To the Editor.—
We read with interest the recent article by O'Donnell et al concerning suramin-induced skin reactions1 but find it important to point out one error. In their introductory paragraph, the authors state that suramin "... remains the drug of choice for Onchocerca volvulus...." Although they accurately reference a 1990 article2 that makes just such an assertion, we would like to point out that this does not reflect current anthelminthic therapy for O volvulus.At one time, suramin did have an important role in the therapy of onchocerciasis. As opposed to diethylcarbamazine, which is exclusively a microfilaricide, suramin is primarily an adulticide (although it does appear to have some microfilaricidal activity).3 However, the advent of ivermectin in the 1980s has transformed the therapy of human onchocerciasis in endemic areas. Ivermectin is orally administered and is touted to be relatively safe and clinically efficacious with dosing every 6 months or annually. Unfortunately, this drug is also primarily for suppressive therapy (ie, it is microfilaricidal but not adulticidal), although it also appears to inhibit expulsion of larvae from the uterus of the adult female worms.
Coyne PE, Maxwell C. Suramin and Therapy of Onchocerciasis. Arch Dermatol. 1992;128(5):698. doi:10.1001/archderm.1992.01680150132023