Jacques Guillot, Thomas Lilin, Fang Fang, Katja Fischer, Charlotte Bernigaud, Françoise Botterel, Jean-François Sutra, Anne Lespine, Olivier Chosidow, Dominique Dreau, Ludwig Serge Aho, F. Moreau, Andrew Kelly, Departement de Dermatolgie, Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Research Group Dynamyc, EA 7380, Université Paris-Est (UPE), Department of Parasitology, College of Animal Science and Technology, Guangxi University [Nanning], Research Group Dynamyc , EA 7380, EnvA (DynamYc), École nationale vétérinaire d'Alfort (ENVA)-Université Paris-Est (UPE), nfections Diseases Department, Scabies Laboratory, QIMR Berghofer Medical Research Institute, QIMR Berghofer Medical Research Institute, ToxAlim (ToxAlim), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole d'Ingénieurs de Purpan (INPT - EI Purpan), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Recherche Agronomique (INRA), Epidemiology and Infection Control Unit, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Cecaveto, Department of Agriculture, Fisheries and Forestry, Queensl and Animal Science Precinct, University of Queensland [Brisbane], Centre de recherche biomédicale (CRBM), Centre de Recherche BioMedicale (CRBM), Hôpital Henri Mondor, Department of Parasitology and Mycology, Biopole d’Alfort, Ecole Nationale Vétérinaire d’Alfort (BIOPOLE - ENVA), Epidemiology in Dermatology and Evaluation in Therapeutics (EpiDermE), Institut National de la Santé et de la Recherche Médicale (INSERM), Societe Francaise de Dermatologie, Fondation Rene Touraine, China Scholarship Council, Bernigaud, Charlotte, Hopital Henri Mondor (APHP), Dynamic Microbiology - EA 7380 (DYNAMIC), École nationale vétérinaire - Alfort (ENVA)-Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES)-Université Paris-Est (UPE)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut National de la Recherche Agronomique (INRA)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Université Fédérale Toulouse Midi-Pyrénées-Ecole d'Ingénieurs de Purpan (INPT - EI Purpan), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, École nationale vétérinaire - Alfort (ENVA)-Université Paris-Est (UPE), and ProdInra, Archive Ouverte
Background Scabies is one of the commonest dermatological conditions globally; however it is a largely underexplored and truly neglected infectious disease. Foremost, improvement in the management of this public health burden is imperative. Current treatments with topical agents and/or oral ivermectin (IVM) are insufficient and drug resistance is emerging. Moxidectin (MOX), with more advantageous pharmacological profiles may be a promising alternative. Methodology/Principal Findings Using a porcine scabies model, 12 pigs were randomly assigned to receive orally either MOX (0.3 mg/kg once), IVM (0.2 mg/kg twice) or no treatment. We evaluated treatment efficacies by assessing mite count, clinical lesions, pruritus and ELISA-determined anti-S. scabiei IgG antibodies reductions. Plasma and skin pharmacokinetic profiles were determined. At day 14 post-treatment, all four MOX-treated but only two IVM-treated pigs were mite-free. MOX efficacy was 100% and remained unchanged until study-end (D47), compared to 62% (range 26–100%) for IVM, with one IVM-treated pig remaining infected until D47. Clinical scabies lesions, pruritus and anti-S. scabiei IgG antibodies had completely disappeared in all MOX-treated but only 75% of IVM-treated pigs. MOX persisted ~9 times longer than IVM in plasma and skin, thereby covering the mite’s entire life cycle and enabling long-lasting efficacy. Conclusions/Significance Our data demonstrate that oral single-dose MOX was more effective than two consecutive IVM-doses, supporting MOX as potential therapeutic approach for scabies., Author Summary Scabies caused by the Sarcoptes scabiei mite affects many people worldwide and has been recently recognized by the WHO as a truly neglected tropical disease. Currently available treatments are insufficient to overcome this insidious disease and its co-morbidities for example impetigo, rheumatic heart disease and post-streptococcal glomerulonephritis. Treatment management is a major issue, as problems with compliance as well as mite resistance to current drugs are reported. Data have accumulated indicating that moxidectin could be a genuine new candidate drug for sustainable scabies control. To provide proof of concept, we utilized an experimental scabies pig model that closely resembles the human route of scabies infection. We demonstrated that a single moxidectin dose, when compared with the currently recommended two-doses ivermectin treatment routine, achieved a better and faster acaricidal efficacy. Importantly, the skin half-life of moxidectin is longer, potentially covering the entire mite life cycle. Our baseline data demonstrate in principle the potential and feasibility of moxidectin treatment for scabies, thereby enabling the move into larger high-powered efficacy and dose ranging studies in human populations. Moxidectin could indeed play a game-changing role in scabies control and has the potential to accelerate the steps towards elimination of this insidious disease.