Drug Therapies for PC Neglected Tropical Diseases

Our work at Standard Co and Secure Data Kit is spread across the global health spectrum but one area we have particular focus on is Neglected Tropical Diseases (NTDs). Neglected Tropical Diseases (https://www.cdc.gov/globalhealth/ntd/diseases/index.html) are a family of diseases that affect over 1 billion people around the world. A subset of these diseases can be prevented through something called Mass Drug Administration (MDA) where medicines are distributed that help prevent these diseases. This is referred to as Preventative Chemotherapy (PC). These diseases are called, you guessed it, PC NTDs. The PC NTDs are: * Dracunculiasis (Guinea Worm Disease) * Lymphatic Filariasis (LF) * Onchocerciasis (Oncho) * Schistosomiasis (SCH) * Soil-transmitted Helminths (STH) (i.e., Ascaris, Hookworm, and Whipworm) * Trachoma Note: you may see mention a disease known as Loasis (Loa Loa). It's generally considered benign so it is not included in the list of targeted NTDs maintained by CDC and WHO. However, if it is detected it will be treated and it can impact which medicines are used. More on that to come For the purposes of this article, we'll leave out Guinea Worm since it's very nearly eradicated (from 3.5 million cases in 1986 to approximately 53 in 2019 Thanks President Carter!) A variety of medicines are donated each year (almost 2 billion tablets!) to treat these diseases. Since many of the diseases happen side-by-side, many of the donated medicines are paired together to target multiple diseases. That's the purpose of this article to help describe the variety of combinations that are used to treat these diseases. First, the medicines that are typically used (I say typically because new medicines come online from time to time to treat these diseases): * Albendazole [ALB] (donated by GSK https://www.gsk.com/media/3350/albendazole-donation-programme-infographic.pdf) * Vermox / Mebendazole [MBD] (donated by J&J https://www.jnj.com/johnson-johnson-extends-long-standing-donation-program-to-support-global-effort-to-tackle-intestinal-worms) * Praziquntel [PZQ] (donated by Merck KGaAhttps://www.emdgroup.com/en/cr-report/2018/products/health-for-all/focus-programs.html) * Diethylcarbamazine [DEC] (donated by Eisai https://www.eisai.com/sustainability/atm/medicines/016.html) * Azithromycin / Zithromax [AZT] (donated by Pfizer https://www.pfizer.com/responsibility/global_health/international_trachoma_initiative) * Ivermectin / Mectizan [IVM] (donated by Merck North America https://www.merck.com/about/featured-stories/mectizan.html) *note: for those unfamiliar, there are two Merck organizations that are completely separate (something I did not know until starting this work). Merck KGaA is based in Germany, Merck is based in North America. Ok, now that we have the diseases and medicines used to treat those diseases, let's discuss the treatment protocols. We'll start with the really straightforward ones: * ALB alone treats STH * MBD alone also treats STH * PZQ alone treats SCH * IVM alone treats Oncho * ALB alone also treats LF if it is co-endemic wit Loa Loa * AZT treats Trachoma (AZT comes in a variety of formats tabular or eye drop) Those are pretty straightforward. Things get a little more complicated when you're dealing with diseases that are co-endemic. That is, you're deploying multiple medicines at the same time to prevent multiple diseases. * IVM + ALB treats LF, Oncho, and/or STH * DEC + ALB treats LF and STH * IVM + DEC + ALB treats LF and STH * IVM + DEC + PZQ treats LF, Oncho, and/or SCH That about covers it. As previously mentioned, new therapies and combinations are coming online at various intervals so we'll try to keep this updated as much as possible.