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Title: Comparison of the cumulative efficacy and safety of chloroquine, artesunate, and chloroquine-primaquine in plasmodium vivax malaria
Authors: Cindy S. Chu
Aung Pyae Phyo
Khin Maung Lwin
Htun Htun Win
Thida San
Aye Aye Aung
Rattanaporn Raksapraidee
Verena I. Carrara
Germana Bancone
James Watson
Kerryn A. Moore
Jacher Wiladphaingern
Stéphane Proux
Kanlaya Sriprawat
Markus Winterberg
Phaik Yeong Cheah
Amy L. Chue
Joel Tarning
Mallika Imwong
François Nosten
Nicholas J. White
Melbourne School of Population and Global Health
Macfarlane Burnet Institute for Medical Research
Mahidol University
Nuffield Department of Clinical Medicine
Mahidol-Oxford Tropical Medicine Research Unit
Keywords: Medicine
Issue Date: 30-Oct-2018
Citation: Clinical Infectious Diseases. Vol.67, No.10 (2018), 1543-1549
Abstract: © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. Background Chloroquine has been recommended for Plasmodium vivax infections for >60 years, but resistance is increasing. To guide future therapies, the cumulative benefits of using slowly eliminated (chloroquine) vs rapidly eliminated (artesunate) antimalarials, and the risks and benefits of adding radical cure (primaquine) were assessed in a 3-way randomized comparison conducted on the Thailand-Myanmar border. Methods Patients with uncomplicated P. vivax malaria were given artesunate (2 mg/kg/day for 5 days), chloroquine (25 mg base/kg over 3 days), or chloroquine-primaquine (0.5 mg/kg/day for 14 days) and were followed for 1 year. Recurrence rates and their effects on anemia were compared. Results Between May 2010 and October 2012, 644 patients were enrolled. Artesunate cleared parasitemia significantly faster than chloroquine. Day 28 recurrence rates were 50% with artesunate (112/224), 8% with chloroquine (18/222; P <.001), and 0.5% with chloroquine-primaquine (1/198; P <.001). Median times to first recurrence were 28 days (interquartile range [IQR], 21-42) with artesunate, 49 days (IQR, 35-74) with chloroquine, and 195 days (IQR, 82-281) with chloroquine-primaquine. Recurrence by day 28, was associated with a mean absolute reduction in hematocrit of 1% (95% confidence interval [CI],.3%-2.0%; P =.009). Primaquine radical cure reduced the total recurrences by 92.4%. One-year recurrence rates were 4.51 (95% CI, 4.19-4.85) per person-year with artesunate, 3.45 (95% CI, 3.18-3.75) with chloroquine (P =.002), and 0.26 (95% CI,.19-.36) with chloroquine-primaquine (P <.001). Conclusions Vivax malaria relapses are predominantly delayed by chloroquine but prevented by primaquine.
ISSN: 15376591
Appears in Collections:Scopus 2018

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