Please use this identifier to cite or link to this item:
Title: Safety and efficacy of primaquine in patients with Plasmodium vivax malaria from South Asia: a systematic review and individual patient data meta-analysis.
Author: Verma, R.
Commons, Robert J.
Gupta, A.
Nitika, M.
Bharti, P.
Thriemer, K.
Rajasekhar, M.
Singh-Phulgenda, S.
Adhikari, B.
Alam, M.
Ghimire, P.
Khan, W.
Kumar, R.
Leslie, T.
Ley, B.
Llanos-Cuentas, A.
Pukrittayakamee, S.
Rijal, K.
Rowland, M.
Saravu, K.
Simpson, J.
Guerin, P.
Price, R.
Sharma, A.
Issue Date: 2023
Publication Title: BMJ Global Health
Volume: 8
Issue: 12
Start Page: e012675
Abstract: Background: The optimal dosing of primaquine to prevent relapsing Plasmodium vivax malaria in South Asia remains unclear. We investigated the efficacy and safety of different primaquine regimens to prevent P. vivax relapse. Methods: A systematic review identified P. vivax efficacy studies from South Asia published between 1 January 2000 and 23 August 2021. In a one-stage meta-analysis of available individual patient data, the cumulative risks of P. vivax recurrence at day 42 and 180 were assessed by primaquine total mg/kg dose and duration. The risk of recurrence by day 180 was also determined in a two-stage meta-analysis. Patients with a >25% drop in haemoglobin to <70 g/L, or an absolute drop of >50 g/L between days 1 and 14 were categorised by daily mg/kg primaquine dose. Results: In 791 patients from 7 studies in the one-stage meta-analysis, the day 180 cumulative risk of recurrence was 61.1% (95% CI 42.2% to 80.4%; 201 patients; 25 recurrences) after treatment without primaquine, 28.8% (95% CI 8.2% to 74.1%; 398 patients; 4 recurrences) following low total (2 to <5 mg/kg) and 0% (96 patients; 0 recurrences) following high total dose primaquine (≥5 mg/kg). In the subsequent two-stage meta-analysis of nine studies (3529 patients), the pooled proportions of P. vivax recurrences by day 180 were 12.1% (95% CI 7.7% to 17.2%), 2.3% (95% CI 0.3% to 5.4%) and 0.7% (95% CI 0% to 6.1%), respectively. No patients had a >25% drop in haemoglobin to <70 g/L. Conclusions: Primaquine treatment led to a marked decrease in P. vivax recurrences following low (~3.5 mg/kg) and high (~7 mg/kg) total doses, with no reported severe haemolytic events.
Internal ID Number: 02391
Health Subject: MALARIA
Type: Journal Article
Appears in Collections:Research Output

Files in This Item:
There are no files associated with this item.

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.