Safety of ivermectin during pregnancy
Authors: Stijn Van Hees, Stephen Raimon, Joseph Nelson Siewe Fodjo, Robert Colebunders
Journal: The Lancet Global Health (2020)

Patricia Nicolas and colleagues (January, 2020),1Nicolas P Maia MF Bassat Q et al.Safety of oral ivermectin during pregnancy: a systematic review and meta-analysis.Lancet Glob Health. 2020; 8: e92-e100Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar in their systematic review on the safety of ivermectin treatment in pregnant women, conclude that ivermectin treatment during pregnancy cannot be considered safe. They propose additional animal toxicology studies and open data repositories of inadvertent exposure during pregnancy as the first step in the further evaluation of ivermectin safety.1Nicolas P Maia MF Bassat Q et al.Safety of oral ivermectin during pregnancy: a systematic review and meta-analysis.Lancet Glob Health. 2020; 8: e92-e100Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar In an accompanying Comment, Christopher King2King CL Is ivermectin safe in pregnancy?.Lancet Glob Health. 2020; 8: e12-e13Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar suggests that a randomised trial to administer ivermectin to pregnant women is nevertheless justified on the basis of available data. We agree that such a trial should be done, not only because untreated infected pregnant women constitute a parasitic reservoir, but also because treating these pregnant women could be beneficial for their children. In an 18-year follow-up study of about 4000 families in west Africa, maternal Onchocerca volvulus infection was associated with a four times increased risk of infection in children. Moreover, children born to mothers infected with O volvulus had a higher microfilarial load, suggestive of a priming of the neonate's immune system to the parasite.3Kirch AK Duerr HP Boatin B et al.Impact of parental onchocerciasis and intensity of transmission on development and persistence of Onchocerca volvulus infection in offspring: an 18 year follow-up study.Parasitology. 2003; 127: 327-335Crossref PubMed Scopus (19) Google Scholar Children weighing less than 15 kg with high microfilarial loads are currently not eligible for ivermectin treatment and are therefore at risk of developing onchocerciasis-associated epilepsy.4Chesnais CB Nana-Djeunga HC Njamnshi AK et al.The temporal relationship between onchocerciasis and epilepsy: a population-based cohort study.Lancet Infect Dis. 2018; 18: 1278-1286Summary Full Text Full Text PDF PubMed Scopus (60) Google Scholar Moreover, we have documented the onset of onchocerciasis-associated epilepsy in children as young as 3 years.5Colebunders R Abd-Elfarag G Carter JY et al.Clinical characteristics of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan.Seizure. 2018; 62: 108-115Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar Taking these new findings into consideration, we believe that a large randomised clinical trial evaluating the safety of ivermectin treatment in pregnant women infected with O volvulus and the potential benefits for their children would be ethically acceptable and needs to be done. We declare no competing interests. Safety of oral ivermectin during pregnancy: a systematic review and meta-analysisThere is insufficient evidence to conclude on the safety profile of ivermectin during pregnancy. Treatment campaigns should focus additional efforts on preventing inadvertent treatment of pregnant women. Full-Text PDF Open AccessIs ivermectin safe in pregnancy?Ivermectin is one of the most important antibiotics discovered. It is recognised as a landmark drug by the American Chemical Society and its discoverers received the Nobel Prize in 2015. Additionally, ivermectin is one of the most widely used anti-parasitic drugs for animals and humans. Since 1987, about 3·7 billion treatments have been given worldwide primarily for mass drug administration (MDA) campaigns for onchocerciasis and lymphatic filariasis in sub-Saharan Africa. Ivermectin is also highly effective against strongyloides, scabies, and ticks, and it has recently been shown to be an effective endectocide that kills feeding mosquitoes with the potential to reduce malaria transmission. Full-Text PDF Open Access