The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis - 24/08/18

Doi : 10.1016/S1473-3099(18)30348-7

Robert J Commons, FRACP ^a,^b,^c, Julie A Simpson, ProfPhD ^d, Kamala Thriemer, PhD ^a, Georgina S Humphreys, PhD ^e,^f, Tesfay Abreha, MPH ^g, Sisay G Alemu, MSc ^i,^j, Arletta Añez, PhD ^k,^l, Nicholas M Anstey, ProfPhD ^a, Ghulam R Awab, PhD ^m,ⁿ, J Kevin Baird, ProfPhD ^f,^o, Bridget E Barber, PhD ^a,^p, Isabelle Borghini-Fuhrer, PhD ^q, Cindy S Chu, MD ^f,^r, Umberto D’Alessandro, PhD ^s,^t, Prabin Dahal, MSc ^e,^f, André Daher, MD ^u,^v,^w, Peter J de Vries, PhD ^x, Annette Erhart, MD ^s,^t,^y, Margarete S M Gomes, PhD ^z,^aa, Lilia Gonzalez-Ceron, PhD ^ab, Matthew J Grigg, PhD ^a,^p, Aliehsan Heidari, PhD ^ac, Jimee Hwang, MD ^ad,^ae, Piet A Kager, ProfMD ^af, Tsige Ketema, PhD ^h,^ah, Wasif A Khan, MHS ^ai, Marcus V G Lacerda, ProfPhD ^aj,^al, Toby Leslie, PhD ^am,^an, Benedikt Ley, PhD ^a, Kartini Lidia, MSc ^ao, Wuelton M Monteiro, ProfPhD ^aj,^ak, Francois Nosten, ProfPhD ^f,^r, Dhelio B Pereira, ProfMD ^ap,^aq, Giao T Phan, PhD ^ag,^ar, Aung P Phyo, PhD ^r, Mark Rowland, ProfPhD ^am, Kavitha Saravu, ProfMD ^as,^at, Carol H Sibley, ProfPhD ^e,^au, André M Siqueira, PhD ^aj,^ak,^av, Kasia Stepniewska, PhD ^e, Inge Sutanto, ProfPhD ^aw, Walter R J Taylor, MD ^m, Guy Thwaites, ProfFRCP ^ax, Binh Q Tran, MD ^ar, Hien T Tran, ProfMD ^f,^ax, Neena Valecha, MD ^ay, José Luiz F Vieira, PhD ^az, Sonam Wangchuk, PhD ^ba, Timothy William, MRCP ^p,^bb, Charles J Woodrow, PhD ^m,^bc, Lina Zuluaga-Idarraga, PhD ^bd, Philippe J Guerin, ProfMD ^e,^f, Nicholas J White, ProfFRS ^f,^m, Ric N Price, ProfFRCP ^a,^b,^f,^⁎
^a Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
^b WorldWide Antimalarial Resistance Network, Clinical module, Darwin, NT, Australia
^c Department of Infectious Diseases, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
^d Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
^e WorldWide Antimalarial Resistance Network, Oxford, UK
^f Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
^g ICAP, Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
^h Department of Biology, Addis Ababa University, Addis Ababa, Ethiopia
ⁱ College of Natural Sciences, Addis Ababa University, Addis Ababa, Ethiopia
^j Armauer Hansen Research Institute, Addis Ababa, Ethiopia
^k Departamento de Salud Pública, Universidad de Barcelona, Barcelona, Spain
^l Organización Panamericana de Salud, Oficina de país Bolivia, La Paz, Bolivia
^m Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
ⁿ Nangarhar Medical Faculty, Nangarhar University, Jalalabad Afghanistan
^o Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
^p Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
^q Medicines for Malaria Venture, Geneva, Switzerland
^r Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
^s Unit of Malariology, Institute of Tropical Medicine, Antwerp, Belgium
^t Medical Research Council Unit, Fajara, The Gambia
^u Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
^v Vice-Presidency of Research and Reference Laboratories, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
^w Liverpool School of Tropical Medicine, Liverpool, UK
^x Department of Internal Medicine, Tergooi Hospital, Hilversum, Netherlands
^y Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
^z Superintendência de Vigilância em Saúde do Estado do Amapá -SVS/AP, Macapá, Amapá, Brazil
^aa Federal University of Amapá, Macapá, Amapá, Brazil
^ab Regional Centre for Public Health Research, National Institute for Public Health, Tapachula, Chiapas, Mexico
^ac Department of Medical Parasitology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
^ad US President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA, USA
^ae Global Health Group, University of California San Francisco, San Francisco, CA, USA
^af Centre for Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, Netherlands
^ag Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, Netherlands
^ah Department of Biology, Jimma University, Jimma, Ethiopia
^ai International Centre for Diarrheal Diseases and Research, Dhaka, Bangladesh
^aj Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
^ak Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
^al Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane (FIOCRUZ-Amazonas), Manaus, Brazil
^am Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
^an HealthNet-TPO, Kabul, Afghanistan
^ao Department of Pharmacology and Therapy, Faculty of Medicine, Nusa Cendana University, Kupang, Indonesia
^ap Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Rondônia, Brazil
^aq Universidade Federal de Rondônia, Porto Velho, Rondônia, Brazil
^ar Tropical Diseases Clinical Research Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam
^as Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
^at Manipal McGill Center for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India
^au Department of Genome Sciences, University of Washington, Seattle, WA, USA
^av Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
^aw Department of Parasitology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
^ax Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
^ay Malaria Research Centre, Delhi, India
^az Federal University of Pará, Belém, Pará, Brazil
^ba Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan
^bb Infectious Diseases Unit, Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
^bc Division of Clinical Sciences, St George’s, University of London, London, UK
^bd Grupo Malaria, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia

^*Correspondence to: Prof Ric N Price, Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811, AustraliaGlobal and Tropical Health DivisionMenzies School of Health ResearchCharles Darwin UniversityPO Box 41096CasuarinaNT0811Australia

connectez-vous ou créez un compte

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Summary

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.

Le texte complet de cet article est disponible en PDF.

Plan

Introduction

Methods

Search strategy and selection criteria

Procedures

Outcomes

Statistical analysis

Role of the funding source

Results

Discussion

Export

Vol 18 - N° 9

P. 1025-1034 - septembre 2018 Retour au numéro

Article précédent

Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report
Emily Kainne Dokubo, Annika Wendland, Suzanne E Mate, Jason T Ladner, Esther L Hamblion, Philomena Raftery, David J Blackley, A Scott Laney, Nuha Mahmoud, Gloria Wayne-Davies, Lisa Hensley, Eric Stavale, Lawrence Fakoli, Christopher Gregory, Tai-Ho Chen, Augustine Koryon, Denise Roth Allen, Jennifer Mann, Andrew Hickey, John Saindon, Mehboob Badini, April Baller, Peter Clement, Fatorma Bolay, Yatta Wapoe, Michael R Wiley, James Logue, Bonnie Dighero-Kemp, Elizabeth Higgs, Alex Gasasira, Desmond E Williams, Bernice Dahn, Francis Kateh, Tolbert Nyenswah, Gustavo Palacios, Mosoka P Fallah

| Article suivant

Comparative efficacy of treatments for Clostridium difficile infection: a systematic review and network meta-analysis
Tumas Beinortas, Nicholas E Burr, Mark H Wilcox, Venkataraman Subramanian

Bienvenue sur EM-consulte, la référence des professionnels de santé.

connectez-vous ou créez un compte

The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis - 24/08/18

Summary

Background

Methods

Findings

Interpretation

Funding

Plan

Export citations

Fichier

Contenu

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL