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Stone W, Mahamar A, Smit MJ, Sanogo K, Sinaba Y, Niambele SM, Sacko A, Keita S, Dicko OM, Diallo M, Maguiraga SO, Samake S, Attaher O, Lanke K, Ter Heine R, Bradley J, McCall MBB, Issiaka D, Traore SF, Bousema T, Drakeley C, Dicko A. Single low-dose tafenoquine combined with dihydroartemisinin-piperaquine to reduce Plasmodium falciparum transmission in Ouelessebougou, Mali: a phase 2, single-blind, randomised clinical trial. THE LANCET. MICROBE 2022; 3:e336-e347. [PMID: 35544095 PMCID: PMC9042793 DOI: 10.1016/s2666-5247(21)00356-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tafenoquine was recently approved as a prophylaxis and radical cure for Plasmodium vivax infection, but its Plasmodium falciparum transmission-blocking efficacy is unclear. We aimed to establish the efficacy and safety of three single low doses of tafenoquine in combination with dihydroartemisinin-piperaquine for reducing gametocyte density and transmission to mosquitoes. METHODS In this four-arm, single-blind, phase 2, randomised controlled trial, participants were recruited at the Clinical Research Unit of the Malaria Research and Training Centre of the University of Bamako in Mali. Eligible participants were aged 12-50 years, with asymptomatic P falciparum microscopy-detected gametocyte carriage, had a bodyweight of 80 kg or less, and had no clinical signs of malaria defined by fever. Participants were randomly assigned (1:1:1:1) to standard treatment with dihydroartemisinin-piperaquine, or dihydroartemisinin-piperaquine plus a single dose of tafenoquine (in solution) at a final dosage of 0·42 mg/kg, 0·83 mg/kg, or 1·66 mg/kg. Randomisation was done with a computer-generated randomisation list and concealed with sealed, opaque envelopes. Dihydroartemisinin-piperaquine was administered as oral tablets over 3 days (day 0, 1, and 2), as per manufacturer instructions. A single dose of tafenoquine was administered as oral solution on day 0 in parallel with the first dose of dihydroartemisinin-piperaquine. Tafenoquine dosing was based on bodyweight to standardise efficacy and risk variance. The primary endpoint, assessed in the per-protocol population, was median percentage change in mosquito infection rate 7 days after treatment compared with baseline. Safety endpoints included frequency and incidence of adverse events. The final follow-up visit was on Dec 23, 2021; the trial is registered with ClinicalTrials.gov, NCT04609098. FINDINGS From Oct 29 to Nov 25, 2020, 1091 individuals were screened for eligibility, 80 of whom were enrolled and randomly assigned (20 per treatment group). Before treatment, 53 (66%) individuals were infectious to mosquitoes, infecting median 12·50% of mosquitoes (IQR 3·64-35·00). Within-group reduction in mosquito infection rate on day 7 was 79·95% (IQR 57·15-100; p=0·0005 for difference from baseline) following dihydroartemisinin-piperaquine only, 100% (98·36-100; p=0·0005) following dihydroartemisinin-piperaquine plus tafenoquine 0·42 mg/kg, 100% (100-100; p=0·0001) following dihydroartemisinin-piperaquine plus tafenoquine 0·83 mg/kg, and 100% (100-100; p=0·0001) following dihydroartemisinin-piperaquine plus tafenoquine 1·66 mg/kg. 55 (69%) of 80 participants had a total of 94 adverse events over the course of the trial; 86 (92%) adverse events were categorised as mild, seven (7%) as moderate, and one (1%) as severe. The most common treatment-related adverse event was mild or moderate headache, which occurred in 15 (19%) participants (dihydroartemisinin-piperaquine n=2; dihydroartemisinin-piperaquine plus tafenoquine 0·42 mg/kg n=6; dihydroartemisinin-piperaquine plus tafenoquine 0·83 mg/kg n=3; and dihydroartemisinin-piperaquine plus tafenoquine 1·66 mg/kg n=4). No serious adverse events occurred. No significant differences in the incidence of all adverse events (p=0·73) or treatment-related adverse events (p=0·62) were observed between treatment groups. INTERPRETATION Tafenoquine was well tolerated at all doses and accelerated P falciparum gametocyte clearance. All tafenoquine doses showed improved transmission reduction at day 7 compared with dihydroartemisinin-piperaquine alone. These data support the case for further research on tafenoquine as a transmission-blocking supplement to standard antimalarials. FUNDING Bill & Melinda Gates Foundation. TRANSLATIONS For the French, Portuguese, Spanish and Swahili translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Will Stone
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Almahamoudou Mahamar
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Merel J Smit
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, Netherlands
| | - Koualy Sanogo
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Youssouf Sinaba
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sidi M Niambele
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Adama Sacko
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekouba Keita
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Oumar M Dicko
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Makonon Diallo
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Seydina O Maguiraga
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Siaka Samake
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Oumar Attaher
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Kjerstin Lanke
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, Netherlands
| | - Rob Ter Heine
- Department of Pharmacy and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, Netherlands
| | - John Bradley
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew B B McCall
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, Netherlands
| | - Djibrilla Issiaka
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Sekou F Traore
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Teun Bousema
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, University of Nijmegen, Nijmegen, Netherlands
| | - Chris Drakeley
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | - Alassane Dicko
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
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Llanos-Cuentas A, Manrrique P, Rosas-Aguirre A, Herrera S, Hsiang MS. Tafenoquine for the treatment of Plasmodium vivax malaria. Expert Opin Pharmacother 2022; 23:759-768. [PMID: 35379070 DOI: 10.1080/14656566.2022.2058394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Plasmodium vivax malaria causes significant disease burden worldwide, especially in Latin America, Southeast Asia, and Oceania. P. vivax is characterized by the production of liver hypnozoites that cause clinical relapses upon periodic activation. Primaquine, an 8-aminoquinoline drug, has been the standard of care for decades to treat liver-stage P. vivax malaria; however, it requires long treatment regimens (one to two weeks) that lead to poor adherence and thus clinical relapses. Tafenoquine (TFQ), a newly available and efficacious single-dose 8-aminoquinoline, aims to address this challenge. Safe administration is possible when paired with the use of glucose-6-phosphate dehydrogenase (G6PD) diagnostics to prevent 8-aminoquinoline-induced hemolysis in patients with underlying G6PD deficiency (G6PDd). AREAS COVERED In this review, the authors present the recent literature regarding the pharmacology, efficacy, safety, and tolerability of TFQ and highlight regional differences in these areas. The authors also discuss the potential for TFQ, complemented with primaquine PQ and effective screening for G6PDd, to improve P. vivax clinical management and facilitate targeted mass drug administration in communities to decrease transmission. EXPERT OPINION Clinical studies show therapeutic efficacy of TFQ as well as a good performance in terms of safety and tolerability. Additional research regarding the effectiveness and safety TFQ in malaria elimination strategies such as targeted or mass drug administration are needed.
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Affiliation(s)
| | - Paulo Manrrique
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, PA, USA
| | - Angel Rosas-Aguirre
- Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sonia Herrera
- Department of Epidemiology, Division of Infectious Diseases and Global Health, Department of Pediatrics, Division of Pediatric Infectious Diseases, University of California San Francisco, San Francisco, CA, United States
| | - Michelle S Hsiang
- Department of Epidemiology, Division of Infectious Diseases and Global Health, Department of Pediatrics, Division of Pediatric Infectious Diseases, University of California San Francisco, San Francisco, CA, United States.,Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, CA, USA.,Department of PediatricsUniversity of California San Francisco (UCSF), San Francisco, CA, USA
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Guo X, Li P, Wang Q, Wang Q, Wang L. Remote Selective Decarboxylative Difluoroarylmethylation of 8-Aminoquinolines under Transition Metal-Free Conditions. Org Chem Front 2022. [DOI: 10.1039/d1qo01912k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A facile transition metal-free decarboxylative C4 selective C-H difluoroarylmethylation of 8-aminoquinolines has been developed. This strategy proceeds under simple aqueous conditions and displays a broad substrate scope and excellent functional...
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Zhao M, Qin Z, Zhang K, Li J. Metal-free site-selective C-H cyanoalkylation of 8-aminoquinoline and aniline-derived amides with azobisisobutyronitrile. RSC Adv 2021; 11:30719-30724. [PMID: 35479854 PMCID: PMC9041112 DOI: 10.1039/d1ra06013a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022] Open
Abstract
Using K2S2O8, an efficient and metal-free site-selective C–H cyanoalkylation of 8-aminoquinoline and aniline-derived amides with AIBN (azobisisobutyronitrile) was developed. Without any catalyst, various substrates and functional groups were compatible to afford corresponding products in moderate to high yields. A mechanism study displayed that a radical–radical coupling process was involved via the N-centered radical generation and delocalization of aryl amides. An efficient metal-free cyanoalkylation of 8-aminoquinoline and aniline-derived amides was achieved in the presence of K2S2O8. The method showed good substrate tolerance and also suitable for bromination and dimerization reactions.![]()
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Affiliation(s)
- Mengfei Zhao
- Department of Organic Chemistry, College of Chemistry, Jilin University 2519 Jiefang Road Changchun 130021 P. R. China
| | - Zengxin Qin
- Department of Organic Chemistry, College of Chemistry, Jilin University 2519 Jiefang Road Changchun 130021 P. R. China
| | - Kaixin Zhang
- Department of Organic Chemistry, College of Chemistry, Jilin University 2519 Jiefang Road Changchun 130021 P. R. China
| | - Jizhen Li
- Department of Organic Chemistry, College of Chemistry, Jilin University 2519 Jiefang Road Changchun 130021 P. R. China
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Markus MB. Safety and Efficacy of Tafenoquine for Plasmodium vivax Malaria Prophylaxis and Radical Cure: Overview and Perspectives. Ther Clin Risk Manag 2021; 17:989-999. [PMID: 34526770 PMCID: PMC8435617 DOI: 10.2147/tcrm.s269336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
This article is inter alia a brief, first-stop guide to possible adverse events (AEs) associated with tafenoquine (TQ) intake. Safety and efficacy findings for TQ in Plasmodium vivax malaria prophylaxis and radical cure are summarized and some of the latest TQ-related studies (published in 2020 and 2021) are highlighted. In addition, little-known biological and other matters concerning malaria parasites and 8-aminoquinoline (8-AQ) drug action are discussed and some correct terminology pertinent to malaria is explained.
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Affiliation(s)
- Miles B Markus
- School of Animal, Plant and Environmental Sciences, Faculty of Science, University of the Witwatersrand, Johannesburg, South Africa
- Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Islam N, Wright S, Lau CL, Doi SAR, Mills DJ, Clark J, Clements ACA, Furuya-Kanamori L. Efficacy of a 3-day pretravel schedule of tafenoquine for malaria chemoprophylaxis: a network meta-analysis. J Travel Med 2021; 28:6217513. [PMID: 33834208 DOI: 10.1093/jtm/taab057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chemoprophylaxis with weekly doses of tafenoquine (200 mg/day for 3 days before departure [loading dose], 200 mg/week during travel and 1-week post-travel [maintenance doses]) is effective in preventing malaria. Effectiveness of malaria chemoprophylaxis drugs in travellers is often compromised by poor compliance. Shorter schedules that can be completed before travel, allowing 'drug-free holidays', could increase compliance and thus reduce travel-related malaria. In this meta-analysis, we examined if a loading dose of tafenoquine alone is effective in preventing malaria in short-term travellers. METHODS Four databases were searched in November 2020 for randomized controlled trials (RCTs) that assessed efficacy and/or safety of tafenoquine for chemoprophylaxis. Network meta-analysis using the generalized pair-wise modelling framework was utilized to estimate the odds ratio (OR) of malaria infection in long-term (>28 days) and short-term (≤28 days) travellers, as well as adverse events (AEs) associated with receiving loading dose of tafenoquine alone, loading dose of tafenoquine followed by maintenance doses, loading dose of mefloquine followed by maintenance doses, or placebo. RESULTS Nine RCTs (1714 participants) were included. In long-term travellers, compared to mefloquine, tafenoquine with maintenance doses (OR = 1.05; 95% confidence interval [CI]: 0.44-2.46) was equally effective in preventing malaria, while there was an increased risk of infection with the loading dose of tafenoquine alone (OR = 2.89; 95% CI: 0.78-10.68) and placebo (OR = 62.91; 95% CI: 8.53-463.88). In short-term travellers, loading dose of tafenoquine alone (OR = 0.98; 95% CI: 0.04-22.42) and tafenoquine with maintenance doses (OR = 1.00; 95% CI: 0.06-16.10) were as effective as mefloquine. The risk of AEs with tafenoquine with maintenance doses (OR = 1.03; 95% CI: 0.67-1.60) was similar to mefloquine, while loading dose of tafenoquine alone (OR = 0.58; 95% CI: 0.20-1.66) was associated with lower risk of AEs, although the difference was not statistically significant. CONCLUSIONS For short-term travellers, loading dose of tafenoquine alone was equally effective, had possibly lower rate of AEs, and likely better compliance than standard tafenoquine or mefloquine chemoprophylaxis schedules with maintenance doses. Studies are needed to confirm if short-term travellers remain free of infection after long-term follow-up. REGISTRATION The meta-analysis was registered in PROSPERO (CRD42021223756). HIGHLIGHT Tafenoquine is the latest approved drug for malaria chemoprophylaxis. A loading dose of tafenoquine (200 mg/day for 3 days before departure) is as effective in preventing malaria in short-term (≤28 days) travellers as chemoprophylaxis schedules of tafenoquine or mefloquine with maintenance doses, allowing travellers to have a 'drug-free holiday'.
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Affiliation(s)
- Nazmul Islam
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, PO BOX 2713, Qatar
| | - Sophie Wright
- ANU Medical School, Australian National University, Canberra, ACT 2601, Australia
| | - Colleen L Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD 4000, Australia
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, PO BOX 2713, Qatar
| | - Deborah J Mills
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD 4000, Australia
- Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Robina, QLD 4226, Australia
| | | | - Luis Furuya-Kanamori
- Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia
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Baird JK. Single loading-dose tafenoquine for malaria chemoprophylaxis during brief travel? J Travel Med 2021; 28:6287694. [PMID: 34050367 PMCID: PMC8271189 DOI: 10.1093/jtm/taab081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 01/29/2023]
Affiliation(s)
- J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta, Indonesia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Bhutani P, Joshi G, Raja N, Bachhav N, Rajanna PK, Bhutani H, Paul AT, Kumar R. U.S. FDA Approved Drugs from 2015-June 2020: A Perspective. J Med Chem 2021; 64:2339-2381. [PMID: 33617716 DOI: 10.1021/acs.jmedchem.0c01786] [Citation(s) in RCA: 228] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the present work, we report compilation and analysis of 245 drugs, including small and macromolecules approved by the U.S. FDA from 2015 until June 2020. Nearly 29% of the drugs were approved for the treatment of various types of cancers. Other major therapeutic areas of focus were infectious diseases (14%); neurological conditions (12%); and genetic, metabolic, and cardiovascular disorders (7-8% each). Itemization of the approved drugs according to the year of approval, sponsor, target, chemical class, major drug-metabolizing enzyme(s), route of administration/elimination, and drug-drug interaction liability (perpetrator or/and victim) is presented and discussed. An effort has been made to analyze the pharmacophores to identify the structural (e.g., aromatic, heterocycle, and aliphatic), elemental (e.g., boron, sulfur, fluorine, phosphorus, and deuterium), and functional group (e.g., nitro drugs) diversity among the approved drugs. Further, descriptor-based chemical space analysis of FDA approved drugs and several strategies utilized for optimizing metabolism leading to their discoveries have been emphasized. Finally, an analysis of drug-likeness for the approved drugs is presented.
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Affiliation(s)
- Priyadeep Bhutani
- Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre, Syngene International Limited, Bangalore 560099, India.,Department of Pharmacy, Birla Institute of Technology and Science (BITS) Pilani, Pilani Campus, Rajasthan 333031, India
| | - Gaurav Joshi
- Laboratory for Drug Design and Synthesis, Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda 151001, India
| | - Nivethitha Raja
- Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre, Syngene International Limited, Bangalore 560099, India
| | - Namrata Bachhav
- 1015 E Cozza Drive # 12, Spokane Washington 99208, United States
| | - Prabhakar K Rajanna
- Pharmaceutical Candidate Optimization, Biocon Bristol-Myers Squibb R&D Centre, Syngene International Limited, Bangalore 560099, India
| | - Hemant Bhutani
- Pharmaceutical Development, Biocon Bristol-Myers Squibb R&D Centre, Bristol-Myers Squibb India Private Limited, Bangalore 560099, India
| | - Atish T Paul
- Department of Pharmacy, Birla Institute of Technology and Science (BITS) Pilani, Pilani Campus, Rajasthan 333031, India
| | - Raj Kumar
- Laboratory for Drug Design and Synthesis, Department of Pharmaceutical Sciences and Natural Products, Central University of Punjab, Bathinda 151001, India
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Development of sustainable research excellence with a global perspective on infectious diseases: Centre de Recherches Médicales de Lambaréné (CERMEL), Gabon. Wien Klin Wochenschr 2021; 133:500-508. [PMID: 33398458 PMCID: PMC7781170 DOI: 10.1007/s00508-020-01794-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022]
Abstract
Medical research in sub-Saharan Africa is of high priority for societies to respond adequately to local health needs. Often enough it remains a challenge to build up capacity in infrastructure and human resources to highest international standards and to sustain this over mid-term to long-term periods due to difficulties in obtaining long-term institutional core funding, attracting highly qualified scientists for medical research and coping with ever changing structural and political environments. The Centre de Recherches Médicales de Lambaréné (CERMEL) serves as model for how to overcome such challenges and to continuously increase its impact on medical care in Central Africa and beyond. Starting off as a research annex to the Albert Schweitzer Hospital in Lambaréné, Gabon, it has since then expanded its activities to academic and regulatory clinical trials for drugs, vaccines and diagnostics in the field of malaria, tuberculosis, and a wide range of poverty related and neglected tropical infectious diseases. Advancing bioethics in medical research in Africa and steadily improving its global networks and infrastructures, CERMEL serves as a reference centre for several international consortia. In close collaboration with national authorities, CERMEL has become one of the main training hubs for medical research in Central Africa. It is hoped that CERMEL and its leitmotiv “to improve medical care for local populations” will serve as an inspiration to other institutions in sub-Saharan Africa to further increase African capacity to advance medicine.
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Maier JD, Siegfried S, Gültekin N, Stanga Z, Baird JK, Grobusch MP, Schlagenhauf P. Efficacy and safety of tafenoquine for malaria chemoprophylaxis (1998-2020): A systematic review and meta-analysis. Travel Med Infect Dis 2020; 39:101908. [PMID: 33227500 DOI: 10.1016/j.tmaid.2020.101908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In 2018, tafenoquine was approved for malaria chemoprophylaxis. We evaluated all available data on the safety and efficacy of tafenoquine chemoprophylaxis. METHODS This systematic review followed the PRISMA guidelines and was registered on PROSPERO (CRD42019123839). We searched PubMed, Embase, Scopus, CINAHL and Cochrane databases. Two authors (JDM, PS) screened all papers. RESULTS We included 44 papers in the qualitative and 9 in the quantitative analyses. These 9 randomized, controlled trials included 2495 participants, aged 12-60 years with 27.3% women. Six studies were conducted in Plasmodium spp.-endemic regions; two were human infection studies. 200 mg weekly tafenoquine and higher dosages lead to a significant reduction of Plasmodium spp. infection compared to placebo and were comparable to 250 mg mefloquine weekly with a protective efficacy between 77.9 and 100% or a total risk ratio of 0.22 (95%-CI: 0.07-0.73; p = 0.013) in favour of tafenoquine. Adverse events (AE) were comparable in frequency and severity between tafenoquine and comparator arms. One study reported significantly more gastrointestinal events in tafenoquine users (p ≤ 0.001). Evidence of increased, reversible, asymptomatic vortex keratopathy in subjects with prolonged tafenoquine exposures was found. A single, serious event of decreased macular sensitivity occurred. CONCLUSION This systematic review and meta-analysis of trials of G6PD-normal adults show that weekly tafenoquine 200 mg is well tolerated and effective as malaria chemoprophylaxis focusing primarily on Plasmodium falciparum but also on Plasmodium vivax. Our safety analysis is limited by heterogenous methods of adverse events reporting. Further research is indicated on the use of tafenoquine in diverse traveller populations.
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Affiliation(s)
- Julian D Maier
- University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Department of Public and Global Health, MilMedBiol Competence Centre, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Sandra Siegfried
- University of Zurich, Biostatistics Department at Epidemiology, Biostatistics and Prevention Institute, Switzerland
| | - Nejla Gültekin
- Centre of Competence for Military and Disaster Medicine, Federal Department of Defence, Civil Protection and Sport DDPS, Swiss Armed Forces, Medical Services, Ittigen, Switzerland
| | - Zeno Stanga
- Centre of Competence for Military and Disaster Medicine, Federal Department of Defence, Civil Protection and Sport DDPS, Swiss Armed Forces, Medical Services, Ittigen, Switzerland
| | - J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Martin P Grobusch
- Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Centres, Amsterdam Public Health, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Patricia Schlagenhauf
- University of Zurich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Department of Public and Global Health, MilMedBiol Competence Centre, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
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Rodrigo C, Rajapakse S, Fernando D. Tafenoquine for preventing relapse in people with Plasmodium vivax malaria. Cochrane Database Syst Rev 2020; 9:CD010458. [PMID: 32892362 PMCID: PMC8094590 DOI: 10.1002/14651858.cd010458.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Plasmodium vivax malaria has a persistent liver stage that causes relapse of the disease and continued P vivax transmission. Primaquine (PQ) is used to clear the liver stage of the parasite, but treatment is required for 14 days. Primaquine also causes haemolysis in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Tafenoquine (TQ) is a new alternative to PQ with a longer half-life and can be used as a single-dose treatment. OBJECTIVES To assess the effects of tafenoquine 300 mg (single dose) on preventing P vivax relapse. SEARCH METHODS We searched the following up to 3 June 2020: the Cochrane Infectious Diseases Group Specialized Register; CENTRAL; MEDLINE; Embase; and three other databases. We also searched the WHO International Clinical Trial Registry Platform and the metaRegister of Controlled Trials for ongoing trials using "tafenoquine" and "malaria" as search terms up to 3 June 2020. SELECTION CRITERIA Randomized controlled trials (RCTs) that gave TQ to prevent relapse in people with P vivax malaria. We planned to include trials irrespective of whether participants had been screened for G6PD enzyme deficiency. DATA COLLECTION AND ANALYSIS All review authors independently extracted data and assessed risk of bias. As true relapse and reinfection are difficult to differentiate in people living in endemic areas, studies report "recurrences" of infection as a proxy for relapse. We carried out meta-analysis where appropriate, and gave estimates as risk ratios (RR) with 95% confidence intervals (CI). We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS Three individually randomized RCTs met our inclusion criteria, all in endemic areas, and thus reporting recurrence. Trials compared TQ with PQ or placebo, and all participants received chloroquine (CQ) to treat the asexual infection). In all trials, pregnant and G6PD-deficient people were excluded. Tafenoquine 300 mg single dose versus no treatment for relapse prevention Two trials assessed this comparison. TQ 300 mg single dose reduces P vivax recurrences compared to no antihypnozoite treatment during a six-month follow-up, but there is moderate uncertainty around effect size (RR 0.32, 95% CI 0.12 to 0.88; 2 trials, 504 participants; moderate-certainty evidence). In people with normal G6PD status, there is probably little or no difference in any type of adverse events (2 trials, 504 participants; moderate-certainty evidence). However, we are uncertain if TQ causes more serious adverse events (2 trials, 504 participants; very low-certainty evidence). Both RCTs reported a total of 23 serious adverse events in TQ groups (One RCT reported 21 events) and a majority (15 events) were a drop in haemoglobin level by > 3g/dl (or >30% reduction from baseline). Tafenoquine 300 mg single dose versus primaquine 15 mg/day for 14 days for relapse prevention Three trials assessed this comparison. There is probably little or no difference between TQ and PQ in preventing recurrences (proxy measure for relapse) up to six months of follow-up (RR 1.04, 95% CI 0.8 to 1.34; 3 trials, 747 participants; moderate-certainty evidence). In people with normal G6PD status, there is probably little or no difference in any type of adverse events (3 trials, 747 participants; moderate-certainty evidence). We are uncertain if TQ can cause more serious adverse events compared to PQ (3 trials, 747 participants; very low-certainty evidence). Two trials had higher point estimates against TQ while the other showed the reverse. Most commonly reported serious adverse event in TQ group was a decline in haemoglobin level (19 out of 29 events). Some other serious adverse events, though observed in the TQ group, are unlikely to be caused by it (Hepatitis E infection, limb abscess, pneumonia, menorrhagia). AUTHORS' CONCLUSIONS TQ 300 mg single dose prevents relapses after clinically parasitologically confirmed P vivax malaria compared to no antihypnozoite treatment, and with no difference detected in studies comparing it to PQ to date. However, the inability to differentiate a true relapse from a recurrence in the available studies may affect these estimates. The drug is untested in children and in people with G6PD deficiency. Single-dose treatment is an important practical advantage compared to using PQ for the same purpose without an overall increase in adverse events in non-pregnant, non-G6PD-deficient adults.
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Affiliation(s)
- Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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12
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Dhiman AK, Thakur A, Kumar I, Kumar R, Sharma U. Co(III)-Catalyzed C-H Amidation of Nitrogen-Containing Heterocycles with Dioxazolones under Mild Conditions. J Org Chem 2020; 85:9244-9254. [PMID: 32558566 DOI: 10.1021/acs.joc.0c01237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A cobalt(III)-catalyzed C-8 selective C-H amidation of quinoline N-oxide using dioxazolone as an amidating reagent under mild conditions is disclosed. The reaction proceeds efficiently with excellent functional group compatibility. The utility of the current method is demonstrated by gram scale synthesis of C-8 amide quinoline N-oxide and by converting this amidated product into functionalized quinolines. Furthermore, the developed catalytic method is also applicable for C-7 amidation of N-pyrimidylindolines and ortho-amidation of benzamides.
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Affiliation(s)
- Ankit Kumar Dhiman
- Natural Product Chemistry and Process Development Division and AcSIR, CSIR-IHBT, Palampur 176061, India
| | - Ankita Thakur
- Natural Product Chemistry and Process Development Division and AcSIR, CSIR-IHBT, Palampur 176061, India
| | - Inder Kumar
- Natural Product Chemistry and Process Development Division and AcSIR, CSIR-IHBT, Palampur 176061, India
| | - Rakesh Kumar
- Natural Product Chemistry and Process Development Division and AcSIR, CSIR-IHBT, Palampur 176061, India
| | - Upendra Sharma
- Natural Product Chemistry and Process Development Division and AcSIR, CSIR-IHBT, Palampur 176061, India
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13
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Abstract
The scientific community worldwide has realized that malaria elimination will not be possible without development of safe and effective transmission-blocking interventions. Primaquine, the only WHO recommended transmission-blocking drug, is not extensively utilized because of the toxicity issues in G6PD deficient individuals. Therefore, there is an urgent need to develop novel therapeutic interventions that can target malaria parasites and effectively block transmission. But at first, it is imperative to unravel the existing portfolio of transmission-blocking drugs. This review highlights transmission-blocking potential of current antimalarial drugs and drugs that are in various stages of clinical development. The collective analysis of the relationships between the structure and the activity of transmission-blocking drugs is expected to help in the design of new transmission-blocking antimalarials.
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14
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Val F, Costa FT, King L, Brito-Sousa JD, Bassat Q, Monteiro WM, Siqueira AM, Luzzatto L, Lacerda MV. Tafenoquine for the prophylaxis, treatment and elimination of malaria: eagerness must meet prudence. Future Microbiol 2019; 14:1261-1279. [PMID: 31596137 DOI: 10.2217/fmb-2019-0202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Malaria puts more than 3 billion people at risk of infection and causes high morbidity and mortality. Plasmodium vivax forms hypnozoites, which may initiate recurrences, even in the absence of reinfection or superinfection. Until recently, the only drug available for eliminating hypnozoites was primaquine (PQ), which, given its short half-life, requires a relatively long course of treatment. Tafenoquine (TQ) is a PQ analog with a longer half-life. This enables radical cure of malaria with a single dose and overcomes adherence issues associated with PQ, thereby increasing effectiveness in real-life settings. Clinical studies have provided sound evidence for TQ's safety and efficacy against malaria, which recently led to its approval by the US FDA. Here, we review aspects of TQ, including how to avoid hemolytic anemia in G6PD deficient patients. We believe that TQ promises to be a major advance toward malaria elimination.
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Affiliation(s)
- Fernando Val
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil
| | - Fabio Tm Costa
- Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, 13083-970, Brazil
| | - Liam King
- The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Jose D Brito-Sousa
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Escola Superior de Ciências da Saúde,Universidade do Estado do Amazonas, Manaus, Amazonas, 69065-001, Brazil
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, 08036, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Distrito da Manhiça, CP 1929, Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, Barcelona, 08010, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, 08950, Spain
| | - Wuelton M Monteiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Escola Superior de Ciências da Saúde,Universidade do Estado do Amazonas, Manaus, Amazonas, 69065-001, Brazil
| | - André M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, 21040-360, Brazil
| | - Lucio Luzzatto
- Department of Hematology & Blood Transfusion, Muhimbili University of Health & Allied Sciences, Dar-es-Salaam, Tanzania
| | - Marcus Vg Lacerda
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, 69040-000, Brazil.,Instituto Leônidas e Maria Deane, FIOCRUZ-AM, Manaus, Amazonas, 69057-070, Brazil
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15
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Copper-catalyzed remote C-H monofluoromethylation of 8-aminoquinolines with dimethyl phosphonate as reductant. Tetrahedron Lett 2019. [DOI: 10.1016/j.tetlet.2019.151077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Abstract
The technical genesis and practice of 8-aminoquinoline therapy of latent malaria offer singular scientific, clinical, and public health insights. The 8-aminoquinolines brought revolutionary scientific discoveries, dogmatic practices, benign neglect, and, finally, enduring promise against endemic malaria. The clinical use of plasmochin-the first rationally synthesized blood schizontocide and the first gametocytocide, tissue schizontocide, and hypnozoitocide of any kind-commenced in 1926. Plasmochin became known to sometimes provoke fatal hemolytic crises. World War II delivered a newer 8-aminoquinoline, primaquine, and the discovery of glucose-6-phosphate dehydrogenase (G6PD) deficiency as the basis of its hemolytic toxicity came in 1956. Primaquine nonetheless became the sole therapeutic option against latent malaria. After 40 years of fitful development, in 2018 the U.S. Food and Drug Administration registered the 8-aminoquinoline called tafenoquine for the prevention of all malarias and the treatment of those that relapse. Tafenoquine also cannot be used in G6PD-unknown or -deficient patients. The hemolytic toxicity of the 8-aminoquinolines impedes their great potential, but this problem has not been a research priority. This review explores the complex technical dimensions of the history of 8-aminoquinolines. The therapeutic principles thus examined may be leveraged in improved practice and in understanding the bright prospect of discovery of newer drugs that cannot harm G6PD-deficient patients.
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17
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Mei H, Han J, Fustero S, Medio-Simon M, Sedgwick DM, Santi C, Ruzziconi R, Soloshonok VA. Fluorine-Containing Drugs Approved by the FDA in 2018. Chemistry 2019; 25:11797-11819. [PMID: 31099931 DOI: 10.1002/chem.201901840] [Citation(s) in RCA: 286] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/17/2019] [Indexed: 12/12/2022]
Abstract
Over the last two decades, fluorine substitution has become one of the essential structural traits in modern pharmaceuticals. Thus, about half of the most successful drugs (blockbuster drugs) contain fluorine atoms. In this review, we profile 17 fluorine-containing drugs approved by the food and drug administration (FDA) in 2018. The newly approved pharmaceuticals feature several types of aromatic F and CF3 , as well as aliphatic (CF2 ) substitution, offering advances in the treatment of various diseases, including cancer, HIV, malarial and smallpox infections.
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Affiliation(s)
- Haibo Mei
- College of Chemical Engineering, Nanjing Forestry University, Nanjing, 210037, China
| | - Jianlin Han
- College of Chemical Engineering, Nanjing Forestry University, Nanjing, 210037, China
| | - Santos Fustero
- Departamento de Química Orgánica, Universidad de Valencia, 46100 Burjassot, Valencia, Spain.,Laboratorio de Moléculas Orgánicas, Centro de Investigación Príncipe Felipe, 46012, Valencia, Spain
| | - Mercedes Medio-Simon
- Departamento de Química Orgánica, Universidad de Valencia, 46100 Burjassot, Valencia, Spain.,Laboratorio de Moléculas Orgánicas, Centro de Investigación Príncipe Felipe, 46012, Valencia, Spain
| | - Daniel M Sedgwick
- Departamento de Química Orgánica, Universidad de Valencia, 46100 Burjassot, Valencia, Spain.,Laboratorio de Moléculas Orgánicas, Centro de Investigación Príncipe Felipe, 46012, Valencia, Spain
| | - Claudio Santi
- Department of Phrmaceutical Sciences, University of Perugia, Via del Liceo 1, 06123, Perugia, Italy
| | - Renzo Ruzziconi
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via Elce di Sotto 8, 06123, Perugia, Italy
| | - Vadim A Soloshonok
- Department of Organic Chemistry I, Faculty of Chemistry, University of the Basque Country UPV/EHU, Paseo Manuel Lardizábal 3, 20018, San Sebastián, Spain.,IKERBASQUE, Basque Foundation for Science, María Díaz de Haro 3, Plaza Bizkaia, 48013, Bilbao, Spain
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18
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Hounkpatin AB, Kreidenweiss A, Held J. Clinical utility of tafenoquine in the prevention of relapse of Plasmodium vivax malaria: a review on the mode of action and emerging trial data. Infect Drug Resist 2019; 12:553-570. [PMID: 30881061 PMCID: PMC6411314 DOI: 10.2147/idr.s151031] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Tafenoquine is an 8-aminoquinoline with activity against all human life cycle stages of Plasmodium vivax, including dormant liver stages – so called hypnozoites. Its long half-life of ~15 days is allowing for a single exposure regimen. It has been under development since 1980 and received approval by the US Food and Drug Administration in summer 2018 as an anti-relapse drug for P. vivax malaria in patients aged 16 years and older and for prophylaxis of malaria caused by any Plasmodium species in adults. Prior to tafenoquine administration, glucose-6-phosphate dehydrogenase (G6PD) deficiency needs to be excluded by testing. Individuals with a deficient G6PD activity are at risk of tafenoquine-induced hemolysis – as is the case for primaquine, the mainstay drug for P. vivax radical cure. A wealth of clinical studies have been conducted and are still ongoing to assess the safety, tolerability, and efficacy of tafenoquine. This review focuses on data emerging from the latest clinical trials on P. vivax radical cure with tafenoquine, the key studies for regulatory approval of tafenoquine, and elucidates the latest hypothesis on the mode of action.
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Affiliation(s)
- Aurore B Hounkpatin
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany, .,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon,
| | - Andrea Kreidenweiss
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany,
| | - Jana Held
- Institute of Tropical Medicine, Eberhard Karls University Tübingen, Tübingen, Germany, .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany, .,Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon,
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19
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Rout S, Mahapatra RK. Plasmodium falciparum: Multidrug resistance. Chem Biol Drug Des 2019; 93:737-759. [DOI: 10.1111/cbdd.13484] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Subhashree Rout
- School of BiotechnologyKIIT University Bhubaneswar Odisha India
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20
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Kumari A, Karnatak M, Singh D, Shankar R, Jat JL, Sharma S, Yadav D, Shrivastava R, Verma VP. Current scenario of artemisinin and its analogues for antimalarial activity. Eur J Med Chem 2018; 163:804-829. [PMID: 30579122 DOI: 10.1016/j.ejmech.2018.12.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/29/2018] [Accepted: 12/02/2018] [Indexed: 11/17/2022]
Abstract
Human malaria, one of the most striking, reemerging infectious diseases, is caused by several types of Plasmodium parasites. Whilst advances have been made in lowering the numbers of cases and deaths, it is clear that a strategy based solely on disease control year on year, without reducing transmission and ultimately eradicating the parasite, is unsustainable. Natural products have served as a template for the design and development of antimalarial drugs currently in the clinic or in the development phase. Artemisinin combine potent, rapid antimalarial activity with a wide therapeutic index and an absence of clinically important resistance. The alkylating ability of artemisinin and its semi-synthetic analogues toward heme related to their antimalarial efficacy are underlined. Although impressive results have already been achieved in malaria research, more systematization and concentration of efforts are required if real breakthroughs are to be made. This review will concisely cover the clinical, preclinical antimalarial and current updates in artemisinin based antimalarial drugs. Diverse classes of semi-synthetic analogs of artemisinin reported in the last decade have also been extensively studied. The experience gained in this respect is discussed.
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Affiliation(s)
- Akriti Kumari
- Department of Chemistry, Banasthali University, Banasthali Newai, 304022, Rajasthan, India
| | - Manvika Karnatak
- Department of Chemistry, Banasthali University, Banasthali Newai, 304022, Rajasthan, India
| | - Davinder Singh
- Bio-Organic Chemistry Division, CSIR-Indian Institute of Integrative Medicine, Jammu, 180001, Jammu and Kashmir, India
| | - Ravi Shankar
- Bio-Organic Chemistry Division, CSIR-Indian Institute of Integrative Medicine, Jammu, 180001, Jammu and Kashmir, India
| | - Jawahar L Jat
- Department of Applied Chemistry, BabaSaheb Bhimrao Ambedkar University (A Central University), Vidya Vihar Raebareli Road, Lucknow, 226025, India
| | - Siddharth Sharma
- Department of Chemistry, Mohanlal Sukhadia University, Udaipur, 313001, India
| | - Dinesh Yadav
- Department of Chemistry, Mohanlal Sukhadia University, Udaipur, 313001, India
| | - Rahul Shrivastava
- Department of Chemistry, Manipal University Jaipur, Jaipur, 303007, India
| | - Ved Prakash Verma
- Department of Chemistry, Banasthali University, Banasthali Newai, 304022, Rajasthan, India.
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21
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Baird JK. Tafenoquine for travelers' malaria: evidence, rationale and recommendations. J Travel Med 2018; 25:5150129. [PMID: 30380095 PMCID: PMC6243017 DOI: 10.1093/jtm/tay110] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/17/2018] [Accepted: 10/30/2018] [Indexed: 01/01/2023]
Abstract
Background Endemic malaria occurring across much of the globe threatens millions of exposed travelers. While unknown numbers of them suffer acute attacks while traveling, each year thousands return from travel and become stricken in the weeks and months following exposure. This represents perhaps the most serious, prevalent and complex problem faced by providers of travel medicine services. Since before World War II, travel medicine practice has relied on synthetic suppressive blood schizontocidal drugs to prevent malaria during exposure, and has applied primaquine for presumptive anti-relapse therapy (post-travel or post-diagnosis of Plasmodium vivax) since 1952. In 2018, the US Food and Drug Administration approved the uses of a new hepatic schizontocidal and hypnozoitocidal 8-aminoquinoline called tafenoquine for the respective prevention of all malarias and for the treatment of those that relapse (P. vivax and Plasmodium ovale). Methods The evidence and rationale for tafenoquine for the prevention and treatment of malaria was gathered by means of a standard search of the medical literature along with the package inserts for the tafenoquine products Arakoda™ and Krintafel™ for the prevention of all malarias and the treatment of relapsing malarias, respectively. Results The development of tafenoquine-an endeavor of 40 years-at last brings two powerful advantages to travel medicine practice against the malaria threat: (i) a weekly regimen of causal prophylaxis; and (ii) a single-dose radical cure for patients infected by vivax or ovale malarias. Conclusions Although broad clinical experience remains to be gathered, tafenoquine appears to promise more practical and effective prevention and treatment of malaria. Tafenoquine thus applied includes important biological and clinical complexities explained in this review, with particular regard to the problem of hemolytic toxicity in G6PD-deficient patients.
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Affiliation(s)
- J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute of Molecular Biology, Jakarta 10430, Indonesia; and Nuffield Department of Medicine, the Centre for Tropical Medicine and Global Health, University of Oxford, UK
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Fukuda MM, Krudsood S, Mohamed K, Green JA, Warrasak S, Noedl H, Euswas A, Ittiverakul M, Buathong N, Sriwichai S, Miller RS, Ohrt C. A randomized, double-blind, active-control trial to evaluate the efficacy and safety of a three day course of tafenoquine monotherapy for the treatment of Plasmodium vivax malaria. PLoS One 2017; 12:e0187376. [PMID: 29121061 PMCID: PMC5679603 DOI: 10.1371/journal.pone.0187376] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/09/2017] [Indexed: 12/19/2022] Open
Abstract
Background Tafenoquine is an investigational 8-aminoquinoline for the prevention of Plasmodium vivax relapse. Tafenoquine has a long half-life and the potential for more convenient dosing, compared with the currently recommended 14-day primaquine regimen. Methods This randomized, active-control, double-blind trial was conducted in Bangkok, Thailand. Seventy patients with microscopically confirmed P. vivax were randomized (2:1) to tafenoquine 400 mg once daily for 3 days or 2500 mg total dose chloroquine phosphate (1500 mg chloroquine base) given over 3 days plus primaquine 15 mg daily for 14 days. Patients were followed to day 120. Results Day 28 adequate clinical response rate in the per-protocol population was 93% (40/43) (90%CI 83–98%) with tafenoquine, and 100% (22/22) (90%CI 87–100%) with chloroquine/primaquine. Day 120 relapse prevention was 100% (35/35) with tafenoquine (90%CI 92–100%), and 95% (19/20) (90%CI 78–100%) with chloroquine/primaquine. Mean (SD) parasite, gametocyte and fever clearance times with tafenoquine were 82.5 h (32.3), 49.1 h (33.0), and 41.1 h (31.4) versus 40.0 h (15.7), 22.7 h (16.4), and 24.7 h (17.7) with chloroquine/primaquine, respectively. Peak methemoglobin was 1.4–25.6% (median 7.4%, mean 9.1%) in the tafenoquine arm, and 0.5–5.9% (median 1.5%, mean 1.9%) in the chloroquine/primaquine arm. There were no clinical symptoms of methemoglobinemia in any patient. Discussion Although there was no difference in efficacy in this study, the slow rate of parasite, gametocyte and fever clearance indicates that tafenoquine should not be used as monotherapy for radical cure of P. vivax malaria. Also, monotherapy increases the potential risk of resistance developing to this long-acting agent. Clinical trials of single-dose tafenoquine 300 mg combined with standard 3-day chloroquine or artemisinin-based combination therapy are ongoing. Trial registration Clinicaltrials.gov NCT01290601
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Affiliation(s)
- Mark M. Fukuda
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
- * E-mail:
| | | | - Khadeeja Mohamed
- GlaxoSmithKline Research and Development, Uxbridge, Middlesex, United Kingdom
| | - Justin A. Green
- GlaxoSmithKline Research and Development, Uxbridge, Middlesex, United Kingdom
| | | | - Harald Noedl
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Ataya Euswas
- Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mali Ittiverakul
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Nillawan Buathong
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | | | - R. Scott Miller
- Armed Forces Research Institute of Medical Science, Bangkok, Thailand
| | - Colin Ohrt
- Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
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23
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Sulyok M, Rückle T, Roth A, Mürbeth RE, Chalon S, Kerr N, Samec SS, Gobeau N, Calle CL, Ibáñez J, Sulyok Z, Held J, Gebru T, Granados P, Brückner S, Nguetse C, Mengue J, Lalremruata A, Sim BKL, Hoffman SL, Möhrle JJ, Kremsner PG, Mordmüller B. DSM265 for Plasmodium falciparum chemoprophylaxis: a randomised, double blinded, phase 1 trial with controlled human malaria infection. THE LANCET. INFECTIOUS DISEASES 2017; 17:636-644. [PMID: 28363637 PMCID: PMC5446410 DOI: 10.1016/s1473-3099(17)30139-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/05/2017] [Accepted: 02/16/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND A drug for causal (ie, pre-erythrocytic) prophylaxis of Plasmodium falciparum malaria with prolonged activity would substantially advance malaria control. DSM265 is an experimental antimalarial that selectively inhibits the parasite dihydroorotate dehydrogenase. DSM265 shows in vitro activity against liver and blood stages of P falciparum. We assessed the prophylactic activity of DSM265 against controlled human malaria infection (CHMI). METHODS At the Institute of Tropical Medicine, Eberhard Karls University (Tübingen, Germany), healthy, malaria-naive adults were allocated to receive 400 mg DSM265 or placebo either 1 day (cohort 1A) or 7 days (cohort 2) before CHMI by direct venous inoculation (DVI) of 3200 aseptic, purified, cryopreserved P falciparum sporozoites (PfSPZ Challenge; Sanaria Inc, Rockville, MD, USA). An additional group received daily atovaquone-proguanil (250-100 mg) for 9 days, starting 1 day before CHMI (cohort 1B). Allocation to DSM265, atovaquone-proguanil, or placebo was randomised by an interactive web response system. Allocation to cohort 1A and 1B was open-label, within cohorts 1A and 2, allocation to DSM265 and placebo was double-blinded. All treatments were given orally. Volunteers were treated with an antimalarial on day 28, or when parasitaemic, as detected by thick blood smear (TBS) microscopy. The primary efficacy endpoint was time-to-parasitaemia, assessed by TBS. All participants receiving at least one dose of chemoprophylaxis or placebo were considered for safety, those receiving PfSPZ Challenge for efficacy analyses. Log-rank test was used to compare time-to-parasitemia between interventions. The trial was registered with ClinicalTrials.gov, number NCT02450578. FINDINGS 22 participants were enrolled between Oct 23, 2015, and Jan 18, 2016. Five participants received 400 mg DSM265 and two participants received placebo 1 day before CHMI (cohort 1A), six participants received daily atovaquone-proguanil 1 day before CHMI (cohort 1B), and six participants received 400 mg DSM265 and two participants received placebo 7 days before CHMI (cohort 2). Five of five participants receiving DSM265 1 day before CHMI and six of six in the atovaquone-proguanil cohort were protected, whereas placebo recipients (two of two) developed malaria on days 11 and 14. When given 7 days before CHMI, three of six volunteers receiving DSM265 became TBS positive on days 11, 13, and 24. The remaining three DSM265-treated, TBS-negative participants of cohort 2 developed transient submicroscopic parasitaemia. Both participants receiving placebo 7 days before CHMI became TBS positive on day 11. The only possible DSM265-related adverse event was a moderate transient elevation in serum bilirubin in one participant. INTERPRETATION A single dose of 400 mg DSM265 was well tolerated and had causal prophylactic activity when given 1 day before CHMI. Future trials are needed to investigate further the use of DSM265 for the prophylaxis of malaria. FUNDING Global Health Innovative Technology Fund, Wellcome Trust, Bill & Melinda Gates Foundation through Medicines for Malaria Venture, and the German Center for Infection Research.
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Affiliation(s)
- Mihály Sulyok
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany.
| | | | - Alexandra Roth
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Raymund E Mürbeth
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | | | - Nicola Kerr
- Medicines for Malaria Venture, Geneva, Switzerland
| | | | | | - Carlos Lamsfus Calle
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Javier Ibáñez
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Zita Sulyok
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Jana Held
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Tamirat Gebru
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Patricia Granados
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Sina Brückner
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Christian Nguetse
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Juliana Mengue
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Albert Lalremruata
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | | | | | | | - Peter G Kremsner
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Benjamin Mordmüller
- Institute of Tropical Medicine, and German Center for Infection Research, partner site Tübingen, Eberhard Karls University, Tübingen, Germany
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Ríos-Orrego A, Blair-Trujillo S, Pabón-Vidal A. Avances en la búsqueda y desarrollo de quimioprofilácticos causales para malaria. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n2a06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ebstie YA, Abay SM, Tadesse WT, Ejigu DA. Tafenoquine and its potential in the treatment and relapse prevention of Plasmodium vivax malaria: the evidence to date. Drug Des Devel Ther 2016; 10:2387-99. [PMID: 27528800 PMCID: PMC4970641 DOI: 10.2147/dddt.s61443] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Despite declining global malaria incidence, the disease continues to be a threat to people living in endemic regions. In 2015, an estimated 214 million new malaria cases and 438,000 deaths due to malaria were recorded. Plasmodium vivax is the second most common cause of malaria next to Plasmodium falciparum. Vivax malaria is prevalent especially in Southeast Asia and the Horn of Africa, with enormous challenges in controlling the disease. Some of the challenges faced by vivax malaria-endemic countries include limited access to effective drugs treating liver stages of the parasite (schizonts and hypnozoites), emergence/spread of drug resistance, and misperception of vivax malaria as nonlethal. Primaquine, the only 8-aminoquinoline derivative approved by the US Food and Drug Administration, is intended to clear intrahepatic hypnozoites of P. vivax (radical cure). However, poor adherence to a prolonged treatment course, drug-induced hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency, and the emergence of resistance make it imperative to look for alternative drugs. Therefore, this review focuses on data accrued to date on tafenoquine and gives insight on the potential role of the drug in preventing relapse and radical cure of patients with vivax malaria.
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Affiliation(s)
| | | | - Wondmagegn T Tadesse
- Department of Pharmacology and Clinical Pharmacy, School of Medicine, College of Health Sciences, Addis Ababa University
| | - Dawit A Ejigu
- Department of Pharmacology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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26
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Ding Y, Liu H, Tekwani BL, Nanayakkara NPD, Khan IA, Walker LA, Doerksen RJ. Methemoglobinemia Hemotoxicity of Some Antimalarial 8-Aminoquinoline Analogues and Their Hydroxylated Derivatives: Density Functional Theory Computation of Ionization Potentials. Chem Res Toxicol 2016; 29:1132-41. [DOI: 10.1021/acs.chemrestox.6b00063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Yuanqing Ding
- National Center for Natural Products Research,
Research Institute
of Pharmaceutical Science, and ‡Department of BioMolecular Sciences, School
of Pharmacy, University of Mississippi, University, Mississippi 38677, United States
| | - Haining Liu
- National Center for Natural Products Research,
Research Institute
of Pharmaceutical Science, and ‡Department of BioMolecular Sciences, School
of Pharmacy, University of Mississippi, University, Mississippi 38677, United States
| | - Babu L. Tekwani
- National Center for Natural Products Research,
Research Institute
of Pharmaceutical Science, and ‡Department of BioMolecular Sciences, School
of Pharmacy, University of Mississippi, University, Mississippi 38677, United States
| | - N. P. Dhammika Nanayakkara
- National Center for Natural Products Research,
Research Institute
of Pharmaceutical Science, and ‡Department of BioMolecular Sciences, School
of Pharmacy, University of Mississippi, University, Mississippi 38677, United States
| | - Ikhlas A. Khan
- National Center for Natural Products Research,
Research Institute
of Pharmaceutical Science, and ‡Department of BioMolecular Sciences, School
of Pharmacy, University of Mississippi, University, Mississippi 38677, United States
| | - Larry A. Walker
- National Center for Natural Products Research,
Research Institute
of Pharmaceutical Science, and ‡Department of BioMolecular Sciences, School
of Pharmacy, University of Mississippi, University, Mississippi 38677, United States
| | - Robert J. Doerksen
- National Center for Natural Products Research,
Research Institute
of Pharmaceutical Science, and ‡Department of BioMolecular Sciences, School
of Pharmacy, University of Mississippi, University, Mississippi 38677, United States
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Wiersinga WJ, Birnie E, Weehuizen TA, Alabi AS, Huson MA, in ’t Veld RAGH, Mabala HK, Adzoda GK, Raczynski-Henk Y, Esen M, Lell B, Kremsner PG, Visser CE, Wuthiekanun V, Peacock SJ, van der Ende A, Limmathurotsakul D, Grobusch MP. Clinical, environmental, and serologic surveillance studies of melioidosis in Gabon, 2012-2013. Emerg Infect Dis 2015; 21:40-7. [PMID: 25530077 PMCID: PMC4285261 DOI: 10.3201/eid2101.140762] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Burkholderia pseudomallei and B. thailandensis are
in the soil; a novel B. pseudomallei sequence type causes lethal
septic shock. Burkholderia pseudomallei, an environmental gram-negative bacillus,
is the causative agent of melioidosis and a bio-threat agent. Reports of B.
pseudomallei isolation from soil and animals in East and West Africa
suggest that melioidosis might be more widely distributed than previously thought.
Because it has been found in equatorial areas with tropical climates, we hypothesized
that B. pseudomallei could exist in Gabon. During 2012–2013,
we conducted a seroprevalance study in which we set up microbiology facilities at a
large clinical referral center and prospectively screened all febrile patients by
conducting blood cultures and testing for B. pseudomallei and
related species; we also determined whether B. pseudomallei could be
isolated from soil. We discovered a novel B. pseudomallei sequence
type that caused lethal septic shock and identified B. pseudomallei
and B. thailandensis in the environment. Our data suggest that
melioidosis is emerging in Central Africa but is unrecognized because of the lack of
diagnostic microbiology facilities.
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Kobayashi T, Gamboa D, Ndiaye D, Cui L, Sutton PL, Vinetz JM. Malaria Diagnosis Across the International Centers of Excellence for Malaria Research: Platforms, Performance, and Standardization. Am J Trop Med Hyg 2015; 93:99-109. [PMID: 26259937 PMCID: PMC4574279 DOI: 10.4269/ajtmh.15-0004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 06/23/2015] [Indexed: 12/14/2022] Open
Abstract
Diagnosis is “the act of identifying a disease, illness, or problem by examining someone or something.” When an individual with acute fever presents for clinical attention, accurate diagnosis leading to specific, prompt treatment often saves lives. As applied to malaria, not only individual patient diagnosis is important but also assessing population-level malaria prevalence using appropriate diagnostic methods is essential for public health purposes. Similarly, identifying (diagnosing) fake antimalarial medications prevents the use of counterfeit drugs that can have disastrous effects. Therefore, accurate diagnosis in broad areas related to malaria is fundamental to improving health-care delivery, informing funding agencies of current malaria situations, and aiding in the prioritization of regional and national control efforts. The International Centers of Excellence for Malaria Research (ICEMR), supported by the U.S. National Institute of Allergy and Infectious Diseases, has collaborated on global efforts to improve malaria diagnostics by working to harmonize and systematize procedures across different regions where endemicity and financial resources vary. In this article, the different diagnostic methods used across each ICEMR are reviewed and challenges are discussed.
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Affiliation(s)
- Tamaki Kobayashi
- *Address correspondence to Tamaki Kobayashi, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W4612, Baltimore, MD 21205, E-mail: or Joseph M. Vinetz, Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0760, E-mail:
| | | | | | | | | | - Joseph M. Vinetz
- *Address correspondence to Tamaki Kobayashi, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, W4612, Baltimore, MD 21205, E-mail: or Joseph M. Vinetz, Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0760, E-mail:
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Abstract
BACKGROUND Plasmodium vivax malaria is widespread, and the persistent liver stage causes relapse of the disease which contributes to continued P. vivax transmission. Primaquine is currently the only drug that cures the parasite liver stage, but requires 14 days to be effective and can cause haemolysis in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency. In addition, there is some evidence of parasite resistance to the drug. Tafenoquine is a new alternative with a longer half-life. OBJECTIVES To assess the effects of tafenoquine in people with P. vivax infection. SEARCH METHODS We searched the following databases up to 13 April 2015: the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; CINAHL; SCOPUS; and LILACS. We also searched the World Health Organization (WHO) International Clinical Trial Registry Platform and the metaRegister of Controlled Trials (mRCT) for ongoing trials using "tafenoquine" and "malaria" as search terms up to 13 April 2015. SELECTION CRITERIA Randomized controlled trials (RCTs) in people with P. vivax malaria. Adverse effects of tafenoquine are assessed in populations where people with G6PD deficiency have been excluded, and in populations without screening for G6PD deficiency. DATA COLLECTION AND ANALYSIS All review authors independently extracted data and assessed trial quality. Meta-analysis was carried out where appropriate, and estimates given as relative risk with 95% confidence intervals. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS Three RCTs met our inclusion criteria, with the asexual infection in both the tafenoquine and comparator arm treated with chloroquine, and in all trials G6PD deficiency patients were excluded. Tafenoquine dose comparisonsThree of the included trials compared eight different dosing regimens. Tafenoquine doses of 300 mg and above resulted in fewer relapses than no hypnozoite treatment over six months follow-up in adults (300 mg single dose: RR 0.19, 95% CI 0.08 to 0.41, one trial, 110 participants, moderate quality evidence; 500 to 600 mg single dose: RR 0.14, 95%CI 0.06 to 0.34, two trials, 122 participants, moderate quality evidence; 1800 mg to 3000 mg in divided doses: RR 0.05, 95% CI 0.01 to 0.23, two trials, 63 participants, low quality evidence).In people with normal G6PD status, there may be little or no difference in serious adverse events (three trials, 358 participants, low quality evidence); or any adverse event (one trial, 272 participants, low quality evidence). Tafenoquine versus primaquine Two of the included trials compared four different dosing regimens of tafenoquine against the standard primaquine regimen of 15 mg/day for 14 days. A single tafenoquine dose of 600 mg may be more effective than primaquine in relation to relapses at six months follow-up (RR 0.29, 95% CI 0.10 to 0.84, two trials, 98 participants, low quality evidence)In people with normal G6PD status, there may be little or no difference for serious adverse events (two trials, 323 participants, low quality evidence) or any adverse event (two trials, 323 participants, low quality evidence) between tafenoquine and primaquine. AUTHORS' CONCLUSIONS Tafenoquine prevents relapses after clinically and parasitologically confirmed P. vivax malaria. The drug is untested in pregnancy, children and in G6PD-deficient people. The shorter treatment course is an important practical advantage in people who do not have G6PD deficiency, but the longer half-life may have more substantive consequences if given inadvertently to people with G6PD deficiency.
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Affiliation(s)
- Senaka Rajapakse
- Faculty of Medicine, University of ColomboDepartment of Clinical Medicine25, Kynsey RoadColomboSri Lanka
| | - Chaturaka Rodrigo
- Faculty of Medicine, University of ColomboDepartment of Clinical Medicine25, Kynsey RoadColomboSri Lanka
| | - Sumadhya Deepika Fernando
- Faculty of Medicine, University of ColomboDepartment of Parasitology25, Kynsey Road,ColomboSri Lanka08
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Held J, Jeyaraj S, Kreidenweiss A. Antimalarial compounds in Phase II clinical development. Expert Opin Investig Drugs 2015; 24:363-82. [PMID: 25563531 DOI: 10.1517/13543784.2015.1000483] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Malaria is a major health problem in endemic countries and chemotherapy remains the most important tool in combating it. Treatment options are limited and essentially rely on a single drug class - the artemisinins. Efforts are ongoing to restrict the evolving threat of artemisinin resistance but declining sensitivity has been reported. Fueled by the ambitious aim of malaria eradication, novel antimalarial compounds, with improved properties, are now in the progressive phase of drug development. AREAS COVERED Herein, the authors describe antimalarial compounds currently in Phase II clinical development and present the results of these investigations. EXPERT OPINION Thanks to recent efforts, a number of promising antimalarial compounds are now in the pipeline. First safety data have been generated for all of these candidates, although their efficacy as antimalarials is still unclear for most of them. Of particular note are KAE609, KAF156 and DSM265, which are of chemical scaffolds new to malaria chemotherapy and would truly diversify antimalarial options. Apart from SAR97276, which also has a novel chemical scaffold that has had its development stopped, all other compounds in the pipeline belong to already known substance classes, which have been chemically modified. At this moment in time, there is not one standout compound that will revolutionize malaria treatment but several compounds that will add to its control in the future.
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Affiliation(s)
- Jana Held
- Institut für Tropenmedizin, Eberhard Karls Universität , Wilhelmstraße 27, D-72074 Tübingen , Germany +49 7071 29 85569 ; +49 7071 295189 ;
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Effect of fluorescent dyes on in vitro-differentiated, late-stage Plasmodium falciparum gametocytes. Antimicrob Agents Chemother 2014; 58:7398-404. [PMID: 25267675 DOI: 10.1128/aac.03772-14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Plasmodium falciparum gametocytes are not associated with clinical symptoms, but they are responsible for transmitting the pathogen to mosquitoes. Therefore, gametocytocidal interventions are important for malaria control and resistance containment. Currently available drugs and vaccines are not well suited for that purpose. Several dyes have potent antimicrobial activity, but their use against gametocytes has not been investigated systematically. The gametocytocidal activity of nine synthetic dyes and four control compounds was tested against stage V gametocytes of the laboratory strain 3D7 and three clinical isolates of P. falciparum with a bioluminescence assay. Five of the fluorescent dyes had submicromolar 50% inhibitory concentration (IC50) values against mature gametocytes. Three mitochondrial dyes, MitoRed, dihexyloxacarbocyanine iodide (DiOC6), and rhodamine B, were highly active (IC(50)s < 200 nM). MitoRed showed the highest activity against gametocytes, with IC(50)s of 70 nM against 3D7 and 120 to 210 nM against clinical isolates. All compounds were more active against the laboratory strain 3D7 than against clinical isolates. In particular, the endoperoxides artesunate and dihydroartemisinin showed a 10-fold higher activity against 3D7 than against clinical isolates. In contrast to all clinically used antimalarials, several fluorescent dyes had surprisingly high in vitro activity against late-stage gametocytes. Since they also act against asexual blood stages, they shall be considered starting points for the development of new antimalarial lead compounds.
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Strategic use of antimalarial drugs that block falciparum malaria parasite transmission to mosquitoes to achieve local malaria elimination. Parasitol Res 2014; 113:3535-46. [PMID: 25185662 DOI: 10.1007/s00436-014-4091-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 08/25/2014] [Indexed: 01/03/2023]
Abstract
The ultimate aim of malaria chemotherapy is not only to treat symptomatic infection but also to reduce transmission potential. With the absence of clinically proven vaccines, drug-mediated blocking of malaria transmission gains growing interest in the research agenda for malaria control and elimination. In addition to the limited arsenal of antimalarials available, the situation is further complicated by the fact that most commonly used antimalarials are being extensively resisted by the parasite and do not assist in blocking its transmission to vectors. Most antimalarials do not exhibit gametocytocidal and/ or sporontocidal activity against the sexual stages of Plasmodium falciparum but may even enhance gametocytogenesis and gametocyte transmissibility. Artemisinin derivatives and 8-aminoquinolines are useful transmission-blocking antimalarials whose optimal actions are on different stages of gametocytes. Transmission control interventions that include gametocytocides covering the spectrum of gametocyte development should be used to reduce and, if possible, stop transmission and infectivity of gametocytes to mosquitoes. Potent gametocytocidal drugs could also help deter the spread of antimalarial drug resistance. Novel proof-of-concept compounds with gametocytocidal activity, such as trioxaquines, synthetic endoperoxides, and spiroindolone, should be further tested for possible clinical utility before investigating the possibility of integrating them in transmission-reducing interventions. Strategic use of potent gametocytocides at appropriate timing with artemisinin-based combination therapies should be given attention, at least, in the short run. This review highlights the role that antimalarials could play in blocking gametocyte transmission and infectivity to mosquitoes and, hence, in reducing the potential of falciparum malaria transmissibility and drug resistance spread.
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Akhter M, Saha R, Tanwar O, Mumtaz Alam M, Zaman MS. Synthesis and antimalarial activity of quinoline-substituted furanone derivatives and their identification as selective falcipain-2 inhibitors. Med Chem Res 2014. [DOI: 10.1007/s00044-014-1139-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Miller AK, Harrell E, Ye L, Baptiste-Brown S, Kleim JP, Ohrt C, Duparc S, Möhrle JJ, Webster A, Stinnett S, Hughes A, Griffith S, Beelen AP. Pharmacokinetic interactions and safety evaluations of coadministered tafenoquine and chloroquine in healthy subjects. Br J Clin Pharmacol 2014; 76:858-67. [PMID: 23701202 DOI: 10.1111/bcp.12160] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 05/09/2013] [Indexed: 11/28/2022] Open
Abstract
AIMS The long-acting 8-aminoquinoline tafenoquine (TQ) coadministered with chloroquine (CQ) may radically cure Plasmodium vivax malaria. Coadministration therapy was evaluated for a pharmacokinetic interaction and for pharmacodynamic, safety and tolerability characteristics. METHODS Healthy subjects, 18-55 years old, without documented glucose-6-phosphate dehydrogenase deficiency, received CQ alone (days 1-2, 600 mg; and day 3, 300 mg), TQ alone (days 2 and 3, 450 mg) or coadministration therapy (day 1, CQ 600 mg; day 2, CQ 600 mg + TQ 450 mg; and day 3, CQ 300 mg + TQ 450 mg) in a randomized, double-blind, parallel-group study. Blood samples for pharmacokinetic and pharmacodynamic analyses and safety data, including electrocardiograms, were collected for 56 days. RESULTS The coadministration of CQ + TQ had no effect on TQ AUC0-t , AUC0-∞ , Tmax or t1/2 . The 90% confidence intervals of CQ + TQ vs. TQ for AUC0-t , AUC0-∞ and t1/2 indicated no drug interaction. On day 2 of CQ + TQ coadministration, TQ Cmax and AUC0-24 increased by 38% (90% confidence interval 1.27, 1.64) and 24% (90% confidence interval 1.04, 1.46), respectively. The pharmacokinetics of CQ and its primary metabolite desethylchloroquine were not affected by TQ. Coadministration had no clinically significant effect on QT intervals and was well tolerated. CONCLUSIONS No clinically significant safety or pharmacokinetic/pharmacodynamic interactions were observed with coadministered CQ and TQ in healthy subjects.
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Green JA, Patel AK, Patel BR, Hussaini A, Harrell EJ, McDonald MJ, Carter N, Mohamed K, Duparc S, Miller AK. Tafenoquine at therapeutic concentrations does not prolong Fridericia-corrected QT interval in healthy subjects. J Clin Pharmacol 2014; 54:995-1005. [PMID: 24700490 PMCID: PMC4283056 DOI: 10.1002/jcph.302] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/01/2014] [Indexed: 11/10/2022]
Abstract
Tafenoquine is being developed for relapse prevention in Plasmodium vivax malaria. This Phase I, single-blind, randomized, placebo- and active-controlled parallel group study investigated whether tafenoquine at supratherapeutic and therapeutic concentrations prolonged cardiac repolarization in healthy volunteers. Subjects aged 18-65 years were randomized to one of five treatment groups (n = 52 per group) to receive placebo, tafenoquine 300, 600, or 1200 mg, or moxifloxacin 400 mg (positive control). Lack of effect was demonstrated if the upper 90% CI of the change from baseline in QTcF following supratherapeutic tafenoquine 1200 mg versus placebo (ΔΔQTcF) was <10 milliseconds for all pre-defined time points. The maximum ΔΔQTcF with tafenoquine 1200 mg (n = 50) was 6.39 milliseconds (90% CI 2.85, 9.94) at 72 hours post-final dose; that is, lack of effect for prolongation of cardiac depolarization was demonstrated. Tafenoquine 300 mg (n = 48) or 600 mg (n = 52) had no effect on ΔΔQTcF. Pharmacokinetic/pharmacodynamic modeling of the tafenoquine-QTcF concentration-effect relationship demonstrated a shallow slope (0.5 ms/μg mL(-1) ) over a wide concentration range. For moxifloxacin (n = 51), maximum ΔΔQTcF was 8.52 milliseconds (90% CI 5.00, 12.04), demonstrating assay sensitivity. In this thorough QT/QTc study, tafenoquine did not have a clinically meaningful effect on cardiac repolarization.
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Affiliation(s)
- Justin A Green
- Diseases of the Developing World Group, GlaxoSmithKline Research and Development, Stockley Park West, Uxbridge, Middlesex, UK
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Elphinstone RE, Higgins SJ, Kain KC. Prevention of Malaria in Travelers: Bite Avoidance and Chemoprophylactic Measures. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2013. [DOI: 10.1007/s40506-013-0005-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Held J, Kreidenweiss A, Mordmüller B. Novel approaches in antimalarial drug discovery. Expert Opin Drug Discov 2013; 8:1325-37. [PMID: 24090219 DOI: 10.1517/17460441.2013.843522] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The development of new antimalarial drugs remains of the utmost importance, since Plasmodium falciparum has developed resistance against nearly all chemotherapeutics in clinical use. In an effort to contain the resistance of P. falciparum against artemisinins and to further eradication efforts, studies are ongoing to identify novel and more efficacious approaches to develop antimalarials. AREAS COVERED The authors review the classical and new approaches to antimalarial drug discovery, with a special emphasis on the various stages of the parasite's life cycle and the different Plasmodium species. The authors discuss the methodologies and strategies for early efficacy testing that aim to narrow down the portfolio of promising compounds. EXPERT OPINION The increased efforts in the discovery and development of new antimalarial compounds have led to the recognition of new promising hits. However, there is still major roadblock of selecting the most promising compounds and then further testing them in early clinical trials, especially in the current restricted economy. Controlled human malaria infection has much potential for speeding-up the early development process of many drug candidates including those which target the pre-erythrocytic stages.
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Affiliation(s)
- Jana Held
- University of Tübingen, Institute of Tropical Medicine , Wilhelmstraße 27, D-72074 Tübingen , Germany +49 7071 29 82364 ; +49 7071 295189 ;
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Robert A, Dechy-Cabaret O, Cazelles JÉRǑM, Benoit-Vical F, Meunier B. Recent Advances in Malaria Chemotherapy. J CHIN CHEM SOC-TAIP 2013. [DOI: 10.1002/jccs.200200046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Drugs that kill or inhibit the sexual stages of Plasmodium in order to prevent transmission are important components of malaria control programmes. Reducing gametocyte carriage is central to the control of Plasmodium falciparum transmission as infection can result in extended periods of gametocytaemia. Unfortunately the number of drugs with activity against gametocytes is limited. Primaquine is currently the only licensed drug with activity against the sexual stages of malaria parasites and its use is hampered by safety concerns. This shortcoming is likely the result of the technical challenges associated with gametocyte studies together with the focus of previous drug discovery campaigns on asexual parasite stages. However recent emphasis on malaria eradication has resulted in an upsurge of interest in identifying compounds with activity against gametocytes. This review examines the gametocytocidal properties of currently available drugs as well as those in the development pipeline and examines the prospects for discovery of new anti-gametocyte compounds.
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Abstract
Plasmodium vivax represents a special challenge to malaria control because of the ability of a single infection to relapse over months to years. P. vivax is more tolerant of low temperatures than P. falciparum, which spreads its potential range far beyond the tropics into sub-Arctic areas. Ordinary malaria control measures such as residual insecticide spraying and impregnated bed nets are effective for P. vivax, but long-lasting (up to 3 years) residual hepatic parasites (hypnozoites) mean that even well-executed malaria control programs must maintain maximal efforts for an extended period in order to eliminate indigenous infections. Hypnozoites are only eliminated by using an 8-aminoquinoline (currently only primaquine), which requires compliance with a long regimen as well as care to avoid those at risk of haemolysis due to the common genetic polymorphism, glucose-6-phosphate dehydrogenase deficiency. Risk of reintroduction of P. vivax into areas without malaria but still containing competent Anopheles vectors is enhanced as persons carrying hypnozoites are undetectable until they become symptomatic from activation of the quiescent liver parasite. Mass drug administration using drug combinations including primaquine have successfully eliminated malaria from small islands demonstrating proof of principal as a potential elimination method. It will be very difficult to maintain adequate malaria surveillance measures for years after malaria has ceased to be a public health problem, which will clearly be required to eliminate relapsing malaria such as P. vivax. New interventions will likely be required to eliminate vivax malaria; highly desirable new products include transmission-blocking vaccines, new drug combinations to treat chloroquine resistant strains and a safe, long-lasting 8-aminoquinoline.
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Anthony MP, Burrows JN, Duparc S, JMoehrle J, Wells TNC. The global pipeline of new medicines for the control and elimination of malaria. Malar J 2012; 11:316. [PMID: 22958514 PMCID: PMC3472257 DOI: 10.1186/1475-2875-11-316] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 07/21/2012] [Indexed: 12/03/2022] Open
Abstract
Over the past decade, there has been a transformation in the portfolio of medicines to combat malaria. New fixed-dose artemisinin combination therapy is available, with four different types having received approval from Stringent Regulatory Authorities or the World Health Organization (WHO). However, there is still scope for improvement. The Malaria Eradication Research agenda identified several gaps in the current portfolio. Simpler regimens, such as a single-dose cure are needed, compared with the current three-day treatment. In addition, new medicines that prevent transmission and also relapse are needed, but with better safety profiles than current medicines. There is also a big opportunity for new medicines to prevent reinfection and to provide chemoprotection. This study reviews the global portfolio of new medicines in development against malaria, as of the summer of 2012. Cell-based phenotypic screening, and 'fast followers' of clinically validated classes, mean that there are now many new classes of molecules starting in clinical development, especially for the blood stages of malaria. There remain significant gaps for medicines blocking transmission, preventing relapse, and long-duration molecules for chemoprotection. The nascent pipeline of new medicines is significantly stronger than five years ago. However, there are still risks ahead in clinical development and sustainable funding of clinical studies is vital if this early promise is going to be delivered.
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Affiliation(s)
- Melinda P Anthony
- Medicines for Malaria Venture (MMV), 20 rte de Pré-Bois 1215, Geneva, Switzerland
| | - Jeremy N Burrows
- Medicines for Malaria Venture (MMV), 20 rte de Pré-Bois 1215, Geneva, Switzerland
| | - Stephan Duparc
- Medicines for Malaria Venture (MMV), 20 rte de Pré-Bois 1215, Geneva, Switzerland
| | - Joerg JMoehrle
- Medicines for Malaria Venture (MMV), 20 rte de Pré-Bois 1215, Geneva, Switzerland
| | - Timothy NC Wells
- Medicines for Malaria Venture (MMV), 20 rte de Pré-Bois 1215, Geneva, Switzerland
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Meremikwu MM, Donegan S, Sinclair D, Esu E, Oringanje C. Intermittent preventive treatment for malaria in children living in areas with seasonal transmission. Cochrane Database Syst Rev 2012; 2012:CD003756. [PMID: 22336792 PMCID: PMC6532713 DOI: 10.1002/14651858.cd003756.pub4] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In malaria endemic areas, pre-school children are at high risk of severe and repeated malaria illness. One possible public health strategy, known as Intermittent Preventive Treatment in children (IPTc), is to treat all children for malaria at regular intervals during the transmission season, regardless of whether they are infected or not. OBJECTIVES To evaluate the effects of IPTc to prevent malaria in preschool children living in endemic areas with seasonal malaria transmission. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register (July 2011), CENTRAL (The Cochrane Library 2011, Issue 6), MEDLINE (1966 to July 2011), EMBASE (1974 to July 2011), LILACS (1982 to July 2011), mRCT (July 2011), and reference lists of identified trials. We also contacted researchers working in the field for unpublished and ongoing trials. SELECTION CRITERIA Individually randomized and cluster-randomized controlled trials of full therapeutic dose of antimalarial or antimalarial drug combinations given at regular intervals compared with placebo or no preventive treatment in children aged six years or less living in an area with seasonal malaria transmission. DATA COLLECTION AND ANALYSIS Two authors independently assessed eligibility, extracted data and assessed the risk of bias in the trials. Data were meta-analysed and measures of effects (ie rate ratio, risk ratio and mean difference) are presented with 95% confidence intervals (CIs). The quality of evidence was assessed using the GRADE methods. MAIN RESULTS Seven trials (12,589 participants), including one cluster-randomized trial, met the inclusion criteria. All were conducted in West Africa, and six of seven trials were restricted to children aged less than 5 years.IPTc prevents approximately three quarters of all clinical malaria episodes (rate ratio 0.26; 95% CI 0.17 to 0.38; 9321 participants, six trials, high quality evidence), and a similar proportion of severe malaria episodes (rate ratio 0.27, 95% CI 0.10 to 0.76; 5964 participants, two trials, high quality evidence). These effects remain present even where insecticide treated net (ITN) usage is high (two trials, 5964 participants, high quality evidence).IPTc probably produces a small reduction in all-cause mortality consistent with the effect on severe malaria, but the trials were underpowered to reach statistical significance (risk ratio 0.66, 95% CI 0.31 to 1.39, moderate quality evidence).The effect on anaemia varied between studies, but the risk of moderately severe anaemia is probably lower with IPTc (risk ratio 0.71, 95% CI 0.52 to 0.98; 8805 participants, five trials, moderate quality evidence).Serious drug-related adverse events, if they occur, are probably rare, with none reported in the six trials (9533 participants, six trials, moderate quality evidence). Amodiaquine plus sulphadoxine-pyrimethamine is the most studied drug combination for seasonal chemoprevention. Although effective, it causes increased vomiting in this age-group (risk ratio 2.78, 95% CI 2.31 to 3.35; two trials, 3544 participants, high quality evidence).When antimalarial IPTc was stopped, no rebound increase in malaria was observed in the three trials which continued follow-up for one season after IPTc. AUTHORS' CONCLUSIONS In areas with seasonal malaria transmission, giving antimalarial drugs to preschool children (age < 6 years) as IPTc during the malaria transmission season markedly reduces episodes of clinical malaria, including severe malaria. This benefit occurs even in areas where insecticide treated net usage is high.
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Affiliation(s)
- Martin M Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria.
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Rodrigues T, Prudêncio M, Moreira R, Mota MM, Lopes F. Targeting the liver stage of malaria parasites: a yet unmet goal. J Med Chem 2011; 55:995-1012. [PMID: 22122518 DOI: 10.1021/jm201095h] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tiago Rodrigues
- Research Institute for Medicines and Pharmaceutical Sciences (iMed.UL), Faculty of Pharmacy, University of Lisbon, Av. Prof. Gama Pinto, 1649-019 Lisbon, Portugal
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Dow GS, Magill AJ, Ohrt C. Clinical development of new prophylactic antimalarial drugs after the 5th Amendment to the Declaration of Helsinki. Ther Clin Risk Manag 2011; 4:803-19. [PMID: 19209263 PMCID: PMC2621393 DOI: 10.2147/tcrm.s1025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Malaria is of continuing concern in nonimmune traveling populations. Traditionally, antimalarial drugs have been developed as agents for dual indications (treatment and prophylaxis). However, since 2000, when the 5th Amendment to the Declaration of Helsinki (DH2000) was adopted, development of new malaria prophylaxis drugs in this manner has ceased. As a consequence, there may not be any new drugs licensed for this indication in the foreseeable future. Major pharmaceutical companies have interpreted DH2000 to mean that the traditional development paradigm may be considered unethical because of doubt over the likelihood of benefit to endemic populations participating in clinical studies, the use of placebo, and the sustainability of post-trial access to study medications. In this article, we explore the basis of these concerns and suggest that the traditional development paradigm remains ethical under certain circumstances. We also consider alternative approaches that may be more attractive to sponsors as they either do not use placebo, or utilize populations in endemic countries who may unambiguously benefit. These approaches represent the way forward in the future, but are at present unproven in clinical practice, and face numerous regulatory, logistical and technical challenges. Consequently, in the short term, we argue that the traditional clinical development paradigm remains the most feasible approach and is ethical and consistent with the spirit of DH2000 under the appropriate circumstances.
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Affiliation(s)
- Geoffrey S Dow
- Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
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Issifou S, Adegnika AA, Lell B. Medical research at the Albert Schweitzer Hospital. Wien Klin Wochenschr 2010; 122 Suppl 1:11-2. [PMID: 20376716 DOI: 10.1007/s00508-010-1327-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Built in 1981, the Medical Research Unit is located at the campus of the Albert Schweitzer Hospital. The main scientific activities of this research unit lie on clinical research focusing on antimalarial drugs and vaccines, and basic studies on pathogenesis of infectious diseases. Since 2002 the Medical Research Unit has experience in organising and hosting high quality training in clinical research in collaboration with the Vienna School of Clinical Research and other partners. For the future, this unit is involved as a key partner in the Central African Network on Tuberculosis, HIV/AIDS and Malaria (CANTAM) consortium playing a central role for the excellence in clinical research in Central Africa.
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Affiliation(s)
- Saadou Issifou
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon.
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Kremsner PG. Tropical Medicine at the University of Tübingen. Wien Klin Wochenschr 2010; 122 Suppl 1:1-3. [DOI: 10.1007/s00508-010-1324-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Randomized, double-blind study of the safety, tolerability, and efficacy of tafenoquine versus mefloquine for malaria prophylaxis in nonimmune subjects. Antimicrob Agents Chemother 2009; 54:792-8. [PMID: 19995933 DOI: 10.1128/aac.00354-09] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study represents the first phase III trial of the safety, tolerability, and effectiveness of tafenoquine for malaria prophylaxis. In a randomized (3:1), double-blinded study, Australian soldiers received weekly malaria prophylaxis with 200 mg tafenoquine (492 subjects) or 250 mg mefloquine (162 subjects) for 6 months on a peacekeeping deployment to East Timor. After returning to Australia, tafenoquine-receiving subjects received a placebo and mefloquine-receiving subjects received 30 mg primaquine daily for 14 days. There were no clinically significant differences between hematological and biochemical parameters of the treatment groups. Treatment-related adverse events for the two groups were similar (tafenoquine, 13.4%; mefloquine, 11.7%). Three subjects on tafenoquine (0.6%) and none on mefloquine discontinued prophylaxis because of possible drug-related adverse events. No diagnoses of malaria occurred for either group during deployment, but 4 cases (0.9%) and 1 case (0.7%) of Plasmodium vivax infection occurred among the tafenoquine and mefloquine groups, respectively, up to 20 weeks after discontinuation of medication. In a subset of subjects recruited for detailed safety assessments, treatment-related mild vortex keratopathy was detected in 93% (69 of 74) of tafenoquine subjects but none of the 21 mefloquine subjects. The vortex keratopathy was not associated with any effect on visual acuity and was fully resolved in all subjects by 1 year. Tafenoquine appears to be safe and well tolerated as malaria prophylaxis. Although the volunteers' precise exposure to malaria could not be proven in this study, tafenoquine appears to be a highly efficacious drug for malaria prophylaxis.
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Meremikwu MM, Donegan S, Esu E. Chemoprophylaxis and intermittent treatment for preventing malaria in children. Cochrane Database Syst Rev 2008:CD003756. [PMID: 18425893 DOI: 10.1002/14651858.cd003756.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Malaria causes repeated illness in children living in endemic areas. Policies of giving antimalarial drugs at regular intervals (prophylaxis or intermittent treatment) are being considered for preschool children. OBJECTIVES To evaluate prophylaxis and intermittent treatment with antimalarial drugs to prevent malaria in young children living in malaria-endemic areas. SEARCH STRATEGY We searched the Cochrane Infectious Diseases Group Specialized Register (August 2007), CENTRAL (The Cochrane Library 2007, Issue 3), MEDLINE (1966 to August 2007), EMBASE (1974 to August 2007), LILACS (1982 to August 2007), mRCT (February 2007), and reference lists of identified trials. We also contacted researchers. SELECTION CRITERIA Individually randomized and cluster-randomized controlled trials comparing antimalarial drugs given at regular intervals (prophylaxis or intermittent treatment) with placebo or no drug in children aged one month to six years or less living in a malaria-endemic area. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed methodological quality. We used relative risk (RR) or weighted mean difference with 95% confidence intervals (CI) for meta-analyses. Where we detected heterogeneity and considered it appropriate to combine the trials, we used the random-effects model (REM). MAIN RESULTS Twenty-one trials (19,394 participants), including six cluster-randomized trials, met the inclusion criteria. Prophylaxis or intermittent treatment with antimalarial drugs resulted in fewer clinical malaria episodes (RR 0.53, 95% CI 0.38 to 0.74, REM; 7037 participants, 10 trials), less severe anaemia (RR 0.70, 95% CI 0.52 to 0.94, REM; 5445 participants, 9 trials), and fewer hospital admissions for any cause (RR 0.64, 95% CI 0.49 to 0.82; 3722 participants, 5 trials). We did not detect a difference in the number of deaths from any cause (RR 0.90, 95% CI 0.65 to 1.23; 7369 participants, 10 trials), but the CI do not exclude a potentially important difference. One trial reported three serious adverse events with no statistically significant difference between study groups (1070 participants). Eight trials measured morbidity and mortality six months to two years after stopping regular antimalarial drugs; overall, there was no statistically significant difference, but participant numbers were small. AUTHORS' CONCLUSIONS Prophylaxis and intermittent treatment with antimalarial drugs reduce clinical malaria and severe anaemia in preschool children.
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Affiliation(s)
- M M Meremikwu
- University of Calabar Teaching Hospital, Department of Paediatrics, PMB 1115, Calabar, Cross River State, Nigeria.
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Castelli F, Capone S, Pedruzzi B, Matteelli A. Antimicrobial prevention and therapy for travelers' infection. Expert Rev Anti Infect Ther 2008; 5:1031-48. [PMID: 18039086 DOI: 10.1586/14787210.5.6.1031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
International journeys are increasing and more than 70 million people from industrialized countries cross the borders of tropical countries every year. More than 50% of them will suffer from some form of infectious illness, ranging from mild travelers' diarrhea to severe dengue fever to fatal malaria, with a wide spectrum of microbiological entities. Travel-related respiratory infections, including TB, and sexually transmitted infections are also increasingly reported. Awareness of travel-related risk is not always adequate among international travelers. Specific training on travel medicine-related issues, as well as better diagnostic facilities for imported diseases, is crucial for physicians and nurses in industrialized countries.
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Affiliation(s)
- Francesco Castelli
- University of Brescia, Unit for Tropical and Imported Diseases, Spedali Civili General Hospital, Piazza Spedali Civili, 1 25123 Brescia, Italy.
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