Response to comment on 'The clinical pharmacology of tafenoquine in the radical cure of Plasmodium vivax malaria: An individual patient data meta-analysis'
Issued Date
2024-02-07
Resource Type
eISSN
2050084X
Scopus ID
2-s2.0-85184545299
Pubmed ID
38323801
Journal Title
eLife
Volume
13
Rights Holder(s)
SCOPUS
Bibliographic Citation
eLife Vol.13 (2024)
Suggested Citation
Watson J.A., Commons R.J., Tarning J., Simpson J.A., Llanos Cuentas A., Lacerda M.V.G., Green J.A., Koh G.C.K.W., Chu C.S., Nosten F.H., Price R.N., Day N.P.J., White N.J. Response to comment on 'The clinical pharmacology of tafenoquine in the radical cure of Plasmodium vivax malaria: An individual patient data meta-analysis'. eLife Vol.13 (2024). doi:10.7554/eLife.91283 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/97225
Title
Response to comment on 'The clinical pharmacology of tafenoquine in the radical cure of Plasmodium vivax malaria: An individual patient data meta-analysis'
Author's Affiliation
WorldWide Antimalarial Resistance Network
Mahidol Oxford Tropical Medicine Research Unit
Oxford University Clinical Research Unit
Melbourne School of Population and Global Health
Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt
Shoklo Malaria Research Unit
Northwick Park Hospital
Menzies School of Health Research
GlaxoSmithKline plc.
Nuffield Department of Medicine
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado
Mahidol Oxford Tropical Medicine Research Unit
Oxford University Clinical Research Unit
Melbourne School of Population and Global Health
Universidad Peruana Cayetano Heredia, Instituto de Medicina Tropical Alexander von Humboldt
Shoklo Malaria Research Unit
Northwick Park Hospital
Menzies School of Health Research
GlaxoSmithKline plc.
Nuffield Department of Medicine
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado
Corresponding Author(s)
Other Contributor(s)
Abstract
In our recent paper on the clinical pharmacology of tafenoquine (Watson et al., 2022), we used all available individual patient pharmacometric data from the tafenoquine pre-registration clinical efficacy trials to characterise the determinants of anti-relapse efficacy in tropical vivax malaria. We concluded that the currently recommended dose of tafenoquine (300 mg in adults, average dose of 5 mg/kg) is insufficient for cure in all adults, and a 50% increase to 450 mg (7.5 mg/kg) would halve the risk of vivax recurrence by four months. We recommended that clinical trials of higher doses should be carried out to assess their safety and tolerability. Sharma and colleagues at the pharmaceutical company GSK defend the currently recommended adult dose of 300 mg as the optimum balance between radical curative efficacy and haemolytic toxicity (Sharma et al., 2024). We contend that the relative haemolytic risks of the 300 mg and 450 mg doses have not been sufficiently well characterised to justify this opinion. In contrast, we provided evidence that the currently recommended 300 mg dose results in sub-maximal efficacy, and that prospective clinical trials of higher doses are warranted to assess their risks and benefits.