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Safety of single-dose primaquine as a Plasmodium falciparum gametocytocide : a systematic review and meta-analysis of individual patient data

Stepniewska, Kasia (författare)
WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Clin Med, Oxford, England.
Allen, Elizabeth N. (författare)
WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Cape Town, Dept Med, Div Clin Pharmacol, Cape Town, South Africa.
Humphreys, Georgina S. (författare)
WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Oxford, Green Templeton Coll, Oxford, England.
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Poirot, Eugenie (författare)
Univ Calif San Francisco, Global Hlth Grp, Malaria Eliminat Initiat, San Francisco, CA 94143 USA.
Craig, Elaine (författare)
WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Clin Med, Oxford, England.
Kennon, Kalynn (författare)
WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Clin Med, Oxford, England.
Yilma, Daniel (författare)
WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Cape Town, Dept Med, Div Clin Pharmacol, Cape Town, South Africa.;Jimma Univ, Jimma Univ Clin Trial Unit, Dept Internal Med, Jimma, Ethiopia.
Bousema, Teun (författare)
London Sch Hyg & Trop Med, Dept Infect & Immun, London, England.;Radboud Univ Nijmegen Med Ctr, Dept Med Microbiol, Nijmegen, Netherlands.
Guerin, Philippe J. (författare)
WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Clin Med, Oxford, England.
White, Nicholas J. (författare)
Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Clin Med, Oxford, England.;Mahidol Univ, Fac Trop Med, Bangkok, Thailand.
Price, Ric N. (författare)
WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Clin Med, Oxford, England.;Menzies Sch Hlth Res, Global & Trop Hlth Div, Darwin, NT, Australia.;Charles Darwin Univ, Darwin, NT, Australia.
Raman, Jaishree (författare)
Natl Inst Communicable Dis, Div Natl Hlth Lab Serv, Parasitol Reference Lab, Johannesburg, South Africa.;Univ Witwatersrand, Fac Hlth Sci, Wits Res Inst Malaria, Johannesburg, South Africa.
Mårtensson, Andreas, 1963- (författare)
Uppsala universitet,Internationell barnhälsa och nutrition
Mwaiswelo, Richard O. (författare)
Muhimbili Univ Hlth & Allied Sci, Dept Parasitol & Med Entomol, Dar Es Salaam, Tanzania.;Hubert Kairuki Mem Univ, Dept Microbiol Immunol & Parasitol, Dar Es Salaam, Tanzania.
Bancone, Germana (författare)
Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Clin Med, Oxford, England.;Mahidol Univ, Fac Trop Med, Shoklo Malaria Res Unit, Mahidol Oxford Trop Med Res Unit, Mae Sot, Thailand.
Bastiaens, Guido J. H. (författare)
Radboud Univ Nijmegen Med Ctr, Dept Med Microbiol, Nijmegen, Netherlands.;Rijnstate Hosp, Lab Med Microbiol & Immunol, Arnhem, Netherlands.
Bjorkman, Anders (författare)
Karolinska Inst, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden.
Brown, Joelle M. (författare)
Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA USA.
D'Alessandro, Umberto (författare)
London Sch Hyg & Trop Med, Med Res Council Unit, Fajara, Gambia.
Dicko, Alassane A. (författare)
Univ Sci Tech & Technol Bamako, Fac Pharm, Malaria Res & Training Ctr, Bamako, Mali.;Univ Sci Tech & Technol Bamako, Fac Med & Dent, Bamako, Mali.
El-Sayed, Badria (författare)
Natl Ctr Res, Trop Med Res Inst, Dept Epidemiol, Khartoum, Sudan.
Elzaki, Salah-Eldin (författare)
Natl Ctr Res, Trop Med Res Inst, Dept Epidemiol, Khartoum, Sudan.
Eziefula, Alice C. (författare)
Univ Sussex, Brighton & Sussex Med Sch, Dept Global Hlth & Infect, Brighton, E Sussex, England.
Goncalves, Bronner P. (författare)
London Sch Hyg & Trop Med, Dept Infect & Immun, London, England.
Hamid, Muzamil Mahdi Abdel (författare)
Univ Khartoum, Inst Endem Dis, Khartoum, Sudan.
Kaneko, Akira (författare)
Karolinska Inst, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden.
Kariuki, Simon (författare)
Kenya Med Res Inst KEMRI, Kisian, Kenya.
Khan, Wasif (författare)
Int Ctr Diarrheal Dis Res, Infect Dis Div, Dhaka, Bangladesh.
Kwambai, Titus K. (författare)
Ctr Dis Control & Prevent, Dept Parasit Dis & Malaria, Kisumu, Kenya.
Ley, Benedikt (författare)
Menzies Sch Hlth Res, Global & Trop Hlth Div, Darwin, NT, Australia.;Charles Darwin Univ, Darwin, NT, Australia.
Ngasala, Billy E. (författare)
Uppsala universitet,Internationell barnhälsa och nutrition,Muhimbili Univ Hlth & Allied Sci, Dept Parasitol & Med Entomol, Dar Es Salaam, Tanzania.
Nosten, Francois (författare)
Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Clin Med, Oxford, England.;Mahidol Univ, Fac Trop Med, Shoklo Malaria Res Unit, Mahidol Oxford Trop Med Res Unit, Mae Sot, Thailand.
Okebe, Joseph (författare)
MRC Unit, Dis Control & Eliminat Theme, Fajara, Gambia.;Univ Liverpool Liverpool Sch Trop Med, Liverpool, Merseyside, England.
Samuels, Aaron M. (författare)
Ctr Dis Control & Prevent, Dept Parasit Dis & Malaria, Kisumu, Kenya.
Smit, Menno R. (författare)
Univ Liverpool Liverpool Sch Trop Med, Liverpool, Merseyside, England.
Stone, Will J. R. (författare)
London Sch Hyg & Trop Med, Dept Infect & Immun, London, England.;Radboud Univ Nijmegen Med Ctr, Dept Med Microbiol, Nijmegen, Netherlands.
Sutanto, Inge (författare)
Univ Indonesia, Fac Med, Dept Parasitol, Depok City, Indonesia.
Ter Kuile, Feiko (författare)
Univ Liverpool Liverpool Sch Trop Med, Liverpool, Merseyside, England.
Tine, Roger C. (författare)
Univ Cheikh Anta Diop, Fac Med, Dept Med Parasitol, Dakar, Senegal.
Tiono, Alfred B. (författare)
Ctr Natl Rech & Format Paludisme, Dept Biomed Sci, Ouagadougou, Burkina Faso.
Drakeley, Chris J. (författare)
London Sch Trop Med & Hyg, Dept Infect Biol, London, England.
Gosling, Roly (författare)
Univ Calif San Francisco, Global Hlth Grp, Malaria Eliminat Initiat, San Francisco, CA 94143 USA.;Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA USA.
Stergachis, Andy (författare)
Univ Washington, Dept Pharm, Sch Pharm & Publ Hlth, Seattle, WA USA.
Barnes, Karen, I (författare)
WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Cape Town, Dept Med, Div Clin Pharmacol, Cape Town, South Africa.
Chen, Ingrid (författare)
Univ Calif San Francisco, Global Hlth Grp, Malaria Eliminat Initiat, San Francisco, CA 94143 USA.
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WorldWide Antimalarial Resistance Network, Oxford, England;Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Clin Med, Oxford, England. WorldWide Antimalarial Resistance Network, Oxford, England.;Univ Cape Town, Dept Med, Div Clin Pharmacol, Cape Town, South Africa. (creator_code:org_t)
Springer Nature, 2022
2022
Engelska.
Ingår i: BMC Medicine. - : Springer Nature. - 1741-7015. ; 20:1
  • Forskningsöversikt (refereegranskat)
Abstract Ämnesord
Stäng  
  • BackgroundIn 2012, the World Health Organization (WHO) recommended single low-dose (SLD, 0.25 mg/kg) primaquine to be added as a Plasmodium (P.) falciparum gametocytocide to artemisinin-based combination therapy (ACT) without glucose-6-phosphate dehydrogenase (G6PD) testing, to accelerate malaria elimination efforts and avoid the spread of artemisinin resistance. Uptake of this recommendation has been relatively slow primarily due to safety concerns.MethodsA systematic review and individual patient data (IPD) meta-analysis of single-dose (SD) primaquine studies for P. falciparum malaria were performed. Absolute and fractional changes in haemoglobin concentration within a week and adverse effects within 28 days of treatment initiation were characterised and compared between primaquine and no primaquine arms using random intercept models.ResultsData comprised 20 studies that enrolled 6406 participants, of whom 5129 (80.1%) had received a single target dose of primaquine ranging between 0.0625 and 0.75 mg/kg. There was no effect of primaquine in G6PD-normal participants on haemoglobin concentrations. However, among 194 G6PD-deficient African participants, a 0.25 mg/kg primaquine target dose resulted in an additional 0.53 g/dL (95% CI 0.17-0.89) reduction in haemoglobin concentration by day 7, with a 0.27 (95% CI 0.19-0.34) g/dL haemoglobin drop estimated for every 0.1 mg/kg increase in primaquine dose. Baseline haemoglobin, young age, and hyperparasitaemia were the main determinants of becoming anaemic (Hb < 10 g/dL), with the nadir observed on ACT day 2 or 3, regardless of G6PD status and exposure to primaquine. Time to recovery from anaemia took longer in young children and those with baseline anaemia or hyperparasitaemia. Serious adverse haematological events after primaquine were few (9/3, 113, 0.3%) and transitory. One blood transfusion was reported in the primaquine arms, and there were no primaquine-related deaths. In controlled studies, the proportions with either haematological or any serious adverse event were similar between primaquine and no primaquine arms.ConclusionsOur results support the WHO recommendation to use 0.25 mg/kg of primaquine as a P. falciparum gametocytocide, including in G6PD-deficient individuals. Although primaquine is associated with a transient reduction in haemoglobin levels in G6PD-deficient individuals, haemoglobin levels at clinical presentation are the major determinants of anaemia in these patients.

Ämnesord

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskaper -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Infectious Medicine (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Infektionsmedicin (hsv//swe)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)
MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskaper (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)
MEDICAL AND HEALTH SCIENCES  -- Health Sciences (hsv//eng)

Nyckelord

Malaria
Primaquine
Clinical trial
Safety
Haemoglobin
Haemoglobinuria adverse events
Individual patient data (IPD)
Meta-analysis
Systematic review

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