Publication:
The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis

Issued Date

2018-09-01

Resource Type

Article

ISSN

14744457
14733099

DOI

10.1016/S1473-3099(18)30348-7

Other identifier(s)

2-s2.0-85053837530

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

The Lancet Infectious Diseases. Vol.18, No.9 (2018), 1025-1034

Suggested Citation

Robert J. Commons, Julie A. Simpson, Kamala Thriemer, Georgina S. Humphreys, Tesfay Abreha, Sisay G. Alemu, Arletta Añez, Nicholas M. Anstey, Ghulam R. Awab, J. Kevin Baird, Bridget E. Barber, Isabelle Borghini-Fuhrer, Cindy S. Chu, Umberto D'Alessandro, Prabin Dahal, André Daher, Peter J. de Vries, Annette Erhart, Margarete S.M. Gomes, Lilia Gonzalez-Ceron, Matthew J. Grigg, Aliehsan Heidari, Jimee Hwang, Piet A. Kager, Tsige Ketema, Wasif A. Khan, Marcus V.G. Lacerda, Toby Leslie, Benedikt Ley, Kartini Lidia, Wuelton M. Monteiro, Francois Nosten, Dhelio B. Pereira, Giao T. Phan, Aung P. Phyo, Mark Rowland, Kavitha Saravu, Carol H. Sibley, André M. Siqueira, Kasia Stepniewska, Inge Sutanto, Walter R.J. Taylor, Guy Thwaites, Binh Q. Tran, Hien T. Tran, Neena Valecha, José Luiz F. Vieira, Sonam Wangchuk, Timothy William, Charles J. Woodrow, Lina Zuluaga-Idarraga, Philippe J. Guerin, Nicholas J. White, Ric N. Price The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis. The Lancet Infectious Diseases. Vol.18, No.9 (2018), 1025-1034. doi:10.1016/S1473-3099(18)30348-7 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/46424

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Title

The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis

Author(s)

Robert J. Commons
 Julie A. Simpson
 Kamala Thriemer
 Georgina S. Humphreys
 Tesfay Abreha
 Sisay G. Alemu
 Arletta Añez
 Nicholas M. Anstey
 Ghulam R. Awab
 J. Kevin Baird
 Bridget E. Barber
 Isabelle Borghini-Fuhrer
 Cindy S. Chu
 Umberto D'Alessandro
 Prabin Dahal
 André Daher
 Peter J. de Vries
 Annette Erhart
 Margarete S.M. Gomes
 Lilia Gonzalez-Ceron
 Matthew J. Grigg
 Aliehsan Heidari
 Jimee Hwang
 Piet A. Kager
 Tsige Ketema
 Wasif A. Khan
 Marcus V.G. Lacerda
 Toby Leslie
 Benedikt Ley
 Kartini Lidia
 Wuelton M. Monteiro
 Francois Nosten
 Dhelio B. Pereira
 Giao T. Phan
 Aung P. Phyo
 Mark Rowland
 Kavitha Saravu
 Carol H. Sibley
 André M. Siqueira
 Kasia Stepniewska
 Inge Sutanto
 Walter R.J. Taylor
 Guy Thwaites
 Binh Q. Tran
 Hien T. Tran
 Neena Valecha
 José Luiz F. Vieira
 Sonam Wangchuk
 Timothy William
 Charles J. Woodrow
 Lina Zuluaga-Idarraga
 Philippe J. Guerin
 Nicholas J. White
 Ric N. Price

Other Contributor(s)

Melbourne School of Population and Global Health
 Health Works, Amsterdam
 Alborz University of Medical Sciences
 Tergooiziekenhuizen
 Cho Ray Hospital
 Jimma University
 Armauer Hansen Research Institute
 Addis Ababa University
 Universitas Indonesia
 Universidad de Antioquia
 University of London
 London School of Hygiene & Tropical Medicine
 Prins Leopold Instituut voor Tropische Geneeskunde
 Royal Brisbane and Women's Hospital
 Fundacao Oswaldo Cruz
 Menzies School of Health Research
 Fundacao Universidade Federal de Rondonia
 National Institute of Malaria Research India
 University of California, San Francisco
 Centers for Disease Control and Prevention
 Liverpool School of Tropical Medicine
 Universidade Federal do Amapa
 Manipal Academy of Higher Education
 Kasturba Medical College, Manipal
 University of Washington, Seattle
 Universiteit Antwerpen
 Mahidol University
 Nuffield Department of Clinical Medicine
 Universidade do Estado do Amazonas
 Universidade Federal do Para
 Universitat de Barcelona
 Amsterdam UMC - University of Amsterdam
 Medicines for Malaria Venture
 Nangarhar University
 WorldWide Antimalarial Resistance Network
 Nusa Cendana University
 Queen Elizabeth Hospital
 Medical Research Council Unit
 National Institute for Public Health
 Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit
 Organización Panamericana de Salud
 WorldWide Antimalarial Resistance Network
 Columbia University Mailman School of Public Health
 International Centre for Diarrheal Diseases and Research
 Eijkman-Oxford Clinical Research Unit
 Ministry of Health
 Secretaria de Saúde do Estado do Amapá
 Oxford University Clinical Research Unit
 Centro de Pesquisa em Medicina Tropical

Abstract

© 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Chloroquine remains the mainstay of treatment for Plasmodium vivax malaria despite increasing reports of treatment failure. We did a systematic review and meta-analysis to investigate the effect of chloroquine dose and the addition of primaquine on the risk of recurrent vivax malaria across different settings. Methods: A systematic review done in MEDLINE, Web of Science, Embase, and Cochrane Database of Systematic Reviews identified P vivax clinical trials published between Jan 1, 2000, and March 22, 2017. Principal investigators were invited to share individual patient data, which were pooled using standardised methods. Cox regression analyses with random effects for study site were used to investigate the roles of chloroquine dose and primaquine use on rate of recurrence between day 7 and day 42 (primary outcome). The review protocol is registered in PROSPERO, number CRD42016053310. Findings: Of 134 identified chloroquine studies, 37 studies (from 17 countries) and 5240 patients were included. 2990 patients were treated with chloroquine alone, of whom 1041 (34·8%) received a dose below the target 25 mg/kg. The risk of recurrence was 32·4% (95% CI 29·8–35·1) by day 42. After controlling for confounders, a 5 mg/kg higher chloroquine dose reduced the rate of recurrence overall (adjusted hazard ratio [AHR] 0·82, 95% CI 0·69–0·97; p=0·021) and in children younger than 5 years (0·59, 0·41–0·86; p=0·0058). Adding primaquine reduced the risk of recurrence to 4·9% (95% CI 3·1–7·7) by day 42, which is lower than with chloroquine alone (AHR 0·10, 0·05–0·17; p<0·0001). Interpretation: Chloroquine is commonly under-dosed in the treatment of vivax malaria. Increasing the recommended dose to 30 mg/kg in children younger than 5 years could reduce substantially the risk of early recurrence when primaquine is not given. Radical cure with primaquine was highly effective in preventing early recurrence and may also improve blood schizontocidal efficacy against chloroquine-resistant P vivax. Funding: Wellcome Trust, Australian National Health and Medical Research Council, and Bill & Melinda Gates Foundation.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/46424

Collections

Scopus 2018