Artemisinin-based combination therapy for treating uncomplicatedPlasmodium vivaxmalaria

Abstract

BackgroundPlasmodium vivax is an important cause of malaria in many parts of Asia and South America, and parasite resistance to the standard treatment (chloroquine) is now high in some parts of Oceania. This review aims to assess the current treatment options in the light of increasing chloroquine resistance. ObjectivesTo compare artemisinin-based combination therapies (ACTs) with alternative antimalarial regimens for treating acute uncomplicated P. vivax malaria. Search methodsWe searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CEN-TRAL); MEDLINE; EMBASE; LILACS; and the metaRegister of Controlled Trials (mRCT) up to 28 March 2013 using "vivax" and "arte* OR dihydroarte*" as search terms. Selection criteriaRandomized controlled trials comparing ACTs versus standard therapy, or comparing alternative ACTs, in adults and children with uncomplicated P. vivax malaria. Data collection and analysisTwo authors independently assessed trials for eligibility and risk of bias, and extracted data. We used recurrent parasitaemia prior to day 28 as a proxy for effective treatment of the blood stage parasite, and compared drug treatments using risk ratios (RR) and 95% confidence intervals (CIs). We used trials following patients for longer than 28 days to assess the duration of the post-treatment prophylactic effect of ACTs. We assessed the quality of the evidence using the GRADE approach. 1 Artemisinin-based combination therapy for treating uncomplicated Plasmodium vivax malaria (Review)

Nonrandomized Controlled Trial of Artesunate plus Sulfadoxine-Pyrimethamine with or without Primaquine for Preventing Posttreatment Circulation of Plasmodium falciparum Gametocytes

“…While the choice of partner drug may also affect posttreatment gametocytemia prevalence, as SP monotherapy is associated with increased posttreatment gametocytemia (17,22), our observations were similar to those observed for other combination therapies elsewhere (17,23). We measured the effect of primaquine through gametocyte clearance, the number of gametocyte-weeks of circulation, and the area under the curve using gametocyte density over time.…”

Therapeutic and Transmission-Blocking Efficacy of Dihydroartemisinin/Piperaquine and Chloroquine against Plasmodium vivax Malaria, Cambodia

“…We confirm that DHA/PPQ acts faster ( < 48 h) than chloroquine (≈72 h) in eliminating sexual and asexual P. vivax parasites and that DHA/PPQ provides an excellent postexposure prophylaxis against potential recurrences for > 2 months ( 11 ). This benefit relies on the combination of artemisinin derivatives (DHA), which are fast-acting drugs capable of eliminating any P. vivax blood stages, and a long-lasting partner drug (PPQ), which has a long terminal elimination half-life and is highly effective in preventing P. vivax recurrence for up to 56 days.…”

The Effect of Dosing Regimens on the Antimalarial Efficacy of Dihydroartemisinin-Piperaquine: A Pooled Analysis of Individual Patient Data

“…The combination of dihydroartemisinin-piperaquine (DP) has been assessed in clinical trials for almost a decade, and shown to be highly efficacious against both Plasmodium falciparum and P. vivax infections [3],[9],[10]. Since 2010, DP has been recommended by WHO for the treatment of uncomplicated falciparum malaria [5], providing a promising alternative to other currently available ACTs, based upon its high efficacy, excellent safety profile, once daily dosing scheme, and prolonged post-treatment prophylactic protection [11]–[13].…”