra, Ghana: approval for first submission: 15/02/2018; approval for first amendment: 18/06/2018 4. The Ethikkommission an der Medizinischen Fakultät der Rheinischen Friedrich-Wilhelms-Universität Bonn, Bonn, Germany: approval for first submission: December 6, 2017; approval for first amendment: 08/05/2018 |
| Health condition(s) or problem(s) studied | Lymphatic filariasis (LF) |
| Intervention | Current intervention as of 25/11/2021: The study involves daily observed treatment with either doxycycline 200 mg for 6 weeks, doxycycline 100 mg for 6 weeks or placebo matching doxycycline for 6 weeks (42 days). Participants with lymphedema stage 1-3 will be randomized (block randomisation) to one of the three treatment regimens, participants with lymphedema stage 4-6 will receive either doxycycline 200 mg or placebo matching doxycycline. 1. DOX 200: doxycycline 200 mg/d for 6 weeks (2 100 mg tablets/day orally) on top of standard MDA (ivermectin 200 µg/kg plus albendazole 400 mg once a year) 2. Placebo (control): placebo matching doxycycline for 6 weeks (2 tablets/day orally) on top of standard MDA (ivermectin 200 µg/kg plus albendazole 400 mg once a year) 3. DOX 100 (additional arm for group A [LE stage 1-3]): doxycycline 100mg/d for 6 weeks (1 tablet 100 mg doxycycline/day plus 1 tablet placebo matching doxycycline orally) on top of standard MDA (ivermectin 200 µg/kg plus albendazole 400 mg once a year) Treatment will be administered ad personam by the trial clinician directly in the villages in the form of daily observed treatment (DOT). All treatment regimens will be administered on top of the standardized methods of hygiene ("standard of care") and on top of standard mass drug administration (MDA; ivermectin 200 µg/kg plus albendazole 400 mg) in areas where MDA is still ongoing. Treatment will be carried out in a blinded manner, meaning that neither the patients nor the caregiver will know to which treatment arm the patients belong. At baseline as well as 6, 12, 18 and 24 months after treatment onset, participants will undergo lymphedema-specific measurements (circumference measurements of the leg, volume measurement of the legs. A questionnaire regarding the occurrence of acute attacks (ADLA) will be carried out every 2 months after treatment onset. Participants will also undergo lymphedema management training at baseline and after 4, 6, 12, 18 and 24 months. Around three years after treatment onset, participants who consent in a separate form will again undergo lymphedema-specific measurements (staging, circumference measurements of the leg, volume measurement of the legs). A questionnaire regarding the occurrence of acute attacks (ADLA) and about hygiene and lymphedema management will be carried out. Participants will also be asked about symptoms related to COVID-19 and their history of infection and vaccination with SARS-CoV-2. Blood and urine will only be sampled from participants who were included in the trial for treatment. Participants will also undergo another lymphedema management training. Previous intervention as of 03/08/2018: The study involves daily observed treatment with either doxycycline 200 mg for 6 weeks, doxycycline 100 mg for 6 weeks or placebo matching doxycycline for 6 weeks (42 days). Participants with lymphedema stage 1-3 will be randomized (block randomisation) to one of the three treatment regimens, participants with lymphedema stage 4-6 will receive either doxycycline 200 mg or placebo matching doxycycline. 1. DOX 200: doxycycline 200 mg/d for 6 weeks (2 100 mg tablets/day orally) on top of standard MDA (ivermectin 200 µg/kg plus albendazole 400 mg once a year) 2. Placebo (control): placebo matching doxycycline for 6 weeks (2 tablets/day orally) on top of standard MDA (ivermectin 200 µg/kg plus albendazole 400 mg once a year) 3. DOX 100 (additional arm for group A [LE stage 1-3]): doxycycline 100mg/d for 6 weeks (1 tablet 100 mg doxycycline/day plus 1 tablet placebo matching doxycycline orally) on top of standard MDA (ivermectin 200 µg/kg plus albendazole 400 mg once a year) Treatment will be administered ad personam by the trial clinician directly in the villages in the form of daily observed treatment (DOT). All treatment regimens will be administered on top of the standardized methods of hygiene ("standard of care") and on top of standard mass drug administration (MDA; ivermectin 200 µg/kg plus albendazole 400 mg) in areas where MDA is still ongoing. Treatment will be carried out in a blinded manner, meaning that neither the patients nor the caregiver will know to which treatment arm the patients belong. Current as of 03/08/2018: At baseline as well as 6, 12, 18 and 24 months after treatment onset, participants will undergo lymphedema-specific measurements (circumference measurements of the leg, volume measurement of the legs. A questionnaire regarding the occurrence of acute attacks (ADLA) will be carried out every 2 months after treatment onset. Participants will also undergo lymphedema management training at baseline and after 4, 6, 12, 18 and 24 months. Previous: At baseline as well as 6, 12 and 24 months after treatment onset, participants will undergo lymphedema-specific measurements (circumference measurements of the leg, volume measurement of the legs, ultrasound measurement of the skin thickness at the ankles). A questionnaire regarding the occurrence of acute attacks (ADLA) will be carried out every 2 months after treatment onset. Participants will also undergo lymphedema management training at baseline and after 4, 6, 12, 18 and 24 months. |
| Intervention type | Drug |
| Phase | Phase II |
| Drug / device / biological / vaccine name(s) | Doxycycline, ivermectin, albendazole |
| Primary outcome measure(s) |
Current primary outcome measure as of 25/11/2021: |
| Key secondary outcome measure(s) |
Current secondary outcome measures as of 25/11/2021: |
| Completion date | 20/08/2020 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Mixed |
| Sex | All |
| Target sample size at registration | 420 |
| Total final enrolment | 420 |
| Key inclusion criteria | 1. Lymphedema of at least one leg grade 1-6 measured on a 7-point scale [3] 2. Age ≥ 14 years and ≤ 65 years 3. Men or non-pregnant women. If women of childbearing-potential, they must use an approved, effective method of contraception (including abstinence) before, during and for at least 2 weeks after the completion of the active intervention with doxycycline or placebo 4. Negative pregnancy test 5. Body weight ≥ 40 kg 6. Resident in LF endemic area for ≥ 2 years 7. Able and willing to give informed consent/ to provide assent to participate in the trial 8. Ability to use established standardized methods of hygiene and effectively applying it prior to the initiation of the drug treatment |
| Key exclusion criteria | 1. No lymphedema or lymphedema stage 7 2. Age < 14 years or > 65 years 3. Body weight < 40 kg 4. Pregnant or breastfeeding women 5. Women of childbearing potential not using an agreed method of contraception (including abstinence; oral contraceptives are not allowed because of interaction with trial drugs) 6. Clinical or biologic evidence of hepatic or renal dysfunction or disease of the central nervous system (CNS) 7. Evidence of severe comorbidities except for features of filarial disease 8. Alcohol or drug abuse 9. History of adverse reactions to doxycycline or other tetracyclines 10. Any significant condition (including medical and psychological/ psychiatric disorder) which in the opinion of the study investigator might interfere with the conduct of the study 11. History of photosensitivity reactions after taking drugs. 12. Concomitant medication with antacids containing aluminium, magnesium or sucralfate and not able to discontinue 13. Concomitant medication with other antibiotics than doxycycline and not able to discontinue 14. Concomitant medication with diuretics or sulfonylurea 15. Concomitant medication with coumarin 16. Haemoglobin < 8 gm/dL 17. Neutrophil count <2000/mm3 - Updated 03/08/2018: Neutrophil count < 1100/mm3 18. Platelet count <100 000/mm3 19. Creatinine > 2 times upper limit of normal 20. AST (GOT) > 2 times upper limit of normal 21. ALT (GPT) > 2 times upper limit of normal 22. Gamma-GT > 2 times upper limit of normal 23. Positive urine pregnancy test |
| Date of first enrolment | 12/03/2018 |
| Date of final enrolment | 21/07/2018 |
Locations
Countries of recruitment
- Ghana
Study participating centre
Kumasi
00000
Ghana
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|---|
| IPD sharing plan summary | Not expected to be made available |
| IPD sharing plan | The datasets generated during and/or analysed during the current study are not expected to be made available as consent was not provided for this. |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Results article | 01/10/2024 | 03/12/2024 | Yes | No | |
| Protocol article | protocol | 30/03/2020 | 02/04/2020 | Yes | No |
| Participant information sheet | Participant information sheet | 11/11/2025 | 11/11/2025 | No | Yes |
Editorial Notes
03/12/2024: The following changes were made to the trial record:
1. Publication reference added.
2. The participant level data sharing statement was added.
19/01/2023: The following changes have been made:
1. The overall trial end date has been changed from 31/12/2021 to 20/08/2020.
2. The intention to publish date was changed from 31/12/2021 to 30/04/2023.
25/11/2021: The following changes have been made:
1. The overall trial end date has been changed from 20/08/2020 to 31/12/2021.
2. The ethics approval has been updated.
3. The intervention has been updated.
4. The primary outcome measure has been updated.
5. The secondary outcome measures have been updated.
6. The plain English summary has been updated.
01/12/2020: The following changes were made to the trial record:
1. The overall trial end date was changed from 31/12/2020 to 20/08/2020.
2. The total final enrolment was added.
02/04/2020: Publication reference added.
03/08/2018: The following changes were made to the trial record:
1. The ethics approval details were added.
2. The interventions, secondary outcome measures and exclusion criteria were updated.
3. The overall trial end date was changed from 30/06/2020 to 31/12/2020.
4. The recruitment start date was changed from 01/11/2017 to 12/03/2018.
5. The recruitment end date was changed from 31/05/2018 to 21/07/2018.
