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Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/46750
Title: Implications of current therapeutic restrictions for primaquine and tafenoquine in the radical cure of vivax malaria
Authors: James Watson
Walter R.J. Taylor
Germana Bancone
Cindy S. Chu
Podjanee Jittamala
Nicholas J. White
Mahidol University
Nuffield Department of Clinical Medicine
Keywords: Medicine
Issue Date: 20-Apr-2018
Citation: PLoS Neglected Tropical Diseases. Vol.12, No.4 (2018)
Abstract: © 2018 Watson et al. Background: The 8-aminoquinoline antimalarials, the only drugs which prevent relapse of vivax and ovale malaria (radical cure), cause dose-dependent oxidant haemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Patients with <30% and <70% of normal G6PD activity are not given standard regimens of primaquine and tafenoquine, respectively. Both drugs are currently considered contraindicated in pregnant and lactating women. Methods: Quantitative G6PD enzyme activity data from 5198 individuals were used to estimate the proportions of heterozygous females who would be ineligible for treatment at the 30% and 70% activity thresholds, and the relationship with the severity of the deficiency. This was used to construct a simple model relating allele frequency in males to the potential population coverage of tafenoquine and primaquine under current prescribing restrictions. Findings: Independent of G6PD deficiency, the current pregnancy and lactation restrictions will exclude ~13% of females from radical cure treatment. This could be reduced to ~4% if 8-aminoquinolines can be prescribed to women breast-feeding infants older than 1 month. At a 30% activity threshold, approximately 8–19% of G6PD heterozygous women are ineligible for primaquine treatment; at a 70% threshold, 50–70% of heterozygous women and approximately 5% of G6PD wild type individuals are ineligible for tafenoquine treatment. Thus, overall in areas where the G6PDd allele frequency is >10% more than 15% of men and more than 25% of women would be unable to receive tafenoquine. In vivax malaria infected patients these proportions will be lowered by any protective effect against P. vivax conferred by G6PD deficiency. Conclusion: If tafenoquine is deployed for radical cure, primaquine will still be needed to obtain high population coverage. Better radical cure antimalarial regimens are needed.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85046340522&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/46750
ISSN: 19352735
19352727
Appears in Collections:Scopus 2018

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