Introduction: Moxidectin is a milbemycin endectocide recently approved for the treatment of human
onchocerciasis. Onchocerciasis, earmarked for elimination of transmission, is a filarial infection endemic
in Africa, Yemen, and the Amazonian focus straddling Venezuela and Brazil. Concerns over whether the
predominant treatment strategy (yearly mass drug administration (MDA) of ivermectin) is sufficient to
achieve elimination in all endemic foci have refocussed attention upon alternative treatments.
Moxidectin’s stronger and longer microfilarial suppression compared to ivermectin in both phase II
and III clinical trials indicates its potential as a novel powerful drug for onchocerciasis elimination.
Areas covered: This work summarizes the chemistry and pharmacology of moxidectin, reviews the
phase II and III clinical trials evidence on tolerability, safety, and efficacy of moxidectin versus ivermectin, and discusses the implications of moxidectin’s current regulatory status.
Expert opinion: Moxidectin’s superior clinical performance has the potential to substantially reduce
times to elimination compared to ivermectin. If donated, moxidectin could mitigate the additional
programmatic costs of biannual ivermectin distribution because, unlike other alternatives, it can use the
existing community-directed treatment infrastructure. A pediatric indication (for children <12 years) and
determination of its usefulness in onchocerciasis–loiasis co-endemic areas will greatly help fulfill the
potential of moxidectin for the treatment and elimination of onchocerciasis.