PMID- 28472383 OWN - NLM STAT- MEDLINE DCOM- 20180525 LR - 20180525 IS - 1537-6591 (Electronic) IS - 1058-4838 (Linking) VI - 65 IP - 5 DP - 2017 Sep 1 TI - Effect of Anthelmintic Treatment on Insulin Resistance: A Cluster-Randomized, Placebo-Controlled Trial in Indonesia. PG - 764-771 LID - 10.1093/cid/cix416 [doi] 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. CI - (c) The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. FAU - Tahapary, Dicky L AU - Tahapary DL AD - Department of Internal Medicine, Division of Endocrinology, Dr Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta. AD - Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands. FAU - de Ruiter, Karin AU - de Ruiter K AD - Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands. FAU - Martin, Ivonne AU - Martin I AD - Medical Statistics and Bioinformatics, Leiden University Medical Center, The Netherlands. AD - Department of Mathematics, Parahyangan Catholic University, Bandung, Indonesia. FAU - Brienen, Eric A T AU - Brienen EAT AD - Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands. FAU - van Lieshout, Lisette AU - van Lieshout L AD - Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands. FAU - Cobbaert, Christa M AU - Cobbaert CM AD - Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, The Netherlands. FAU - Soewondo, Pradana AU - Soewondo P AD - Department of Internal Medicine, Division of Endocrinology, Dr Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta. FAU - Djuardi, Yenny AU - Djuardi Y AD - Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta. FAU - Wiria, Aprilianto E AU - Wiria AE AD - Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands. AD - Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta. FAU - Houwing-Duistermaat, Jeanine J AU - Houwing-Duistermaat JJ AD - Medical Statistics and Bioinformatics, Leiden University Medical Center, The Netherlands. AD - Department of Statistics, University of Leeds, United Kingdom. FAU - Sartono, Erliyani AU - Sartono E AD - Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands. FAU - Smit, Johannes W A AU - Smit JWA AD - Department of Internal Medicine, Radboud University Medical Centre, Nijmegen. AD - Department of Internal Medicine, Leiden University Medical Center, The Netherlands. FAU - Yazdanbakhsh, Maria AU - Yazdanbakhsh M AD - Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands. FAU - Supali, Taniawati AU - Supali T AD - Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta. LA - eng PT - Journal Article PT - Randomized Controlled Trial PL - United States TA - Clin Infect Dis JT - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JID - 9203213 RN - 0 (Anthelmintics) RN - F4216019LN (Albendazole) SB - IM MH - Adult MH - Albendazole/adverse effects/therapeutic use MH - Anthelmintics/*adverse effects/*therapeutic use MH - Diabetes Mellitus MH - Female MH - Helminthiasis/*drug therapy/*epidemiology MH - Humans MH - Indonesia MH - *Insulin Resistance MH - Male MH - Middle Aged MH - Prevalence OTO - NOTNLM OT - anthelmintic OT - deworming OT - diabetes OT - helminths OT - insulin resistance EDAT- 2017/05/05 06:00 MHDA- 2018/05/26 06:00 CRDT- 2017/05/05 06:00 PHST- 2017/02/17 00:00 [received] PHST- 2017/04/28 00:00 [accepted] PHST- 2017/05/05 06:00 [pubmed] PHST- 2018/05/26 06:00 [medline] PHST- 2017/05/05 06:00 [entrez] AID - 3791906 [pii] AID - 10.1093/cid/cix416 [doi] PST - ppublish SO - Clin Infect Dis. 2017 Sep 1;65(5):764-771. doi: 10.1093/cid/cix416.