TY - JOUR
T1 - Effect of anthelmintic treatment on insulin resistance
T2 - A cluster-randomized, placebo-controlled trial in Indonesia
AU - Tahapary, Dicky L.
AU - De Ruiter, Karin
AU - Martin, Ivonne
AU - Brienen, Eric A.T.
AU - Van Lieshout, Lisette
AU - Cobbaert, Christa M.
AU - Soewondo, Pradana
AU - Djuardi, Yenny
AU - Wiria, Aprilianto E.
AU - Houwing-Duistermaat, Jeanine J.
AU - Sartono, Erliyani
AU - Smit, Johannes W.A.
AU - Yazdanbakhsh, Maria
AU - Supali, Taniawati
N1 - Funding Information:
Disclaimer. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Financial support. This work was supported by The Royal Netherlands Academy of Arts and Science (Reference 57-SPIN3-JRP) and Universitas Indonesia (research grant BOPTN 2742/H2.R12/HKP.05.00/2013).
Publisher Copyright:
© Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Background. Emerging evidence suggests that helminth infections are associated with lower insulin resistance (IR). Current deworming programs might remove this helminth-associated protective effect. Therefore, we evaluated the anthelmintic treatment effect on changes in IR. Methods. We conducted a double-blind, household-cluster-randomized, placebo-controlled clinical trial on Flores island, Indonesia, an area endemic for soil-transmitted helminths (STHs). All subjects received 4 rounds of albendazole or matching placebo with 3-month intervals, for 3 consecutive days. The primary outcome was the change in homeostatic model assessment of IR in those aged >16 years. An intention-to-treat analysis was performed involving all subjects and ad hoc in the helminth-infected subjects. Results. We examined 797 (in 329 households) and 872 (in 353 households) subjects, who were assigned randomly into the albendazole and placebo arms, respectively. Albendazole was associated with a significant reduction in STH prevalence, total immunoglobulin E (IgE), and eosinophil count. Whereas albendazole had no effect on IR (estimated treatment effect, 0.006 [95% confidence interval, -.010 to .021]; P = .48) at the community level, it was associated with a significant increase in IR (estimated treatment effect, 0.031 [95% confidence interval, .004 to .059]; P = .04) (P value for interaction = .01) among helminth-infected subjects as detected by microscopy. Pathway analysis suggested that this might in part be due to an increased body mass index or a reduced eosinophil count. Conclusions. Anthelmintic treatment reduces STH prevalence, total IgE, and eosinophil count but has no effect on IR at the community level. In helminth-infected subjects, treatment significantly increases IR, highlighting the need for metabolic health monitoring with ongoing deworming programs. Clinical Trials Registration. ISRCTN 75636394.
AB - Background. Emerging evidence suggests that helminth infections are associated with lower insulin resistance (IR). Current deworming programs might remove this helminth-associated protective effect. Therefore, we evaluated the anthelmintic treatment effect on changes in IR. Methods. We conducted a double-blind, household-cluster-randomized, placebo-controlled clinical trial on Flores island, Indonesia, an area endemic for soil-transmitted helminths (STHs). All subjects received 4 rounds of albendazole or matching placebo with 3-month intervals, for 3 consecutive days. The primary outcome was the change in homeostatic model assessment of IR in those aged >16 years. An intention-to-treat analysis was performed involving all subjects and ad hoc in the helminth-infected subjects. Results. We examined 797 (in 329 households) and 872 (in 353 households) subjects, who were assigned randomly into the albendazole and placebo arms, respectively. Albendazole was associated with a significant reduction in STH prevalence, total immunoglobulin E (IgE), and eosinophil count. Whereas albendazole had no effect on IR (estimated treatment effect, 0.006 [95% confidence interval, -.010 to .021]; P = .48) at the community level, it was associated with a significant increase in IR (estimated treatment effect, 0.031 [95% confidence interval, .004 to .059]; P = .04) (P value for interaction = .01) among helminth-infected subjects as detected by microscopy. Pathway analysis suggested that this might in part be due to an increased body mass index or a reduced eosinophil count. Conclusions. Anthelmintic treatment reduces STH prevalence, total IgE, and eosinophil count but has no effect on IR at the community level. In helminth-infected subjects, treatment significantly increases IR, highlighting the need for metabolic health monitoring with ongoing deworming programs. Clinical Trials Registration. ISRCTN 75636394.
KW - Anthelmintic
KW - Deworming
KW - Diabetes
KW - Helminths
KW - Insulin resistance
UR - http://www.scopus.com/inward/record.url?scp=85026785923&partnerID=8YFLogxK
U2 - 10.1093/cid/cix416
DO - 10.1093/cid/cix416
M3 - Article
C2 - 28472383
AN - SCOPUS:85026785923
SN - 1058-4838
VL - 65
SP - 764
EP - 771
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 5
ER -