Efficacy of Single-Dose Primaquine With Artemisinin Combination Therapy on Plasmodium falciparum Gametocytes and Transmission: An Individual Patient Meta-Analysis.
Loading...
Date
2020
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Infectious Disease
Abstract
Background
Since the World Health Organization recommended single low-dose (0.25 mg/kg) primaquine (PQ) in combina-tion with artemisinin-based combination therapies (ACTs) in areas of low transmission or artemisinin-resistant Plasmodium falcip-arum, several single-site studies have been conducted to assess efficacy.
Methods
An individual patient meta-analysis to assess gametocytocidal and transmission-blocking efficacy of PQ in combina-tion with different ACTs was conducted. Random effects logistic regression was used to quantify PQ effect on (1) gametocyte car-riage in the first 2 weeks post treatment; and (2) the probability of infecting at least 1 mosquito or of a mosquito becoming infected.
Results
In 2574 participants from 14 studies, PQ reduced PCR-determined gametocyte carriage on days 7 and 14, most ap-parently in patients presenting with gametocytemia on day 0 (odds ratio [OR], 0.22; 95% confidence interval [CI], .17–.28 and OR, 0.12; 95% CI, .08–.16, respectively). Rate of decline in gametocyte carriage was faster when PQ was combined with artemether-lumefantrine (AL) compared to dihydroartemisinin-piperaquine (DP) (P= .010 for day 7). Addition of 0.25 mg/kg PQ was associ-ated with near complete prevention of transmission to mosquitoes.
Conclusions
Transmission blocking is achieved with 0.25 mg/kg PQ. Gametocyte persistence and infectivity are lower when PQ is combined with AL compared to DP.
Keywords. single low-dose primaquine; Plasmodium falciparum; gametocytemia.
Description
Keywords
Plasmodium falciparum, Gametocytemia., Single-Dose Primaquine
Citation
Stepniewska, K., Humphreys, G.S., Gonçalves, B.P., Craig, E., Gosling, R., Guerin, P.J., Price, R.N., Barnes, K.I., Raman, J., Smit, M. and D'Alessandro, U., 2020. Efficacy of single-dose primaquine with artemisinin combination therapy on Plasmodium falciparum gametocytes and transmission: an individual patient meta-analysis. Journal of Infectious Disease, (jiaa498).