03929nas a2200577 4500000000100000008004100001260003700042653005700079653002400136653002100160100001600181700001500197700001200212700001500224700001300239700001600252700001100268700001800279700001200297700001400309700002000323700002200343700002200365700002100387700001400408700002300422700002000445700001700465700001300482700001500495700001300510700001200523700001500535700001300550700001300563700001900576700001300595700001400608700001800622700001700640700001300657700001500670700001800685700001300703245019200716856009900908300001301007490000701020520231001027022001403337 2021 d bPublic Library of Science (PLoS) 10 aPublic Health, Environmental and Occupational Health 10 aInfectious Diseases 10 aivermectin (IVM) 1 aJittamala P 1 aMonteiro W 1 aSmit MR 1 aPedrique B 1 aSpecht S 1 aChaccour CJ 1 aDard C 1 aDel Giudice P 1 aKhieu V 1 aMaruani A 1 aFailoc-Rojas VE 1 aSáez-de-Ocariz M 1 aSoriano-Arandes A 1 aPiquero-Casals J 1 aFaisant A 1 aBrenier-Pinchart M 1 aWimmersberger D 1 aCoulibaly JT 1 aKeiser J 1 aBoralevi F 1 aSokana O 1 aMarks M 1 aEngelman D 1 aRomani L 1 aSteer AC 1 avon Seidlein L 1 aWhite NJ 1 aHarriss E 1 aStepniewska K 1 aHumphreys GS 1 aKennon K 1 aGuérin PJ 1 aKobylinski KC 1 aDowns JA 00 aA systematic review and an individual patient data meta-analysis of ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current contraindication? uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0009144&type=printable ae0009144 0 v15 3 a
Background
Oral ivermectin is a safe broad spectrum anthelminthic used for treating several neglected tropical diseases (NTDs). Currently, ivermectin use is contraindicated in children weighing less than 15 kg, restricting access to this drug for the treatment of NTDs. Here we provide an updated systematic review of the literature and we conducted an individual-level patient data (IPD) meta-analysis describing the safety of ivermectin in children weighing less than 15 kg.
Methodology/Principal findings
A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for IPD guidelines by searching MEDLINE via PubMed, Web of Science, Ovid Embase, LILACS, Cochrane Database of Systematic Reviews, TOXLINE for all clinical trials, case series, case reports, and database entries for reports on the use of ivermectin in children weighing less than 15 kg that were published between 1 January 1980 to 25 October 2019. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42017056515. A total of 3,730 publications were identified, 97 were selected for potential inclusion, but only 17 sources describing 15 studies met the minimum criteria which consisted of known weights of children less than 15 kg linked to possible adverse events, and provided comprehensive IPD. A total of 1,088 children weighing less than 15 kg were administered oral ivermectin for one of the following indications: scabies, mass drug administration for scabies control, crusted scabies, cutaneous larva migrans, myiasis, pthiriasis, strongyloidiasis, trichuriasis, and parasitic disease of unknown origin. Overall a total of 1.4% (15/1,088) of children experienced 18 adverse events all of which were mild and self-limiting. No serious adverse events were reported.
Conclusions/Significance
Existing limited data suggest that oral ivermectin in children weighing less than 15 kilograms is safe. Data from well-designed clinical trials are needed to provide further assurance.
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