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Randomized Controlled Trial
. 2017 Sep 1;65(5):764-771.
doi: 10.1093/cid/cix416.

Effect of Anthelmintic Treatment on Insulin Resistance: A Cluster-Randomized, Placebo-Controlled Trial in Indonesia

Dicky L Tahapary  1   2 , Karin de Ruiter  2 , Ivonne Martin  3   4 , Eric A T Brienen  2 , Lisette van Lieshout  2 , Christa M Cobbaert  5 , Pradana Soewondo  1 , Yenny Djuardi  6 , Aprilianto E Wiria  2   6 , Jeanine J Houwing-Duistermaat  3   7 , Erliyani Sartono  2 , Johannes W A Smit  8   9 , Maria Yazdanbakhsh  2 , Taniawati Supali  6
Affiliations
Randomized Controlled Trial

Effect of Anthelmintic Treatment on Insulin Resistance: A Cluster-Randomized, Placebo-Controlled Trial in Indonesia

Dicky L Tahapary et al. Clin Infect Dis. .

Abstract

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.

Keywords: anthelmintic; deworming; diabetes; helminths; insulin resistance.

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