This comparative safety surveillance study reveals that about one third and one-in-six participants experience mass drug administration-associated adverse events with ivermectin, diethylcarbamazine, and albendazole (IDA) and diethylcarbamazine and albendazole (DA) therapy, respectively (p < 0.0001). Dizziness, drowsiness, diarrhea, headache, stomach pain, and confusion are the most reported adverse events that occurred at a higher frequency in the IDA treatment group compared with the DA treatment group (p < 0.001).

Female sex, taking three or more diethylcarbamazine or ivermectin tablets, and having chronic or pre-existing clinical conditions are significantly associated with adverse events following IDA therapy.

Both IDA and DA therapy are well tolerated, and the associated adverse events are transient and mild to moderate with a few severe cases. Hence, safety monitoring is recommended for the timely detection and management of adverse events following mass drug administration.