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Master Thesis

Caractérisation du risque d'effets indésirables graves lors du traitement de la loase. Implications pour la pratique clinique et en santé publique

Abstract : Loiasis (Loa loa filariasis) is often deemed to be a benign condition but individuals with high microfilarial densities (MFD) are at risk of encephalopathy following ivermectin administration (IVM). As onchocerciasis control programs are based on mass drug administration of ivermectin, these serious adverse events (SAE) hamper their deployment in Central Africa. This thesis aims to better characterize the risk (i) before treatment, by investigating the influence of individual factors on the level of risk, and (ii) after treatment to determine to which extent the pre-treatment MFD can be inferred from the MFD obtained after treatment. Methods: (i) data from two clinical trials conducted in 1995-1996 and 2005 in Cameroon were pooled to model the risk of SAE as a logistic function of age, sex, and MFD (as a fractional polynomial). (ii) Data from six clinical trials with pre- and post-IVM MFD measurements were used to calculate the sensitivity, specificity, and positive and negative predictive values of different post-IVM MFD cutoffs for classifying individuals according to the commonly used pre-treatment thresholds. Results: we outlined how individual factors (age and sex) can influence the level of risk of post-IVM SAE and showed that the threshold above which IVM should be contraindicated could be adapted according to these factors. We also show that the post-treatment threshold of 1,000 mf/mL used to impute the occurrence of a SAE to IVM and L. loa is probably too low, and propose abacuses that can be used to assess this imputability in mass or individual treatments. Conclusions: the therapeutic management of loiasis is still poorly defined. The recent demonstration of its impact on life expectancy should lead to the definition of adequate management strategies for loiasis and its complications after treatment, including in Northern settings.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03423998
Contributor : Faculté de Médecine Um Connect in order to contact the contributor
Submitted on : Wednesday, November 10, 2021 - 11:41:44 AM
Last modification on : Thursday, November 18, 2021 - 3:19:41 AM

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Charlotte Boullé. Caractérisation du risque d'effets indésirables graves lors du traitement de la loase. Implications pour la pratique clinique et en santé publique. Human health and pathology. 2021. ⟨dumas-03423998⟩

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