Publication:
The risk of Plasmodium vivax parasitaemia after P. falciparum malaria: An individual patient data meta-analysis from the WorldWide Antimalarial Resistance Network

Issued Date

2020-11-19

Resource Type

Article

ISSN

15491676
15491277

DOI

10.1371/journal.pmed.1003393

Other identifier(s)

2-s2.0-85096458934

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

PLoS Medicine. Vol.17, No.11 (2020)

Suggested Citation

Mohammad S. Hossain, Robert J. Commons, Nicholas M. Douglas, Kamala Thriemer, Bereket H. Alemayehu, Chanaki Amaratunga, Anupkumar R. Anvikar, Elizabeth A. Ashley, Puji B.S. Asih, Verena I. Carrara, Chanthap Lon, Umberto D’Alessandro, Timothy M.E. Davis, Arjen M. Dondorp, Michael D. Edstein, Rick M. Fairhurst, Marcelo U. Ferreira, Jimee Hwang, Bart Janssens, Harin Karunajeewa, Jean R. Kiechel, Simone Ladeia-Andrade, Moses Laman, Mayfong Mayxay, Rose McGready, Brioni R. Moore, Ivo Mueller, Paul N. Newton, Nguyen T. Thuy-Nhien, Harald Noedl, Francois Nosten, Aung P. Phyo, Jeanne R. Poespoprodjo, David L. Saunders, Frank Smithuis, Michele D. Spring, Kasia Stepniewska, Seila Suon, Yupin Suputtamongkol, Din Syafruddin, Hien T. Tran, Neena Valecha, Michel van Herp, Michele van Vugt, Nicholas J. White, Philippe J. Guerin, Julie A. Simpson, Ric N. Price The risk of Plasmodium vivax parasitaemia after P. falciparum malaria: An individual patient data meta-analysis from the WorldWide Antimalarial Resistance Network. PLoS Medicine. Vol.17, No.11 (2020). doi:10.1371/journal.pmed.1003393 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/60552

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Title

The risk of Plasmodium vivax parasitaemia after P. falciparum malaria: An individual patient data meta-analysis from the WorldWide Antimalarial Resistance Network

Author(s)

Mohammad S. Hossain
 Robert J. Commons
 Nicholas M. Douglas
 Kamala Thriemer
 Bereket H. Alemayehu
 Chanaki Amaratunga
 Anupkumar R. Anvikar
 Elizabeth A. Ashley
 Puji B.S. Asih
 Verena I. Carrara
 Chanthap Lon
 Umberto D’Alessandro
 Timothy M.E. Davis
 Arjen M. Dondorp
 Michael D. Edstein
 Rick M. Fairhurst
 Marcelo U. Ferreira
 Jimee Hwang
 Bart Janssens
 Harin Karunajeewa
 Jean R. Kiechel
 Simone Ladeia-Andrade
 Moses Laman
 Mayfong Mayxay
 Rose McGready
 Brioni R. Moore
 Ivo Mueller
 Paul N. Newton
 Nguyen T. Thuy-Nhien
 Harald Noedl
 Francois Nosten
 Aung P. Phyo
 Jeanne R. Poespoprodjo
 David L. Saunders
 Frank Smithuis
 Michele D. Spring
 Kasia Stepniewska
 Seila Suon
 Yupin Suputtamongkol
 Din Syafruddin
 Hien T. Tran
 Neena Valecha
 Michel van Herp
 Michele van Vugt
 Nicholas J. White
 Philippe J. Guerin
 Julie A. Simpson
 Ric N. Price

Other Contributor(s)

Oxford University Clinical Research Unit
 Melbourne Medical School
 Melbourne School of Population and Global Health
 Medecins Sans Frontieres, Brussels
 Papua New Guinea Institute of Medical Research
 Eijkman Institute for Molecular Biology
 Hasanuddin University
 Universitas Gadjah Mada
 Shoklo Malaria Research Unit
 The University of Western Australia
 Curtin University
 Sunshine Hospital
 Columbia University Irving Medical Center
 Walter and Eliza Hall Institute of Medical Research
 University of Melbourne
 Fundacao Oswaldo Cruz
 Menzies School of Health Research
 National Institute of Malaria Research India
 University of California, San Francisco
 Centers for Disease Control and Prevention
 National Institute of Allergy and Infectious Diseases (NIAID)
 Armed Forces Research Institute of Medical Sciences, Thailand
 Mahosot Hospital, Lao
 Mahidol University
 Ballarat Health Services
 Faculty of Medicine, Siriraj Hospital, Mahidol University
 International Centre for Diarrhoeal Disease Research Bangladesh
 Slotervaart Hospital
 Nuffield Department of Medicine
 United States Army
 Universidade de Sao Paulo - USP
 Institut Pasteur, Paris
 Drugs for Neglected Diseases initiative (DNDi)
 LSTMH
 Myanmar Oxford Clinical Research Unit
 University of Health Sciences
 Australian Defence Force Malaria and Infectious Disease Institute
 MARIB
 Mimika District Hospital
 Ministry of Health of Brazil
 Medical Action Myanmar
 Armed Forces Research Institute of Medical Sciences
 Papuan Health and Community Development Foundation
 WorldWide Antimalarial Resistance Network (WWARN)
 National Center for Parasitology, Entomology and Malaria Control

Abstract

© 2020 Public Library of Science. All rights reserved. Background There is a high risk of Plasmodium vivax parasitaemia following treatment of falciparum malaria. Our study aimed to quantify this risk and the associated determinants using an individual patient data meta-analysis in order to identify populations in which a policy of universal radical cure, combining artemisinin-based combination therapy (ACT) with a hypnozoitocidal antimalarial drug, would be beneficial. Methods and findings A systematic review of Medline, Embase, Web of Science, and the Cochrane Database of Systematic Reviews identified efficacy studies of uncomplicated falciparum malaria treated with ACT that were undertaken in regions coendemic for P. vivax between 1 January 1960 and 5 January 2018. Data from eligible studies were pooled using standardised methodology. The risk of P. vivax parasitaemia at days 42 and 63 and associated risk factors were investigated by multivariable Cox regression analyses. Study quality was assessed using a tool developed by the Joanna Briggs Institute. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018097400). In total, 42 studies enrolling 15,341 patients were included in the analysis, including 30 randomised controlled trials and 12 cohort studies. Overall, 14,146 (92.2%) patients had P. falciparum monoinfection and 1,195 (7.8%) mixed infection with P. falciparum and P. vivax. The median age was 17.0 years (interquartile range [IQR] = 9.0–29.0 years; range = 0–80 years), with 1,584 (10.3%) patients younger than 5 years. 2,711 (17.7%) patients were treated with artemether-lumefantrine (AL, 13 studies), 651 (4.2%) with artesunate-amodiaquine (AA, 6 studies), 7,340 (47.8%) with artesunate-mefloquine (AM, 25 studies), and 4,639 (30.2%) with dihydroartemisinin-piperaquine (DP, 16 studies). 14,537 patients (94.8%) were enrolled from the Asia-Pacific region, 684 (4.5%) from the Americas, and 120 (0.8%) from Africa. At day 42, the cumulative risk of vivax parasitaemia following treatment of P. falciparum was 31.1% (95% CI 28.9–33.4) after AL, 14.1% (95% CI 10.8–18.3) after AA, 7.4% (95% CI 6.7–8.1) after AM, and 4.5% (95% CI 3.9–5.3) after DP. By day 63, the risks had risen to 39.9% (95% CI 36.6–43.3), 42.4% (95% CI 34.7–51.2), 22.8% (95% CI 21.2–24.4), and 12.8% (95% CI 11.4–14.5), respectively. In multivariable analyses, the highest rate of P. vivax parasitaemia over 42 days of follow-up was in patients residing in areas of short relapse periodicity (adjusted hazard ratio [AHR] = 6.2, 95% CI 2.0–19.5; p = 0.002); patients treated with AL (AHR = 6.2, 95% CI 4.6–8.5; p < 0.001), AA (AHR = 2.3, 95% CI 1.4–3.7; p = 0.001), or AM (AHR = 1.4, 95% CI 1.0–1.9; p = 0.028) compared with DP; and patients who did not clear their initial parasitaemia within 2 days (AHR = 1.8, 95% CI 1.4–2.3; p < 0.001). The analysis was limited by heterogeneity between study populations and lack of data from very low transmission settings. Study quality was high. Conclusions In this meta-analysis, we found a high risk of P. vivax parasitaemia after treatment of P. falciparum malaria that varied significantly between studies. These P. vivax infections are likely attributable to relapses that could be prevented with radical cure including a hypnozoitocidal agent; however, the benefits of such a novel strategy will vary considerably between geographical areas.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/60552

Collections

Scopus 2020