Publication: Dihydroartemisinin-piperaquine versus
chloroquine to treat vivax malaria in Afghanistan: an open randomized,non-inferiority, trial
Issued Date
2010-04
Resource Type
Language
eng
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application/pdf
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858779 bytes
ISSN
1475-2875 (electronic)
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Mahidol University
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BioMed Central
Bibliographic Citation
Awab GR, Pukrittayakamee S, Imwong M, Dondorp AM, Woodrow CJ, Lee SJ, et al. Dihydroartemisinin-piperaquine versus chloroquine to treat vivax malaria in Afghanistan: an open randomized,
non-inferiority, trial. Malar J 2010 Apr 21;9:105.
Suggested Citation
Awab, Ghulam Rahim, Sasithon Pukrittayakamee, ศศิธร ผู้กฤตยาคามี, Mallika Imwong, มัลลิกา อิ่มวงศ์, Dondorp, Arjen M., Woodrow, Charles J., Lee, Sue Jean, Day, Nicholas P.J., Pratap Singhasivanon, ประตาป สิงหศิวานนท์, White, Nicholas J., Kaker, Faizullah Dihydroartemisinin-piperaquine versus
chloroquine to treat vivax malaria in Afghanistan: an open randomized,non-inferiority, trial. Awab GR, Pukrittayakamee S, Imwong M, Dondorp AM, Woodrow CJ, Lee SJ, et al. Dihydroartemisinin-piperaquine versus chloroquine to treat vivax malaria in Afghanistan: an open randomized,
non-inferiority, trial. Malar J 2010 Apr 21;9:105.. doi:10.1186/1475-2875-9-105 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/758
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Title
Dihydroartemisinin-piperaquine versus
chloroquine to treat vivax malaria in Afghanistan: an open randomized,non-inferiority, trial
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Abstract
BACKGROUND: Afghanistan's national guidelines recommend chloroquine for the
treatment of Plasmodium vivax infection, the parasite responsible for the
majority of its malaria burden. Chloroquine resistance in P. vivax is emerging in
Asia. Therapeutic responses across Afghanistan have not been evaluated in detail.
METHODS: Between July 2007 and February 2009, an open-label, randomized
controlled trial of chloroquine and dihydroartemisinin-piperaquine in patients
aged three months and over with slide-confirmed P. vivax mono-infections was
conducted. Consistent with current national guidelines, primaquine was not
administered. Subjects were followed up daily during the acute phase of illness
(days 0-3) and weekly until day 56. The primary endpoint was the overall
cumulative parasitological failure rate at day 56 after the start of treatment,
with the hypothesis being that dihydroartemisinin-piperaquine was non-inferior
compared to chloroquine (Delta = 5% difference in proportion of failures).
RESULTS: Of 2,182 individuals with positive blood films for P. vivax, 536 were
enrolled in the trial. The day 28 cure rate was 100% in both treatment groups.
Parasite clearance was more rapid with dihydroartemisinin-piperaquine than
chloroquine. At day 56, there were more recurrent infections in the chloroquine
arm (8.9%, 95% CI 6.0-13.1%) than the dihydroartemisinin-piperaquine arm (2.8%,
95% CI 1.4-5.8%), a difference in cumulative recurrence rate of 6.1% (2-sided
90%CI +2.6 to +9.7%). The log-rank test comparing the survival curves confirmed
the superiority of dihydroartemisinin-piperaquine over chloroquine (p = 0.003).
Multivariate analysis showed that a lower initial haemoglobin concentration was
also independently associated with recurrence. Both regimens were well tolerated
and no serious adverse events were reported.
CONCLUSIONS: Chloroquine remains an efficacious treatment for the treatment of
vivax malaria in Afghanistan. In a setting where radical therapy cannot be
administered, dihydroartemisinin-piperaquine provides additional benefit in terms
of post-treatment prophylaxis, reducing the incidence of recurrence from 4-8
weeks after treatment.