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Kiguba R, Olsson S, Waitt C. Pharmacovigilance in low- and middle-income countries: A review with particular focus on Africa. Br J Clin Pharmacol 2023; 89:491-509. [PMID: 34937122 DOI: 10.1111/bcp.15193] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 01/25/2023] Open
Abstract
Low- and middle-income countries (LMIC) face unique challenges with regard to the establishment of robust pharmacovigilance systems capable of generating data to inform healthcare policy and practice. These include the limited integration and reliability of pharmacovigilance systems across LMIC despite recent efforts to harmonize pharmacovigilance rules and regulations in several regional economic communities. There are particular challenges relating to the need to translate reporting tools into numerous local languages and the low numbers of healthcare providers relative to number of patients, with very short consultation times. Additional factors frequent in LMIC include high uptake of herbal and traditional medication, mostly by self-medication; disruptive political conflicts jeopardizing fragile systems; and little or no access to drug utilization data, which makes it difficult to reliably estimate the true risks of medicines use. Pharmacovigilance activities are hindered by the scarcity of well-trained personnel with little or no budgetary support from national governments; high turnover of pharmacovigilance staff whose training involves a substantial amount of resources; and little awareness of pharmacovigilance among healthcare workers, decision makers and consumers. Furthermore, little collaboration between public health programmes and national medicines regulatory authorities coupled with limited investment in pharmacovigilance activities, especially during mass drug administration for neglected tropical diseases and mass vaccinations, produces major challenges in establishing a culture where pharmacovigilance is systematically embedded. Very low spontaneous reporting rates with poor quality reports hinders robust signal detection analyses. This review summarises the specific challenges and areas of progress in pharmacovigilance in LMIC with special focus on the situation in Africa.
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Affiliation(s)
- Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda
| | - Sten Olsson
- Pharmacovigilance Consulting, Uppsala, Sweden
| | - Catriona Waitt
- Department of Pharmacology and Therapeutics, University of Liverpool, UK.,Infectious Diseases Institute, Makerere University College of Health Sciences, Uganda
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Assefa A, Mohammed H, Anand A, Abera A, Sime H, Minta AA, Tadesse M, Tadesse Y, Girma S, Bekele W, Etana K, Alemayehu BH, Teka H, Dilu D, Haile M, Solomon H, Moriarty LF, Zhou Z, Svigel SS, Ezema B, Tasew G, Woyessa A, Hwang J, Murphy M. Therapeutic efficacies of artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated Plasmodium falciparum and chloroquine and dihydroartemisinin-piperaquine for uncomplicated Plasmodium vivax infection in Ethiopia. Malar J 2022; 21:359. [PMID: 36451216 PMCID: PMC9714156 DOI: 10.1186/s12936-022-04350-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Routine monitoring of anti-malarial drugs is recommended for early detection of drug resistance and to inform national malaria treatment guidelines. In Ethiopia, the national treatment guidelines employ a species-specific approach. Artemether-lumefantrine (AL) and chloroquine (CQ) are the first-line schizonticidal treatments for Plasmodium falciparum and Plasmodium vivax, respectively. The National Malaria Control and Elimination Programme in Ethiopia is considering dihydroartemisinin-piperaquine (DHA/PPQ) as an alternative regimen for P. falciparum and P. vivax. METHODS The study assessed the clinical and parasitological efficacy of AL, CQ, and DHA/PPQ in four arms. Patients over 6 months and less than 18 years of age with uncomplicated malaria mono-infection were recruited and allocated to AL against P. falciparum and CQ against P. vivax. Patients 18 years or older with uncomplicated malaria mono-infection were recruited and randomized to AL or dihydroartemisinin-piperaquine (DHA/PPQ) against P. falciparum and CQ or DHA/PPQ for P. vivax. Patients were followed up for 28 (for CQ and AL) or 42 days (for DHA/PPQ) according to the WHO recommendations. Polymerase chain reaction (PCR)-corrected and uncorrected estimates were analysed by Kaplan Meier survival analysis and per protocol methods. RESULTS A total of 379 patients were enroled in four arms (n = 106, AL-P. falciparum; n = 75, DHA/PPQ- P. falciparum; n = 142, CQ-P. vivax; n = 56, DHA/PPQ-P. vivax). High PCR-corrected adequate clinical and parasitological response (ACPR) rates were observed at the primary end points of 28 days for AL and CQ and 42 days for DHA/PPQ. ACPR rates were 100% in AL-Pf (95% CI: 96-100), 98% in CQ-P. vivax (95% CI: 95-100) at 28 days, and 100% in the DHA/PPQ arms for both P. falciparum and P. vivax at 42 days. For secondary endpoints, by day three 99% of AL-P. falciparum patients (n = 101) cleared parasites and 100% were afebrile. For all other arms, 100% of patients cleared parasites and were afebrile by day three. No serious adverse events were reported. CONCLUSION This study demonstrated high therapeutic efficacy for the anti-malarial drugs currently used by the malaria control programme in Ethiopia and provides information on the efficacy of DHA/PPQ for the treatment of P. falciparum and P. vivax as an alternative option.
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Affiliation(s)
- Ashenafi Assefa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia. .,Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Hussein Mohammed
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anjoli Anand
- grid.416738.f0000 0001 2163 0069Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA ,grid.416738.f0000 0001 2163 0069Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Adugna Abera
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Heven Sime
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anna A. Minta
- grid.416738.f0000 0001 2163 0069Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA ,grid.416738.f0000 0001 2163 0069Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | | | - Samuel Girma
- ICAP at Columbia University, Addis Ababa, Ethiopia ,U.S. President’s Malaria Initiative, USA Agency for International Development, Addis Ababa, Ethiopia
| | - Worku Bekele
- World Health Organization, Addis Ababa, Ethiopia
| | - Kebede Etana
- grid.414835.f0000 0004 0439 6364Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Hiwot Teka
- U.S. President’s Malaria Initiative, USA Agency for International Development, Addis Ababa, Ethiopia
| | - Dereje Dilu
- grid.414835.f0000 0004 0439 6364Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Mebrahtom Haile
- grid.414835.f0000 0004 0439 6364Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Hiwot Solomon
- grid.414835.f0000 0004 0439 6364Ethiopian Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Leah F. Moriarty
- grid.416738.f0000 0001 2163 0069U.S. President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Zhiyong Zhou
- grid.416738.f0000 0001 2163 0069Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Samaly Souza Svigel
- grid.416738.f0000 0001 2163 0069Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Bryan Ezema
- grid.416738.f0000 0001 2163 0069Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Geremew Tasew
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adugna Woyessa
- grid.452387.f0000 0001 0508 7211Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Jimee Hwang
- grid.416738.f0000 0001 2163 0069U.S. President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Matthew Murphy
- grid.416738.f0000 0001 2163 0069U.S. President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention, Atlanta, GA USA
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Rouamba T, Sondo P, Yerbanga IW, Compaore A, Traore-Coulibaly M, Hien FS, Diande NA, Valea I, Tahita MC, Baiden R, Binka F, Tinto H. Prospective observational study to evaluate the clinical and biological safety profile of pyronaridine-artesunate in a rural health district in Burkina Faso. Pharmacol Res Perspect 2022; 10:e00987. [PMID: 35855566 PMCID: PMC9297024 DOI: 10.1002/prp2.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
The assessment in real‐life conditions of the safety and efficacy of new antimalarial drugs is of greatest interest. This study aimed to monitor and evaluate both clinical and biological safety of pyronaridine‐artesunate (PA) in real‐life conditions in Burkina Faso's health system. This was a single‐arm, open‐label study, where patients attending Nanoro health facilities with uncomplicated malaria were consented to be part of a cohort event monitoring (CEM). At inclusion (day‐0), PA was administered orally once a day for 3 days. Patients spontaneous reported any clinical adverse events (AEs) occurring within 28 days following the treatment. Additionally, the study focused on AEs of special interest (AESI), namely clinical signs related to hepatotoxicity and increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST). A nested subset of patients with blood sample collection at day‐0 and day‐7 were monitored to investigate the effect of PA on biochemistry parameters. From September 2017 to October 2018, 2786 patients were treated with PA. About 97.8% (2720/2786) of patients did not report any AE. The most commonly reported events were respiratory, thoracic, and mediastinal disorders (8.3 per 1000), infections and infestations (7.9 per 1000), and gastrointestinal disorders (7.2 per 1000). No clinical or biological hepatotoxicity event related to PA was reported during the follow‐up. Changes in biochemistry parameters remained within laboratory reference ranges. The study showed that PA is a well‐tolerated drug and should be considered as a good option by malaria control programs in countries where existing first‐line antimalarial drugs are continuously threatened by the emergence of drug resistance.
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Affiliation(s)
- Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Paul Sondo
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Isidore W Yerbanga
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Adelaide Compaore
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Maminata Traore-Coulibaly
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Franck S Hien
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Nassirou A Diande
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Innocent Valea
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Marc Christian Tahita
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | | | | | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
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Piperaquine Pharmacokinetic and Pharmacodynamic Profiles in Healthy Volunteers of Papua New Guinea after Administration of Three-Monthly Doses of Dihydroartemisinin–Piperaquine. Antimicrob Agents Chemother 2022; 66:e0018522. [DOI: 10.1128/aac.00185-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mass drug administration (MDA) with monthly dihydroartemisinin-piperaquine (DHA-PQP) appears useful in malaria control and elimination strategies. Determining the relationship between consecutive piperaquine phosphate (PQP) exposure and its impact on QT interval prolongation is a key safety consideration for MDA campaigns.
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CELLARIER D, PONS F, REBARDY M, PAEZ J, ROMMEL S, MOSCATO C, GANTOIS N, LABOURDERE E, HOWE R, CELLARIER G. [Clinical-Biological analyses and electrocardiographic follow-up of 104 cases of plasmodium falciparum malaria treated at Camp Kosseï in N'Djamena (Tchad)]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2021; 1:mtsi.2021.163. [PMID: 35685860 PMCID: PMC9128475 DOI: 10.48327/mtsi.2021.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to assess the commonly accepted potential effects of Artemisinin-based combinaison therapy (ACT) on repolarization and QT. METHOD We realized a retrospective study, evaluating epidemiologic, clinical, biological and electrocardiographic data for patients treated for falciparum malaria, between August 31st and November 3rd, 2017 in the Pôle de santé unique on the Camp Kosseï of N'Djamena. RESULTS One hundred and four patients were included (28,6 years old [0 - 75 years], 72% male). All had fever (38,4 °C [36,6 - 41,5 °C]), asthenia, and main symptoms were headache and arthromyalgia (58%). No significant difference was noted after treatment concerning biological data (especially kaliemia: 3.81 versus 3.91 mmol/l, p = 0.154). There was no significant increase of QTc (415.8 versus 421.4 ms, p = 0.89) with the two ACT treatment used and no adverse events. DISCUSSION Population is essentially composed of Chadian men, often partly immunized, that can modify clinical presentation. French soldiers' medical follow up in military operations decreases contra-indications of ACT. CONCLUSIONS These results are in favor of a good cardiac tolerance of ACT with piperaquine and it should be proposed not to realize systematic ECG for the French soldiers in external operation when treated with ACT.
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Affiliation(s)
| | - Frédéric PONS
- Hôpital d'instruction des armées (HIA) Sainte Anne de Toulon, France
| | | | | | | | | | | | | | | | - Gilles CELLARIER
- Hôpital d'instruction des armées (HIA) Sainte Anne de Toulon, France,*
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Vignier N, Bouchaud O, Angheben A, Bottieau E, Calleri G, Salas-Coronas J, Martin C, Ramos JM, Mechain M, Rapp C, Nothdurft HD, Velasco M, Bardají A, Rojo-Marcos G, Visser LG, Hatz C, Bisoffi Z, Jelinek T, Duparc S, Bourhis Y, Tommasini S, Iannucelli M, Bacchieri A, Mattera GG, Merlo Pich E, Behrens RH. Longitudinal study based on a safety registry for malaria patients treated with artenimol-piperaquine in six European countries. Malar J 2021; 20:214. [PMID: 33964945 PMCID: PMC8105939 DOI: 10.1186/s12936-021-03750-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background European travellers to endemic countries are at risk of malaria and may be affected by a different range of co-morbidities than natives of endemic regions. The safety profile, especially cardiac issues, of artenimol (previously dihydroartemisinin)–piperaquine (APQ) Eurartesim® during treatment of uncomplicated imported falciparum malaria is not adequately described due to the lack of longitudinal studies in this population. The present study was conducted to partially fill this gap. Methods Participants were recruited through Health Care Provider’s safety registry in 15 centres across 6 European countries in the period 2013–2016. Adverse events (AE) were collected, with a special focus on cardiovascular safety by including electrocardiogram QT intervals evaluated after correction with either Bazett’s (QTcB) or Fridericia’s (QTcF) methods, at baseline and after treatment. QTcB and/or QTcF prolongation were defined by a value > 450 ms for males and children and > 470 ms for females. Results Among 294 participants, 30.3% were women, 13.7% of Caucasian origin, 13.5% were current smoker, 13.6% current alcohol consumer and 42.2% declared at least one illness history. The mean (SD) age and body mass index were 39.8 years old (13.2) and 25.9 kg/m2 (4.7). Among them, 75 reported a total of 129 AE (27 serious), 46 being suspected to be related to APQ (11 serious) and mostly labelled as due to haematological, gastrointestinal, or infection. Women and Non-African participants had significantly (p < 0.05) more AEs. Among AEs, 21 were due to cardiotoxicity (7.1%), mostly QT prolongation, while 6 were due to neurotoxicity (2.0%), mostly dizziness. Using QTcF correction, QT prolongation was observed in 17/143 participants (11.9%), only 2 of them reporting QTcF > 500 ms (milliseconds) but no clinical symptoms. Using QTcB correction increases of > 60 ms were present in 9 participants (6.3%). A trend towards increased prolongation was observed in those over 65 years of age but only a few subjects were in this group. No new safety signal was reported. The overall efficacy rate was 255/257 (99.2%). Conclusions APQ appears as an effective and well-tolerated drug for treatment of malaria in patients recruited in European countries. AEs and QT prolongation were in the range of those obtained in larger cohorts from endemic countries. Trial registration This study has been registered in EU Post-Authorization Studies Register as EUPAS6942 Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03750-x.
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Affiliation(s)
- Nicolas Vignier
- Department of Infectious and Tropical Diseases, and Laboratoire Éducations et Pratiques de Santé (LEPS EA 3412), Sorbonne Paris Nord University, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France. .,Centre D'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, France. .,INSERM, Sorbonne Université, Institut Pierre Louis D'Épidémiologie et de Santé Publique IPLESP, Paris, France.
| | - Olivier Bouchaud
- Department of Infectious and Tropical Diseases, and Laboratoire Éducations et Pratiques de Santé (LEPS EA 3412), Sorbonne Paris Nord University, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France.,TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy
| | - Andrea Angheben
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Emmanuel Bottieau
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Guido Calleri
- Azienda Sanitaria Locale "Cità Di Torino", Torino, Italy
| | - Joaquín Salas-Coronas
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Tropical Medicine Unit, Hospital de Poniente, El Ejido, Almería, Spain
| | | | - José Manuel Ramos
- Consulta de Enfermedades Importadas Y Parasitología Clínica, Unidad de Enfermedades Infecciosas, Hospital General Universitario Alicante, Alicante, Spain
| | | | | | | | - Maria Velasco
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Azucena Bardají
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação Em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Gerardo Rojo-Marcos
- Hospital Universitario Príncipe de Asturias, Alcalà de Henares, Madrid, Spain
| | - Leo G Visser
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands
| | - Christoph Hatz
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Zeno Bisoffi
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Tomas Jelinek
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Berliner Centrum Fürr Reise- Und Tropenmedizin, Berlin, Germany
| | | | | | | | | | | | | | | | - Ronald H Behrens
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Clinical Research Dept, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Berrueta M, Ciapponi A, Bardach A, Cairoli FR, Castellano FJ, Xiong X, Stergachis A, Zaraa S, Meulen AST, Buekens P. Maternal and neonatal data collection systems in low- and middle-income countries for maternal vaccines active safety surveillance systems: A scoping review. BMC Pregnancy Childbirth 2021; 21:217. [PMID: 33731029 PMCID: PMC7968860 DOI: 10.1186/s12884-021-03686-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most post-licensure vaccine pharmacovigilance in low- and middle-income countries (LMICs) are passive reporting systems. These have limited utility for maternal immunization pharmacovigilance in LMIC settings and need to be supplemented with active surveillance. Our study's main objective was to identify existing perinatal data collection systems in LMICs that collect individual information on maternal and neonatal health outcomes and could be developed to inform active safety surveillance of novel vaccines for use during pregnancy. METHODS A scoping review was performed following the Arksey and O'Malley six-stage approach. We included studies describing electronic or mixed paper-electronic data collection systems in LMICs, including research networks, electronic medical records, and custom software platforms for health information systems. Medline PubMed, EMBASE, Global Health, Cochrane Library, LILACS, Bibliography of Asian Studies (BAS), and CINAHL were searched through August 2019. We also searched grey literature including through Google and websites of existing relevant perinatal data collection systems, as well as contacted authors of key studies and experts in the field to validate the information and identify additional sources of relevant unpublished information. RESULTS A total of 11,817 records were identified. The full texts of 264 records describing 96 data collection systems were assessed for eligibility. Eight perinatal data collection systems met our inclusion criteria: Global Network's Maternal Newborn Health Registry, International Network for the Demographic Evaluation of Populations and their Health; Perinatal Informatic System; Pregnancy Exposure Registry & Birth Defects Surveillance; SmartCare; Open Medical Record System; Open Smart Register Platform and District Health Information Software 2. These selected systems were qualitatively characterized according to seven different domains: governance; system design; system management; data management; data sources, outcomes and data quality. CONCLUSION This review provides a list of active maternal and neonatal data collection systems in LMICs and their characteristics as well as their outreach, strengths, and limitations. Findings could potentially help further understand where to obtain population-based high-quality information on outcomes to inform the conduct of maternal immunization active vaccine safety surveillance activities and research in LMICs.
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Affiliation(s)
- Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Federico Rodriguez Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Fabricio J Castellano
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | | | - Sabra Zaraa
- University of Washington, Seattle, WA, 98195-7631, USA
| | | | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
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Wang Q, Zou Y, Pan Z, Zhang H, Deng C, Yuan Y, Guo J, Tang Y, Julie N, Wu W, Li G, Li M, Tan R, Huang X, Guo W, Li C, Xu Q, Song J. Efficacy and Safety of Artemisinin-Piperaquine for the Treatment of Uncomplicated Malaria: A Systematic Review. Front Pharmacol 2020; 11:562363. [PMID: 33013398 PMCID: PMC7516161 DOI: 10.3389/fphar.2020.562363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/24/2020] [Indexed: 01/14/2023] Open
Abstract
Objective The World Health Organization recommends artemisinin-based combination therapies (ACTs) for the treatment of uncomplicated malaria to improve the therapeutic efficacy and limit the choice of drug-resistant parasites. This systematic review and meta-analysis aimed to evaluate the comparative efficacy and safety of artemisinin-piperaquine (AP) in the treatment of uncomplicated malaria relative to other commonly used ACTs. Methods As per the PRISMA guidelines, the EMBASE, MEDLINE, the Google Scholar Library, and Cochrane library databases were systematically searched from inception until July 2020 with the following terms: “artemisinin-piperaquine” or “AP.” Only randomized controlled trials (RCTs) were included. The competing interventions included dihydroartemisinin–piperaquine (DHA-PPQ), artemether–lumefantrine (AL, Coartem), artesunate-melfloquine (ASAM) and artesunate-amodiaquine (ASAQ, Artekin). Single-arm clinical trial on AP was also assessed. The reported outcomes, including the overall response, cure rate, fever and parasite clearance time, hematology, biochemistry, electrocardiogram (ECG), adverse events, recurrence rate, and sensitivity analyses, were systematically investigated. All data were analyzed using the Review Manager 5.3. Results A total of seven studies were reviewed, including five RCTs and two single-arm studies. A pooled analysis of 5 RCTs (n = 772) revealed a comparable efficacy on polymerase chain reaction (PCR)-confirmed cure rate between AP and competing interventions in treating uncomplicated malaria. As for the fever and parasite clearance time, due to the lack of complete data in some studies, only 3 studies’ data could be used. The patients showed good tolerance to all drugs, and some side-effects (such as headache, anoxia, vomiting, nausea, and dizziness) were reported for every group, but they were self-limited and showed no significant difference. Conclusions AP appeared to show similar efficacy and safety, with a simpler mode of administration and easier compliance when compared with other ACTs used in the treatment of uncomplicated malaria. Considering that the potential evolution of drug resistance is of a great concern, additional RCTs with high-quality and more rigorous design are warranted to substantiate the efficacy and safety in different populations and epidemiological regions.
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Affiliation(s)
- Qi Wang
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuanyuan Zou
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ziyi Pan
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hongying Zhang
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Changsheng Deng
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yueming Yuan
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China.,Institute of Science and Technology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiawen Guo
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China.,Institute of Science and Technology, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yexiao Tang
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nadia Julie
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wanting Wu
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoming Li
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingqiang Li
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruixiang Tan
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinan Huang
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenfeng Guo
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Changqing Li
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qin Xu
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianping Song
- Artemisinin Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China
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9
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Pooled Multicenter Analysis of Cardiovascular Safety and Population Pharmacokinetic Properties of Piperaquine in African Patients with Uncomplicated Falciparum Malaria. Antimicrob Agents Chemother 2020; 64:AAC.01848-19. [PMID: 32312783 PMCID: PMC7318010 DOI: 10.1128/aac.01848-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/08/2020] [Indexed: 01/08/2023] Open
Abstract
Dihydroartemisinin-piperaquine has shown excellent efficacy and tolerability in malaria treatment. However, concerns have been raised of potentially harmful cardiotoxic effects associated with piperaquine. The population pharmacokinetics and cardiac effects of piperaquine were evaluated in 1,000 patients, mostly children enrolled in a multicenter trial from 10 sites in Africa. A linear relationship described the QTc-prolonging effect of piperaquine, estimating a 5.90-ms mean QTc prolongation per 100-ng/ml increase in piperaquine concentration. Dihydroartemisinin-piperaquine has shown excellent efficacy and tolerability in malaria treatment. However, concerns have been raised of potentially harmful cardiotoxic effects associated with piperaquine. The population pharmacokinetics and cardiac effects of piperaquine were evaluated in 1,000 patients, mostly children enrolled in a multicenter trial from 10 sites in Africa. A linear relationship described the QTc-prolonging effect of piperaquine, estimating a 5.90-ms mean QTc prolongation per 100-ng/ml increase in piperaquine concentration. The effect of piperaquine on absolute QTc interval estimated a mean maximum QTc interval of 456 ms (50% effective concentration of 209 ng/ml). Simulations from the pharmacokinetic-pharmacodynamic models predicted 1.98 to 2.46% risk of having QTc prolongation of >60 ms in all treatment settings. Although piperaquine administration resulted in QTc prolongation, no cardiovascular adverse events were found in these patients. Thus, the use of dihydroartemisinin-piperaquine should not be limited by this concern. (This study has been registered at ClinicalTrials.gov under identifier NCT02199951.)
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10
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Rouamba T, Sondo P, Derra K, Nakanabo-Diallo S, Bihoun B, Rouamba E, Tarnagda Z, Kazienga A, Valea I, Sorgho H, Pagnoni F, Samadoulougou-Kirakoya F, Tinto H. Optimal Approach and Strategies to Strengthen Pharmacovigilance in Sub-Saharan Africa: A Cohort Study of Patients Treated with First-Line Artemisinin-Based Combination Therapies in the Nanoro Health and Demographic Surveillance System, Burkina Faso. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:1507-1521. [PMID: 32368010 PMCID: PMC7174163 DOI: 10.2147/dddt.s224857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/08/2020] [Indexed: 12/21/2022]
Abstract
Background and purpose Resource-limited countries face challenges in setting up effective pharmacovigilance systems. This study aimed to monitor the occurrence of adverse events (AEs) after the use of artemisinin-based combination therapies (ACTs), identify potential drivers of reporting suspected adverse drug reactions (ADRs) and monitor AEs among women who were inadvertently exposed to ACTs in the first trimester of pregnancy. Patients and methods We conducted a prospective observational study from May 2010 to July 2012 in Nanoro Health and Demographic Surveillance System (HDSS), Burkina Faso. The HDSS area was divided into active and passive surveillance areas to monitor AEs among patients (regardless of age or sex) who received a first-line ACT (artemether–lumefantrine or artesunate–amodiaquine). In the active surveillance area, patients were followed up for 28 days, while in the passive surveillance area, patients were encouraged to return voluntarily to the health facility to report any occurrence of AEs until day 28 after drug intake. We assessed the crude incidence rates of AEs in both cohorts and performed Cox regression with mixed random effects to identify potential drivers of ADR occurrence. Results In total, 3170 participants were included in the study. Of these, 40.3% had reported at least one AE, with 39.6% and 44.4% from active and passive surveillance groups, respectively. The types of ADRs were similar in both groups. The most frequent reported ADRs were anorexia, weakness, cough, dizziness and pruritus. One case of abortion and eight cases of death were reported, but none of them was related to the ACT. The variance in random factors showed a high variability of ADR occurrence between patients in both groups, whereas variability between health facilities was low in the active surveillance group and high in passive surveillance group. Taking more than two concomitant medications was associated with high hazard in ADR occurrence, whereas the rainy season was associated with low hazard. Conclusion This study showed that both passive and active surveillance approaches were useful tools. The HDSS allowed us to capture a few cases of exposure during the first trimester of pregnancy. The passive surveillance approach, which is more likely to be implemented by malaria control programs, seems to be more relevant in the Sub-Saharan African context.
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Affiliation(s)
- Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso.,Center for Research in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Paul Sondo
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Karim Derra
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Seydou Nakanabo-Diallo
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso.,Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Biebo Bihoun
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Eli Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Zekiba Tarnagda
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Adama Kazienga
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Innocent Valea
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Hermann Sorgho
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | | | - Fati Samadoulougou-Kirakoya
- Center for Research in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
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11
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Godman B, McCabe H, D Leong T. Fixed dose drug combinations - are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries. Expert Rev Pharmacoecon Outcomes Res 2020; 20:1-26. [PMID: 32237953 DOI: 10.1080/14737167.2020.1734456] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: There are positive aspects regarding the prescribing of fixed dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower- and middle-income countries (LMICs) which have the greatest prevalence of both infectious and noninfectious diseases and issues of affordability.Areas covered: Review of potential advantages, disadvantages, cost-effectiveness, and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where there are concerns with their value.Expert commentary: FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates, and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis, and hypertension are valued and listed in the country's essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which are being addressed.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Holly McCabe
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Trudy D Leong
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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12
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Chan XHS, Win YN, Haeusler IL, Tan JY, Loganathan S, Saralamba S, Chan SKS, Ashley EA, Barnes KI, Baiden R, Bassi PU, Djimde A, Dorsey G, Duparc S, Hanboonkunupakarn B, ter Kuile FO, Lacerda MVG, Nasa A, Nosten FH, Onyeji CO, Pukrittayakamee S, Siqueira AM, Tarning J, Taylor WRJ, Valentini G, van Vugt M, Wesche D, Day NPJ, Huang CLH, Brugada J, Price RN, White NJ. Factors affecting the electrocardiographic QT interval in malaria: A systematic review and meta-analysis of individual patient data. PLoS Med 2020; 17:e1003040. [PMID: 32134952 PMCID: PMC7058280 DOI: 10.1371/journal.pmed.1003040] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/05/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Electrocardiographic QT interval prolongation is the most widely used risk marker for ventricular arrhythmia potential and thus an important component of drug cardiotoxicity assessments. Several antimalarial medicines are associated with QT interval prolongation. However, interpretation of electrocardiographic changes is confounded by the coincidence of peak antimalarial drug concentrations with recovery from malaria. We therefore reviewed all available data to characterise the effects of malaria disease and demographic factors on the QT interval in order to improve assessment of electrocardiographic changes in the treatment and prevention of malaria. METHODS AND FINDINGS We conducted a systematic review and meta-analysis of individual patient data. We searched clinical bibliographic databases (last on August 21, 2017) for studies of the quinoline and structurally related antimalarials for malaria-related indications in human participants in which electrocardiograms were systematically recorded. Unpublished studies were identified by the World Health Organization (WHO) Evidence Review Group (ERG) on the Cardiotoxicity of Antimalarials. Risk of bias was assessed using the Pharmacoepidemiological Research on Outcomes of Therapeutics by a European Consortium (PROTECT) checklist for adverse drug events. Bayesian hierarchical multivariable regression with generalised additive models was used to investigate the effects of malaria and demographic factors on the pretreatment QT interval. The meta-analysis included 10,452 individuals (9,778 malaria patients, including 343 with severe disease, and 674 healthy participants) from 43 studies. 7,170 (68.6%) had fever (body temperature ≥ 37.5°C), and none developed ventricular arrhythmia after antimalarial treatment. Compared to healthy participants, patients with uncomplicated falciparum malaria had shorter QT intervals (-61.77 milliseconds; 95% credible interval [CI]: -80.71 to -42.83) and increased sensitivity of the QT interval to heart rate changes. These effects were greater in severe malaria (-110.89 milliseconds; 95% CI: -140.38 to -81.25). Body temperature was associated independently with clinically significant QT shortening of 2.80 milliseconds (95% CI: -3.17 to -2.42) per 1°C increase. Study limitations include that it was not possible to assess the effect of other factors that may affect the QT interval but are not consistently collected in malaria clinical trials. CONCLUSIONS Adjustment for malaria and fever-recovery-related QT lengthening is necessary to avoid misattributing malaria-disease-related QT changes to antimalarial drug effects. This would improve risk assessments of antimalarial-related cardiotoxicity in clinical research and practice. Similar adjustments may be indicated for other febrile illnesses for which QT-interval-prolonging medications are important therapeutic options.
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Affiliation(s)
- Xin Hui S. Chan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Yan Naung Win
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Health and Diseases Control Unit, Naypyidaw, Myanmar
| | - Ilsa L. Haeusler
- WorldWide Antimalarial Research Network, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jireh Y. Tan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Shanghavie Loganathan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Christ Church College, University of Oxford, Oxford, United Kingdom
| | - Sompob Saralamba
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Shu Kiat S. Chan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Singapore Armed Forces Medical Corps, Singapore
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao PDR
| | - Karen I. Barnes
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- WorldWide Antimalarial Resistance Network, Cape Town, South Africa
| | | | - Peter U. Bassi
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Abdoulaye Djimde
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science Techniques and Technologies of Bamako, Bamako, Mali
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | | | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Marcus V. G. Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas e Maria Deane (FIOCRUZ-Amazonas), Fundação Oswaldo Cruz, Manaus, Brazil
| | - Amit Nasa
- Sun Pharmaceutical Industries Ltd, Gurgaon, Haryana, India
| | - François H. Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Sasithon Pukrittayakamee
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- The Royal Society of Thailand, Dusit, Bangkok, Thailand
| | - André M. Siqueira
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Joel Tarning
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- WorldWide Antimalarial Research Network, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Walter R. J. Taylor
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Michèle van Vugt
- Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - David Wesche
- Certara, Princeton, New Jersey, United States of America
| | - Nicholas P. J. Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Josep Brugada
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ric N. Price
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Nicholas J. White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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13
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Harbuzariu A, Pitts S, Cespedes JC, Harp KO, Nti A, Shaw AP, Liu M, Stiles JK. Modelling heme-mediated brain injury associated with cerebral malaria in human brain cortical organoids. Sci Rep 2019; 9:19162. [PMID: 31844087 PMCID: PMC6914785 DOI: 10.1038/s41598-019-55631-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/26/2019] [Indexed: 01/09/2023] Open
Abstract
Human cerebral malaria (HCM), a severe encephalopathy associated with Plasmodium falciparum infection, has a 20-30% mortality rate and predominantly affects African children. The mechanisms mediating HCM-associated brain injury are difficult to study in human subjects, highlighting the urgent need for non-invasive ex vivo human models. HCM elevates the systemic levels of free heme, which damages the blood-brain barrier and neurons in distinct regions of the brain. We determined the effects of heme on induced pluripotent stem cells (iPSCs) and a three-dimensional cortical organoid system and assessed apoptosis and differentiation. We evaluated biomarkers associated with heme-induced brain injury, including a pro-inflammatory chemokine, CXCL-10, and its receptor, CXCR3, brain-derived neurotrophic factor (BDNF) and a receptor tyrosine-protein kinase, ERBB4, in the organoids. We then tested the neuroprotective effect of neuregulin-1 (NRG-1) against heme treatment in organoids. Neural stem and mature cells differentially expressed CXCL-10, CXCR3, BDNF and ERBB4 in the developing organoids and in response to heme-induced neuronal injury. The organoids underwent apoptosis and structural changes that were attenuated by NRG-1. Thus, cortical organoids can be used to model heme-induced cortical brain injury associated with HCM pathogenesis as well as for testing agents that reduce brain injury and neurological sequelae.
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Affiliation(s)
- Adriana Harbuzariu
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA, 30310, USA.
| | - Sidney Pitts
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA, 30310, USA
| | - Juan Carlos Cespedes
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA, 30310, USA
| | - Keri Oxendine Harp
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA, 30310, USA
| | - Annette Nti
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA, 30310, USA
| | - Andrew P Shaw
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, 315 Ferst Drive, Atlanta, GA, 30332, USA
| | - Mingli Liu
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA, 30310, USA
| | - Jonathan K Stiles
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA, 30310, USA.
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14
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Deng C, Huang B, Wang Q, Wu W, Zheng S, Zhang H, Li D, Feng D, Li G, Xue L, Yang T, Tuo F, Mohadji F, Su XZ, Xu Q, Wu Z, Lin L, Zhou J, Yan H, Bacar A, Said Abdallah K, Kéké RA, Msa Mliva A, Mohamed M, Wang X, Huang S, Oithik F, Li XB, Lu F, Fay MP, Liu XH, Wellems TE, Song J. Large-scale Artemisinin-Piperaquine Mass Drug Administration With or Without Primaquine Dramatically Reduces Malaria in a Highly Endemic Region of Africa. Clin Infect Dis 2019; 67:1670-1676. [PMID: 29846536 DOI: 10.1093/cid/ciy364] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/23/2018] [Indexed: 01/08/2023] Open
Abstract
Background Mass drug administration (MDA), with or without low-dose primaquine (PMQLD), is being considered for malaria elimination programs. The potential of PMQLD to block malaria transmission by mosquitoes must be balanced against liabilities of its use. Methods Artemisinin-piperaquine (AP), with or without PMQLD, was administered in 3 monthly rounds across Anjouan Island, Union of Comoros. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and PfK13 Kelch-propeller gene polymorphisms were evaluated. Results Coverage of 85 to 93% of the Anjouan population was achieved with AP plus PMQLD (AP+PMQLD) in 2 districts (population 97164) and with AP alone in 5 districts (224471). Between the months of April-September in both 2012 and 2013, average monthly malaria hospital rates per 100000 people fell from 310.8 to 2.06 in the AP+PMQLD population (ratio 2.06/310.8 = 0.66%; 95% CI: 0.02%, 3.62%; P = .00007) and from 412.1 to 2.60 in the AP population (ratio 0.63%; 95% CI: 0.11%, 1.93%; P < .00001). Effectiveness of AP+PMQLD was 0.9908 (95% CI: 0.9053, 0.9991), while effectiveness of AP alone was 0.9913 (95% CI: 0.9657, 0.9978). Both regimens were well tolerated, without severe adverse events. Analysis of 52 malaria samples after MDA showed no evidence for selection of PfK13 Kelch-propeller mutations. Conclusions Steep reductions of malaria cases were achieved by 3 monthly rounds of either AP+PMQLD or AP alone, suggesting potential for highly successful MDA without PMQLD in epidemiological settings such as those on Anjouan. A major challenge is to sustain and expand the public health benefits of malaria reductions by MDA.
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Affiliation(s)
| | - Bo Huang
- Institute of Tropical Medicine, People's Republic of China
| | - Qi Wang
- Institute of Tropical Medicine, People's Republic of China.,Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Wanting Wu
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Shaoqin Zheng
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Hongying Zhang
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Di Li
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Danghong Feng
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Guoming Li
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Linlu Xue
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Tao Yang
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Fei Tuo
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Fouad Mohadji
- Ministry of Health Comoros, Moroni, Union of Comoros, Bethesda, Maryland
| | - Xin-Zhuan Su
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Qin Xu
- Institute of Tropical Medicine, People's Republic of China
| | - Zhibing Wu
- First Affiliated Hospital, People's Republic of China
| | - Li Lin
- First Affiliated Hospital, People's Republic of China
| | - Jiuyao Zhou
- Traditional Chinese Medicine College, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Hong Yan
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Affane Bacar
- National Malaria Control Programme, Moroni, Union of Comoros, People's Republic of China
| | - Kamal Said Abdallah
- National Malaria Control Programme, Moroni, Union of Comoros, People's Republic of China
| | - Rachadi A Kéké
- National Malaria Control Programme, Moroni, Union of Comoros, People's Republic of China
| | - Ahamada Msa Mliva
- Ministry of Health Comoros, Moroni, Union of Comoros, Bethesda, Maryland
| | - Moussa Mohamed
- Ministry of Health Comoros, Moroni, Union of Comoros, Bethesda, Maryland
| | - Xinhua Wang
- Guangzhou Medical University, People's Republic of China
| | - Shiguang Huang
- School of Stomatology, Jinan University, People's Republic of China
| | - Fatihou Oithik
- Ministry of Health Comoros, Moroni, Union of Comoros, Bethesda, Maryland
| | - Xiao-Bo Li
- Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Fangli Lu
- Department of Parasitology, Zhongshan School of Medicine, People's Republic of China.,Key Laboratory of Tropical Disease Control in Ministry of Education, Sun Yat-sen University, Guangdong, People's Republic of China
| | - Michael P Fay
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Xiao-Hong Liu
- First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
| | - Thomas E Wellems
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jianping Song
- Institute of Tropical Medicine, People's Republic of China.,Science and Technology Park, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China
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15
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Lourenço C, Tatem AJ, Atkinson PM, Cohen JM, Pindolia D, Bhavnani D, Le Menach A. Strengthening surveillance systems for malaria elimination: a global landscaping of system performance, 2015-2017. Malar J 2019; 18:315. [PMID: 31533740 PMCID: PMC6751607 DOI: 10.1186/s12936-019-2960-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surveillance is a core component of an effective system to support malaria elimination. Poor surveillance data will prevent countries from monitoring progress towards elimination and targeting interventions to the last remaining at-risk places. An evaluation of the performance of surveillance systems in 16 countries was conducted to identify key gaps which could be addressed to build effective systems for malaria elimination. METHODS A standardized surveillance system landscaping was conducted between 2015 and 2017 in collaboration with governmental malaria programmes. Malaria surveillance guidelines from the World Health Organization and other technical bodies were used to identify the characteristics of an optimal surveillance system, against which systems of study countries were compared. Data collection was conducted through review of existing material and datasets, and interviews with key stakeholders, and the outcomes were summarized descriptively. Additionally, the cumulative fraction of incident infections reported through surveillance systems was estimated using surveillance data, government records, survey data, and other scientific sources. RESULTS The landscaping identified common gaps across countries related to the lack of surveillance coverage in remote communities or in the private sector, the lack of adequate health information architecture to capture high quality case-based data, poor integration of data from other sources such as intervention information, poor visualization of generated information, and its lack of availability for making programmatic decisions. The median percentage of symptomatic cases captured by the surveillance systems in the 16 countries was estimated to be 37%, mostly driven by the lack of treatment-seeking in the public health sector (64%) or, in countries with large private sectors, the lack of integration of this sector within the surveillance system. CONCLUSIONS The landscaping analysis undertaken provides a clear framework through which to identify multiple gaps in current malaria surveillance systems. While perfect systems are not required to eliminate malaria, closing the gaps identified will allow countries to deploy resources more efficiently, track progress, and accelerate towards malaria elimination. Since the landscaping undertaken here, several countries have addressed some of the identified gaps by improving coverage of surveillance, integrating case data with other information, and strengthening visualization and use of data.
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Affiliation(s)
- Christopher Lourenço
- Clinton Health Access Initiative, CHAI, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA. .,WorldPop, Department of Geography and Environmental Science, University of Southampton, Southampton, UK.
| | - Andrew J Tatem
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Peter M Atkinson
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - Justin M Cohen
- Clinton Health Access Initiative, CHAI, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA
| | - Deepa Pindolia
- Clinton Health Access Initiative, CHAI, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA
| | - Darlene Bhavnani
- Clinton Health Access Initiative, CHAI, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA
| | - Arnaud Le Menach
- Clinton Health Access Initiative, CHAI, 383 Dorchester Ave, Suite 400, Boston, MA, 02127, USA
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16
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Epelboin L, Rapp C, Faucher JF, Méchaï F, Bottieau E, Matheron S, Malvy D, Caumes E. Management and treatment of uncomplicated imported malaria in adults. Update of the French malaria clinical guidelines. Med Mal Infect 2019; 50:194-212. [PMID: 31493957 DOI: 10.1016/j.medmal.2019.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 07/11/2019] [Indexed: 12/25/2022]
Affiliation(s)
- L Epelboin
- Unité des maladies infectieuses et tropicales, centre hospitalier Andrée Rosemon, avenue des Flamboyants, 97300 Cayenne, French Guiana.
| | - C Rapp
- Hôpital Américain de Paris, 63, boulevard Victor Hugo, 92200 Neuilly, France; Hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94163 Saint-Mandé, France
| | - J F Faucher
- Service des maladies infectieuses et tropicales and UMR 1094, CHU Dupuytren 2, 87042 Limoges, France
| | - F Méchaï
- Service des maladies infectieuses et tropicales, hôpital Avicenne, 93000 Bobigny, France
| | - E Bottieau
- Institute of tropical medicine, Antwerp, Belgium
| | - S Matheron
- Service des maladies infectieuses et tropicales, CHU Bichat - Claude Bernard, 75018 Paris, France
| | - D Malvy
- Service des maladies infectieuses et tropicales, CHU Bordeaux, 33000 Bordeaux France
| | - E Caumes
- Hôpital Pitié-Salpêtrière, 43-87, boulevard de l'Hôpital, 75013 Paris, France
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17
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Torre C, Cary M, Borges FC, Ferreira PS, Alarcão J, Leufkens HG, Costa J, Martins AP. Intensive Monitoring Studies for Assessing Medicines: A Systematic Review. Front Med (Lausanne) 2019; 6:147. [PMID: 31380375 PMCID: PMC6659411 DOI: 10.3389/fmed.2019.00147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/12/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction: Intensive monitoring (IM) is one of the methods of post-marketing active surveillance based upon event monitoring, which has received interest in the current medicines regulatory landscape. For a specific period of time, IM involves primary data collection and is actively focused on gathering longitudinal information, mainly safety, since the first day of drug use. Objectives: To describe IM systems and studies' data published over 11-years period (2006–2016). Specifically, we reviewed study population/event surveillance, methodological approaches, limitations, and its applications in the real-world evidence generation data. Methods: We completed a systematic search of MEDLINE and EMBASE to identify studies published from 2006 to 2016, that used IM methodology. We extracted data using a standardized form and results were analyzed descriptively. The methodological quality of selected studies was assessed using the modified Downs and Black checklist. Results: From 1,400 screened citations, we identified 86 papers, corresponding to 69 different studies. Seventy percent of reviewed studies corresponded to established IM systems, of which, more than half were prescription event monitoring (PEM) and modified-PEM. Among non-established IM systems, vaccines were the most common studied drugs (n = 14). The median cohort size ranged from 488 (hospitals) to 10,479 (PEM) patients. Patients and caregivers were the event data source in 39.1% of studies. The mean overall quality score was similar between established and non-established IM. Conclusions: Over the study period, IM studies were implemented in 26 countries with different maturity levels of post-marketing surveillance systems. We identified two major limitations: only 20% of studies were conducted at hospital-level, which is a matter of concern, insofar as healthcare systems are facing a lack of access to new medicines at ambulatory care level. Additionally, IM access to data of drug exposure cohorts, either at identification or at follow-up stages, could somehow constitute a barrier, given the complexity of managerial, linkable, and privacy data issues.
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Affiliation(s)
- Carla Torre
- Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies, Lisbon, Portugal.,Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Maria Cary
- Centre for Health Evaluation and Research (CEFAR), National Association of Pharmacies, Lisbon, Portugal
| | - Fábio Cardoso Borges
- Department of Epidemiology and National Cancer Registry (RON), Portuguese Institute of Oncology, Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Paula S Ferreira
- Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.,Setubal and Santarem Regional Pharmacovigilance Unit, Lisbon, Portugal
| | - Joana Alarcão
- Faculty of Medicine, Center for Evidence-Based Medicine, University of Lisbon, Lisbon, Portugal
| | - Hubert G Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - João Costa
- Faculty of Medicine, Center for Evidence-Based Medicine, University of Lisbon, Lisbon, Portugal.,Faculty of Medicine, Institute of Molecular Medicine and Laboratory of Clinical Pharmacology and Therapeutics, University of Lisbon, Lisbon, Portugal
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18
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Leblanc C, Vasse C, Minodier P, Mornand P, Naudin J, Quinet B, Siriez JY, Sorge F, de Suremain N, Thellier M, Kendjo E, Faye A, Imbert P. Management and prevention of imported malaria in children. Update of the French guidelines. Med Mal Infect 2019; 50:127-140. [PMID: 30885541 DOI: 10.1016/j.medmal.2019.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 02/18/2019] [Indexed: 01/09/2023]
Abstract
Since the 2007 French guidelines on imported Falciparum malaria, the epidemiology, treatment, and prevention of malaria have changed considerably requiring guidelines for all Plasmodium species to be updated. Over the past decade, the incidence of imported malaria has decreased in all age groups, reflecting the decrease in the incidence of malaria in endemic areas. The rates of severe pediatric cases have increased as in adults, but fatalities are rare. The parasitological diagnosis requires a thick blood smear (or a rapid immunochromatographic test) and a thin blood film. Alternatively, a rapid antigen detection test can be paired with a thin blood film. Thrombocytopenia in children presenting with fever is highly predictive of malaria following travel to a malaria-endemic area and, when detected, malaria should be strongly considered. The first-line treatment of uncomplicated P. falciparum malaria is now an artemisinin-based combination therapy (ACT), either artemether-lumefantrine or artenimol-piperaquine, as recommended by the World Health Organization in endemic areas. Uncomplicated presentations of non-falciparum malaria should be treated either with chloroquine or ACT. The first-line treatment of severe malaria is now intravenous artesunate which is more effective than quinine in endemic areas. Quinine is restricted to cases where artesunate is contraindicated or unavailable. Prevention of malaria in pediatric travelers consists of nocturnal personal protection against mosquitoes (especially insecticide-treated nets) combined with chemoprophylaxis according to the risk level.
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Affiliation(s)
- C Leblanc
- Pédiatrie générale et maladies infectieuses, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - C Vasse
- Accueil des urgences pédiatriques, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - P Minodier
- Urgences enfants, CHU Nord, chemin des Bourrely, 13015 Marseille, France; Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - P Mornand
- Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Service de pédiatrie et aval des urgences, hôpital d'Enfants A. Trousseau, 26, avenue du docteur Arnold-Netter, 75012 Paris, France
| | - J Naudin
- Réanimation pédiatrique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - B Quinet
- Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Service de pédiatrie et aval des urgences, hôpital d'Enfants A. Trousseau, 26, avenue du docteur Arnold-Netter, 75012 Paris, France
| | - J Y Siriez
- Accueil des urgences pédiatriques, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - F Sorge
- Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Service de pédiatrie générale, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - N de Suremain
- Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Service de pédiatrie et aval des urgences, hôpital d'Enfants A. Trousseau, 26, avenue du docteur Arnold-Netter, 75012 Paris, France
| | - M Thellier
- Centre national de référence du paludisme, service de parasitologie-mycologie, hôpital Pitié-Salpêtrière, 43-87, boulevard de l'Hôpital, 75013 Paris, France
| | - E Kendjo
- Centre national de référence du paludisme, service de parasitologie-mycologie, hôpital Pitié-Salpêtrière, 43-87, boulevard de l'Hôpital, 75013 Paris, France
| | - A Faye
- Pédiatrie générale et maladies infectieuses, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - P Imbert
- Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre de vaccinations internationales, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
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19
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Funck-Brentano C, Bacchieri A, Valentini G, Pace S, Tommasini S, Voiriot P, Ubben D, Duparc S, Evene E, Felices M, Corsi M. Effects of Dihydroartemisinin-Piperaquine Phosphate and Artemether-Lumefantrine on QTc Interval Prolongation. Sci Rep 2019; 9:777. [PMID: 30692558 PMCID: PMC6349839 DOI: 10.1038/s41598-018-37112-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/04/2018] [Indexed: 12/21/2022] Open
Abstract
QT/QTc interval prolongation reflects delayed cardiac repolarization which can lead to Torsade de Pointes and sudden death. Many antimalarial drugs prolong QT/QTc interval. However, due to confounding factors in patients with malaria, the precise extent of this effect has been found to be highly variable among studies. We compared the effects of dihydroartemisinin-piperaquine phosphate (DHA-PQP) and artemether-lumefantrine (A-L) on QT interval duration in healthy volunteers. In this randomized, parallel groups, active moxifloxacin- and placebo-controlled study, prolongation of the QT/QTc interval following treatment with DHA-PQP in fasted and fed condition and A-L in fed state was investigated in healthy subjects (n = 287; Clinicaltrials.gov: NCT01103830). DHA-PQP resulted in significant mean (95% confidence interval (CI)) maximum increases in QTc Fridericia (QTcF) of 21.0 ms (15.7, 26.4) for DHA-PQP fasted, 35.9 ms (31.1, 40.6) for DHA-PQP high-fat/low-caloric and 46.0 ms (39.6, 52.3) for DHA-PQP high-fat/high-caloric breakfast. For A-L, the largest difference from baseline relative to placebo was 9.9 ms (95% CI: 6.8, 12.9). Increases in QTcF related to maximum plasma concentrations of piperaquine. Moxifloxacin demonstrated assay sensitivity. Increases in QTcF following DHA-PQP and A-L were clinically relevant. Food increased piperaquine exposure and QTcF interval prolongation emphasizing the need to administer DHA-PQP in the fasting state.
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Affiliation(s)
- Christian Funck-Brentano
- INSERM, CIC-1421 and UMR ICAN 1166, Sorbonne Université, Faculty of Medicine, AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and Clinical Investigation Center, Institute of Cardiometabolism and Nutrition (ICAN), F-75013, Paris, France.
| | | | - Giovanni Valentini
- Sigma-tau Industrie Farmaceutiche Riunite S.p.A., Pomezia, (Rome), Italy
| | - Silvia Pace
- Sigma-tau Industrie Farmaceutiche Riunite S.p.A., Pomezia, (Rome), Italy
| | - Silva Tommasini
- Sigma-tau Industrie Farmaceutiche Riunite S.p.A., Pomezia, (Rome), Italy
| | | | - David Ubben
- Medicines for Malaria Venture, Geneva, Switzerland
| | | | | | | | - Marco Corsi
- Sigma-tau Industrie Farmaceutiche Riunite S.p.A., Pomezia, (Rome), Italy
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20
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Millat-Martínez P, Ila R, Laman M, Robinson L, Karunajeewa H, Abel H, Pulai K, Sanz S, Manning L, Moore B, Bassat Q, Mitjà O. Electrocardiographic Safety of Repeated Monthly Dihydroartemisinin-Piperaquine as a Candidate for Mass Drug Administration. Antimicrob Agents Chemother 2018; 62:e01153-18. [PMID: 30249696 PMCID: PMC6256794 DOI: 10.1128/aac.01153-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/08/2018] [Indexed: 11/20/2022] Open
Abstract
Mass drug administration (MDA) of sequential rounds of antimalarial drugs is being considered for use as a tool for malaria elimination. As an effective and long-acting antimalarial, dihydroartemisinin-piperaquine (DHA-PQP) appears to be suitable as a candidate for MDA. However, the absence of cardiac safety data following repeated administration hinders its use in the extended schedules proposed for MDA. We conducted an interventional study in Lihir Island, Papua New Guinea, using healthy individuals age 3 to 60 years who received a standard 3-day course of DHA-PQP on 3 consecutive months. Twelve-lead electrocardiography (ECG) readings were conducted predose and 4 h after the final dose of each month. The primary safety endpoint was QT interval correction (QTc using Fridericia's correction [QTcF]) prolongation from baseline to 4 h postdosing. We compared the difference in prolongations between the third course postdose and the first course postdose. Of 84 enrolled participants, 69 (82%) participants completed all treatment courses and ECG measurements. The average increase in QTcF was 19.6 ms (standard deviation [SD], 17.8 ms) and 17.1 ms (SD, 17.1 ms) for the first-course and third-course postdosing ECGs risk difference, -2.4 (95% confidence interval [95% CI], -6.9 to 2.1; P = 0.285), respectively. We recorded a QTcF prolongation of >60 ms from baseline in 3 (4.3%) and 2 (2.9%) participants after the first course and third course (P = 1.00), respectively. No participants had QTcF intervals of >500 ms at any time point. Three consecutive monthly courses of DHA-PQP were as safe as a single course. The absence of cumulative cardiotoxicity with repeated dosing supports the use of monthly DHA-PQP as part of malaria elimination strategies.
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Affiliation(s)
- Pere Millat-Martínez
- Lihir Malaria Elimination Programme (LMEP), Lihir Island, New Ireland Province, Papua New Guinea
- ISGlobal, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
| | - Rhoda Ila
- Lihir Malaria Elimination Programme (LMEP), Lihir Island, New Ireland Province, Papua New Guinea
| | - Moses Laman
- Department of Paediatrics, Modilon Hospital, Madang, Papua New Guinea
- Papua New Guinea Institute of Medical Research (IMR), Madang, Papua New Guinea
| | - Leanne Robinson
- Papua New Guinea Institute of Medical Research (IMR), Madang, Papua New Guinea
- Burnet Institute, Melbourne, Victoria, Australia
- Division of Population Health and Immunity, Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Harin Karunajeewa
- Division of Population Health and Immunity, Walter and Eliza Hall Institute, Parkville, Victoria, Australia
- Western Centre for Health Research and Education, Western Health, Melbourne, Victoria, Australia
| | - Haina Abel
- Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, New Ireland Province, Papua New Guinea
| | - Kevin Pulai
- Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, New Ireland Province, Papua New Guinea
| | - Sergi Sanz
- ISGlobal, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
- Biostatistics Unit, Department of Public Health, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Laurens Manning
- Medical School, University of Western Australia, Harry Perkins Research Institute, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Brioni Moore
- Medical School, University of Western Australia, Harry Perkins Research Institute, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Quique Bassat
- ISGlobal, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Paediatric Infectious Diseases Unit, Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Oriol Mitjà
- ISGlobal, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
- Lihir Medical Centre, International SOS-Newcrest Mining, Lihir Island, New Ireland Province, Papua New Guinea
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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21
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Haeusler IL, Chan XHS, Guérin PJ, White NJ. The arrhythmogenic cardiotoxicity of the quinoline and structurally related antimalarial drugs: a systematic review. BMC Med 2018; 16:200. [PMID: 30400791 PMCID: PMC6220451 DOI: 10.1186/s12916-018-1188-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/09/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several quinoline and structurally related antimalarial drugs are associated with cardiovascular side effects, particularly hypotension and electrocardiographic QT interval prolongation. A prolonged QT interval is a sensitive but not specific risk marker for the development of Torsade de Pointes-a potentially lethal polymorphic ventricular tachyarrhythmia. The increasing use of quinoline and structurally related antimalarials in mass treatments to eliminate malaria rapidly highlights the need to review their cardiovascular safety profiles. METHODS The primary objective of this systematic review was to describe the documented clinical and electrocardiographic cardiovascular side effects of quinine, mefloquine, lumefantrine, piperaquine, halofantrine, chloroquine, sulfadoxine-pyrimethamine, amodiaquine, and primaquine. Trials in healthy subjects or patients with Plasmodium falciparum or P. vivax infection were included if at least two ECGs were conducted during the trial. All trial designs were included except case reports and pooled analyses. Secondary outcomes were the methods adopted by trials for measuring and reporting the QT interval. RESULTS Data from trials published between 1982 and July 2016 were included. A total of 177 trials met the inclusion criteria. 35,448 participants received quinoline antimalarials in these trials, of which 18,436 participants underwent ECG evaluation. Subjects with co-medication use or comorbidities including cardiovascular disease were excluded from the majority of trials. Dihydroartemisinin-piperaquine was the drug most studied (5083 participants). Despite enormous use over the past 60 years, only 1076, 452, and 150 patients had ECG recordings reported in studies of chloroquine, amodiaquine, and primaquine respectively. Transiently high concentrations of quinine, quinidine, and chloroquine following parenteral administration have all been associated with hypotension, but there were no documented reports of death or syncope attributable to a cardiovascular cause, nor of electrocardiographic recordings of ventricular arrhythmia in these trials. The large volume of missing outcome information and the heterogeneity of ECG interval reporting and measurement methodology did not allow pooled quantitative analysis of QT interval changes. CONCLUSIONS No serious cardiac adverse effects were recorded in malaria clinical trials of 35,548 participants who received quinoline and structurally related antimalarials with close follow-up including 18,436 individuals who underwent ECG evaluation. While these findings provide further evidence of the rarity of serious cardiovascular events after treatment with these drugs, they also underscore the need for continued strengthening of pharmacovigilance systems for robust detection of rare drug adverse events in real-world populations. A standardised approach to measurement and reporting of ECG data in malaria trials is also needed. TRIAL REGISTRATION PROSPERO CRD42016036678.
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Affiliation(s)
- Ilsa L Haeusler
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Philippe J Guérin
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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22
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Williams PCM, Berkley JA. Guidelines for the treatment of dysentery (shigellosis): a systematic review of the evidence. Paediatr Int Child Health 2018; 38:S50-S65. [PMID: 29790845 PMCID: PMC6021764 DOI: 10.1080/20469047.2017.1409454] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/04/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Shigella remains the primary cause of diarrhoea in paediatric patients worldwide and accounts for up to 40,000 deaths per year. Current guidelines for the treatment of shigellosis are based on data which are over a decade old. In an era of increasing antimicrobial resistance, an updated review of the appropriate empirical therapy for shigellosis in children is necessary, taking into account susceptibility patterns, cost and the risk of adverse events. METHODS A systematic review of the current published literature on the treatment of shigella dysentery was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS The initial search produced 131 results, of which nine studies met the inclusion criteria. The quality of the studies was assessed as per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. International guidelines were also reviewed. There is a lack of current research regarding the clinical treatment of shigellosis in paediatric and adult patients, despite rising antimicrobial resistance worldwide. In particular, there is a lack of studies assessing the non-susceptibility of community-acquired strains, with almost all published research pertaining to microbiological data from hospital-based settings. DISCUSSION Current WHO guidelines support the use of fluoroquinolones (first-line), β-lactams (second-line) and cephalosporins (second-line) which accords with currently available evidence and other international guidelines, and there is no strong evidence for changing this guidance. Azithromycin is appropriate as a second-line therapy in regions where the rate of non-susceptibility of ciprofloxacin is known to be high, and research suggests that, from a cardiac point of view, azithromycin is safer than other macrolide antibiotics. Cefixime is also a reasonable alternative, although its use must be weighed against the risk of dissemination of extended-spectrum β-lactamase-producing organisms.
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Affiliation(s)
| | - James A. Berkley
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network (CHAIN), Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, The University of Oxford, Oxford, UK
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Dama S, Niangaly H, Djimde M, Sagara I, Guindo CO, Zeguime A, Dara A, Djimde AA, Doumbo OK. A randomized trial of dihydroartemisinin-piperaquine versus artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Mali. Malar J 2018; 17:347. [PMID: 30290808 PMCID: PMC6173860 DOI: 10.1186/s12936-018-2496-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/28/2018] [Indexed: 11/28/2022] Open
Abstract
Background Artemether–lumefantrine (AL) and artesunate–amodiaquine are first-line treatment for uncomplicated malaria in many endemic countries, including Mali. Dihydroartemisinin–piperaquine (DHA–PQ) is also an alternative first-line artemisinin-based combination therapy, but only few data are available on DHA–PQ efficacy in sub-Saharan Africa. The main aim of this study was to compare clinical efficacy of DHA–PQ versus AL, using the World Health Organization (WHO) 42-day in vivo protocol. Methods The efficacy of three-dose regimens of DHA–PQ was compared to AL combination in a randomized, comparative open label trial using the WHO 42-day follow-up protocol from 2013 to 2015 in Doneguebougou and Torodo, Mali. The primary endpoint was to access the PCR-corrected Adequate Clinical and Parasitological Responses at day 28. Results A total of 317 uncomplicated malaria patients were enrolled, with 159 in DHA–PQ arm and 158 in AL arm. The parasite positivity rate decreased from 68.4% (95% CI 60.5–75.5) on day 1 to 3.8% (95% CI 1.4–8.1) on day 2 for DHA–PQ and 79.8% (95% CI 72.3–85.7) on day 1 to 9.5% (95% CI 5.4–15.2) on day 2 for AL, (p = 0.04). There was a significant difference in the uncorrected ACPR between DHA–PQ and AL, both at 28-day and 42-day follow-up with 97.4% (95% CI 93.5–99.3) in DHA–PQ vs 84.5% (95% CI 77.8–89.8) in AL (p < 0.001) and 94.2% (95% CI 89.3–97.3) in DHA–PQ vs 73.4% (95% CI 65.7–80.2) in AL, respectively (p < 0.001). After molecular correction, there was no significant difference in ACPRc between DHA–PQ and AL, both at the 28-day and 42-day follow-up with 99.4% (95% CI 96.5–100) in DHA–PQ versus 98.1% (95% CI 94.5–99.6) in AL (p = 0.3) and 99.3% (95% CI 96.5–100) in DHA–PQ vs 97.4% (95% CI 93.5–99.3) in AL (p = 0.2). There was no significant difference between DHA–PQ and AL in QTc prolongation 12.1% vs 7%, respectively (p = 0.4). Conclusion The results showed that dihydroartemisinin–piperaquine and artemether–lumefantrine were clinically efficacious on Plasmodium falciparum parasites in Mali.
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Affiliation(s)
- Souleymane Dama
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali.
| | - Hamidou Niangaly
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Moussa Djimde
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Issaka Sagara
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Cheick Oumar Guindo
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Amatigue Zeguime
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Antoine Dara
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Abdoulaye A Djimde
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Ogobara K Doumbo
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
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Chan XHS, Win YN, Mawer LJ, Tan JY, Brugada J, White NJ. Risk of sudden unexplained death after use of dihydroartemisinin-piperaquine for malaria: a systematic review and Bayesian meta-analysis. THE LANCET. INFECTIOUS DISEASES 2018; 18:913-923. [PMID: 29887371 PMCID: PMC6060085 DOI: 10.1016/s1473-3099(18)30297-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dihydroartemisinin-piperaquine is an effective and well tolerated artemisinin-based combination therapy that has been assessed extensively for the prevention and treatment of malaria. Piperaquine, similar to several structurally related antimalarials currently used, can prolong cardiac ventricular repolarisation duration and the electrocardiographic QT interval, leading to concerns about its proarrhythmic potential. We aimed to assess the risk of potentially lethal iatrogenic ventricular arrhythmias in individuals receiving dihydroartemisinin-piperaquine. METHODS We did a systematic review and Bayesian meta-analysis. We searched clinical bibliographic databases (last on May 24, 2017) for studies of dihydroartemisinin-piperaquine in human beings. Further unpublished studies were identified with the WHO Evidence Review Group on the Cardiotoxicity of Antimalarials. We searched for articles containing "dihydroartemisinin-piperaquine" as title, abstract, or subject heading keywords, with synonyms and variant spellings as additional search terms. We excluded animal studies, but did not apply limits on language or publication date. Eligible studies were prospective, randomised, controlled trials or cohort studies in which individuals received at least one 3-day treatment course of dihydroartemisinin-piperaquine for mass drug administration, preventive therapy, or case management of uncomplicated malaria, with follow-up over at least 3 days. At least two independent reviewers screened titles, abstracts, and full texts, agreed study eligibility, and extracted information about study and participant characteristics, adverse event surveillance methodology, dihydroartemisinin-piperaquine exposures, loss-to-follow up, and any deaths after dihydroartemisinin-piperaquine treatment into a standardised database. The risk of sudden unexplained death after dihydroartemisinin-piperaquine with 95% credible intervals (CI) generated by Bayesian meta-analysis was compared with the baseline rate of sudden cardiac death. FINDINGS Our search identified 94 eligible primary studies including data for 197 867 individuals who had received dihydroartemisinin-piperaquine: 154 505 in mass drug administration programmes; 15 188 in 14 studies of repeated courses in preventive therapies and case management of uncomplicated malaria; and 28 174 as single-course treatments of uncomplicated malaria in 76 case-management studies. There was one potentially drug-related sudden unexplained death: a healthy woman aged 16 in Mozambique who developed heart palpitations several hours after the second dose of dihydroartemisinin-piperaquine and collapsed and died on the way to hospital (no autopsy or ECG was done). The median pooled risk estimate of sudden unexplained death after dihydroartemisinin-piperaquine was 1 in 757 950 (95% CI 1 in 2 854 490 to 1 in 209 114). This risk estimate was not higher than the baseline rate of sudden cardiac death (0·7-11·9 per 100 000 person-years or 1 in 1 714 280 to 1 in 100 835 over a 30-day risk period). The risk of bias was low in most studies and unclear in a few. INTERPRETATION Dihydroartemisinin-piperaquine was associated with a low risk of sudden unexplained death that was not higher than the baseline rate of sudden cardiac death. Concerns about repolarisation-related cardiotoxicity need not limit its current use for the prevention and treatment of malaria. FUNDING Wellcome Trust, UK Medical Research Council, WHO, Bill & Melinda Gates Foundation, and University of Oxford.
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Affiliation(s)
- Xin Hui S Chan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Yan Naung Win
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Defence Services Medical Research Centre & Health and Disease Control Unit, Naypyidaw, Myanmar
| | - Laura J Mawer
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Royal Free London NHS Foundation Trust, London, UK
| | - Jireh Y Tan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Josep Brugada
- Arrhythmia Section, Cardiology Department, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Spain
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Kaboré L, Yaméogo TM, Sombié I, Ouédraogo M, Fofana S, Berthé A, Semdé R, Kirakoya-Samadoulougou F. Plaidoyer pour un renforcement du système de pharmacovigilance au Burkina Faso. SANTE PUBLIQUE 2018; 29:921-925. [PMID: 29473406 DOI: 10.3917/spub.176.0921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Large-scale deployment of new medicines has been observed over the last two decades in many Sub-Saharan Africa countries faced with major public health issues such as malaria and HIV/AIDS. However, some of these medicines may be responsible for varying degrees of toxicity, with adverse drug reactions leading to decreased compliance or even discontinuation of treatment. Pharmacovigilance systems therefore had to be set up in these countries, such as in Burkina Faso, West Africa, which initiated the organization of pharmacovigilance activities in 2008. Despite this progress, the systems in place have not yet achieved a sufficient level of performance to deal with drug-related health issues, highlighting the need for further actions. Pharmacovigilance in Burkina Faso can be strengthened at multiple levels: pre-service and in-service training of health workers; the establishment of active surveillance based on sentinel sites; informing the public and raising awareness; and strengthening national coordination.
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D'Alessandro U, Hill J, Tarning J, Pell C, Webster J, Gutman J, Sevene E. Treatment of uncomplicated and severe malaria during pregnancy. THE LANCET. INFECTIOUS DISEASES 2018; 18:e133-e146. [PMID: 29395998 DOI: 10.1016/s1473-3099(18)30065-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/19/2017] [Accepted: 10/13/2017] [Indexed: 12/13/2022]
Abstract
Over the past 10 years, the available evidence on the treatment of malaria during pregnancy has increased substantially. Owing to their relative ease of use, good sensitivity and specificity, histidine rich protein 2 based rapid diagnostic tests are appropriate for symptomatic pregnant women; however, such tests are less appropriate for systematic screening because they will not detect an important proportion of infections among asymptomatic women. The effect of pregnancy on the pharmacokinetics of antimalarial drugs varies greatly between studies and class of antimalarial drugs, emphasising the need for prospective studies in pregnant and non-pregnant women. For the treatment of malaria during the first trimester, international guidelines are being reviewed by WHO. For the second and third trimester of pregnancy, results from several trials have confirmed that artemisinin-based combination treatments are safe and efficacious, although tolerability and efficacy might vary by treatment. It is now essential to translate such evidence into policies and clinical practice that benefit pregnant women in countries where malaria is endemic. Access to parasitological diagnosis or appropriate antimalarial treatment remains low in many countries and regions. Therefore, there is a pressing need for research to identify quality improvement interventions targeting pregnant women and health providers. In addition, efficient and practical systems for pharmacovigilance are needed to further expand knowledge on the safety of antimalarial drugs, particularly in the first trimester of pregnancy.
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Affiliation(s)
- Umberto D'Alessandro
- Medical Research Council Unit, Banjul, The Gambia; London School of Hygiene & Tropical Medicine, London, UK.
| | - Jenny Hill
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joel Tarning
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Jayne Webster
- London School of Hygiene & Tropical Medicine, London, UK
| | - Julie Gutman
- Malaria Branch, US Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Esperanca Sevene
- Manhiça Health Research Center (CISM), Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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Leong FJ, Jain JP, Feng Y, Goswami B, Stein DS. A phase 1 evaluation of the pharmacokinetic/pharmacodynamic interaction of the anti-malarial agents KAF156 and piperaquine. Malar J 2018; 17:7. [PMID: 29304859 PMCID: PMC5756412 DOI: 10.1186/s12936-017-2162-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/23/2017] [Indexed: 01/16/2023] Open
Abstract
Background KAF156 is a novel imidazolopiperazine anti-malarial with activity against pre-erythrocytic liver stages, asexual and sexual blood stages. Based on in vitro data, a two-way pharmacokinetic interaction was hypothesized for KAF156 use in combination with piperaquine (PPQ) as both drugs are CYP3A4 substrates and inhibitors. Potential combination effects on the QT interval were also assessed. Methods This was an open-label, parallel-group, single-dose study in healthy volunteers randomized to three parallel arms (1:1:1) of 800 mg KAF156 + 1280 mg PPQ, 800 mg KAF156 alone and 1280 mg PPQ alone. Triplicate ECGs were done up to 48 h post-dose. Routine safety and pharmacokinetic assessments were carried out up to 61 days. Results Of the 72 healthy male subjects recruited, 68 completed the study. Co-administration of PPQ and KAF156 had no overall effect on AUC of either compound, but the Cmax values of both KAF156 (~ 23%) and piperaquine (~ 70%) increased. Both drugs given alone or in combination were well tolerated with no deaths or serious adverse events (SAEs). AEs were observed at the frequency of 87.5, 79.2 and 58.3% respectively for KAF156 + PPQ, PPQ and KAF156 arms. The most common AEs were nausea and headache. There were no Grade 3 or 4 events. There were no ECG related AEs, no QTcF interval > 480 ms and no QTcF interval increase from baseline > 60 ms. There was a positive ∆QTcF trend in the KAF156 + PPQ arm when either KAF156 or piperaquine concentration increases, but there was no significant difference between the combination arm and other arms in maximum ∆QTcF. Conclusions No safety/cardiac risk or drug interaction was identified which would preclude use of a KAF156 and PPQ combination in future studies.
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Affiliation(s)
- F Joel Leong
- Novartis Institute for Tropical Diseases, Singapore, Singapore. .,D3, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
| | | | - Yiyan Feng
- Novartis Institutes for BioMedical Research, Shanghai, People's Republic of China
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Chotsiri P, Wattanakul T, Hoglund RM, Hanboonkunupakarn B, Pukrittayakamee S, Blessborn D, Jittamala P, White NJ, Day NPJ, Tarning J. Population pharmacokinetics and electrocardiographic effects of dihydroartemisinin-piperaquine in healthy volunteers. Br J Clin Pharmacol 2017; 83:2752-2766. [PMID: 28695570 PMCID: PMC5698590 DOI: 10.1111/bcp.13372] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/21/2017] [Accepted: 06/30/2017] [Indexed: 12/21/2022] Open
Abstract
Aims The aims of the present study were to evaluate the pharmacokinetic properties of dihydroartemisinin (DHA) and piperaquine, potential drug–drug interactions with concomitant primaquine treatment, and piperaquine effects on the electrocardiogram in healthy volunteers. Methods The population pharmacokinetic properties of DHA and piperaquine were assessed in 16 healthy Thai adults using an open‐label, randomized, crossover study. Drug concentration–time data and electrocardiographic measurements were evaluated with nonlinear mixed‐effects modelling. Results The developed models described DHA and piperaquine population pharmacokinetics accurately. Concomitant treatment with primaquine did not affect the pharmacokinetic properties of DHA or piperaquine. A linear pharmacokinetic–pharmacodynamic model described satisfactorily the relationship between the individually corrected QT intervals and piperaquine concentrations; the population mean QT interval increased by 4.17 ms per 100 ng ml–1 increase in piperaquine plasma concentration. Simulations from the final model showed that monthly and bimonthly mass drug administration in healthy subjects would result in median maximum QT interval prolongations of 18.9 ms and 16.8 ms, respectively, and would be very unlikely to result in prolongation of more than 50 ms. A single low dose of primaquine can be added safely to the existing DHA–piperaquine treatment in areas of multiresistant Plasmodium falciparum malaria. Conclusions Pharmacokinetic–pharmacodynamic modelling and simulation in healthy adult volunteers suggested that therapeutic doses of DHA–piperaquine in the prevention or treatment of P. falciparum malaria are unlikely to be associated with dangerous QT prolongation.
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Affiliation(s)
- Palang Chotsiri
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thanaporn Wattanakul
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Richard M Hoglund
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | | | - Daniel Blessborn
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Joel Tarning
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Post-licensure safety evaluation of dihydroartemisinin piperaquine in the three major ecological zones across Ghana. PLoS One 2017; 12:e0174503. [PMID: 28358871 PMCID: PMC5373525 DOI: 10.1371/journal.pone.0174503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 03/06/2017] [Indexed: 01/17/2023] Open
Abstract
Background Uncommon and rare adverse events (AEs), with delayed onset may not be detected before new drugs are licensed and deployed. The present study examined the post licensure safety of dihydroartemisinin-piperaquine (DHP) as an additional treatment for malaria in Ghana. The relationship between the incidence of AEs, treatment completion rate, participant characteristics and concomitant medications are reported. Methods A study conducted from September 2013 to June 2014 in Navrongo, Kintampo and Dodowa health research centres in Ghana is presented. Participants had confirmed malaria and no known allergy to study drug. Patients provided informed consent and had their symptoms and results of their clinical examinations documented. Treatment with Eurartesim® (20/160mg dihydroartemisinin and 40/320mg piperaquine by Sigma-Tau Incorporated) was given, according to the body weight of patients. First treatment doses were under observation but the second and third doses were taken at home except in a sub-study involving a nested cohort. Patients were contacted at Day 5 (± 2 days) either on telephone or by a home visit to document any AEs experienced. Patients were asked to report to the study team any other AEs that occurred within 28 days post-treatment. All patients in the nested cohort had electrocardiogram (ECG). Findings A total of 4563 patients, 52.1% females and 48.2% <6 years completed the study. A total of 444 patients were enrolled into the nested cohort. About 33% had temperature ≥ 37.5°C at enrolment. Approximately 3.4% reported taking prior antimalarials, 19.4% other medications and 86% took at least one concomitant medication. Incidence of AEs was 7.6% including infections (4.6%), gastrointestinal disorders (1.0%) and local reactions at the site of venesection (0.5%). Others were respiratory disorders (0.4%) and nervous system disorders (0.3%). There were nine adverse events of special interest (AESI); itching/pruritus (7), dizziness (1), and skin lesions (1). Patients who took medications prior to enrolment had higher incidence of AEs compared with those without (9.3% vs. 6.1%; P<0.001). Statistically significant associations were found between the reported AEs and age of patients (P<0.001), their body mass index (BMI) (P< 0.001) and parasite densities (P< 0.001). Conclusion Dihydroartemisinin-Piperaquine was well tolerated with no serious safety concerns identified. Obesity and prior enrolment medication were among significant factors associated with increased AEs reporting.
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Burrows JN, Duparc S, Gutteridge WE, Hooft van Huijsduijnen R, Kaszubska W, Macintyre F, Mazzuri S, Möhrle JJ, Wells TNC. New developments in anti-malarial target candidate and product profiles. Malar J 2017; 16:26. [PMID: 28086874 PMCID: PMC5237200 DOI: 10.1186/s12936-016-1675-x] [Citation(s) in RCA: 297] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
A decade of discovery and development of new anti-malarial medicines has led to a renewed focus on malaria elimination and eradication. Changes in the way new anti-malarial drugs are discovered and developed have led to a dramatic increase in the number and diversity of new molecules presently in pre-clinical and early clinical development. The twin challenges faced can be summarized by multi-drug resistant malaria from the Greater Mekong Sub-region, and the need to provide simplified medicines. This review lists changes in anti-malarial target candidate and target product profiles over the last 4 years. As well as new medicines to treat disease and prevent transmission, there has been increased focus on the longer term goal of finding new medicines for chemoprotection, potentially with long-acting molecules, or parenteral formulations. Other gaps in the malaria armamentarium, such as drugs to treat severe malaria and endectocides (that kill mosquitoes which feed on people who have taken the drug), are defined here. Ultimately the elimination of malaria requires medicines that are safe and well-tolerated to be used in vulnerable populations: in pregnancy, especially the first trimester, and in those suffering from malnutrition or co-infection with other pathogens. These updates reflect the maturing of an understanding of the key challenges in producing the next generation of medicines to control, eliminate and ultimately eradicate malaria.
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Affiliation(s)
- Jeremy N Burrows
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva 15, Switzerland
| | - Stephan Duparc
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva 15, Switzerland
| | | | | | - Wiweka Kaszubska
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva 15, Switzerland
| | - Fiona Macintyre
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva 15, Switzerland
| | | | - Jörg J Möhrle
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva 15, Switzerland
| | - Timothy N C Wells
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva 15, Switzerland.
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Assi SB, Aba YT, Yavo JC, Nguessan AF, Tchiekoi NB, San KM, Bissagnéné E, Duparc S, Lameyre V, Tanoh MA. Safety of a fixed-dose combination of artesunate and amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in real-life conditions of use in Côte d'Ivoire. Malar J 2017; 16:8. [PMID: 28049523 PMCID: PMC5209945 DOI: 10.1186/s12936-016-1655-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background In many malaria-endemic, sub-Saharan African countries, existing pharmacovigilance systems are not sufficiently operational to document reliably the safety profile of anti-malarial drugs. This study describes the implantation of a community-based pharmacovigilance system in Côte d’Ivoire and its use to document the safety of ASAQ Winthrop® (artesunate–amodiaquine). Methods This prospective, longitudinal, descriptive, non-comparative, non-interventional study on the use of artesunate–amodiaquine in real-life conditions of use was conducted in seven Community Health Centres of the Agboville district in Côte d’Ivoire. Twenty trained Health Centre employees and 70 trained community health workers were involved in data collection in the field. All patients with suspected uncomplicated falciparum malaria, seeking treatment at one of the participating Health Centres, and treated with artesunate–amodiaquine could be enrolled. Two visits were planned, one for inclusion at the Health Centre and a second at home, performed by a community health worker 3–10 days after the inclusion visit. Administration of artesunate–amodiaquine was unsupervised. Adverse events (AEs) were documented at the home visit or during any unexpected visit to the Health Centre or to the hospital and coded and adjudicated by a local pharmacovigilance committee. Symptoms suggestive of hepatic failure, severe neutropaenia, extrapyramidal disorders and retinopathy were considered a priori as AEs of special interest. Results Some 15,228 malaria episodes in 12,198 patients were evaluated; 2545 AEs were documented during 1978 malaria episodes (13.0%). The most frequently observed events were asthenia (682 cases), vomiting (482 cases) and somnolence (174 cases). Most reported AEs were of mild or moderate intensity and resolved without corrective treatment. One-hundred and five (105) AEs reported during 100 episodes (0.7%) were considered as serious. Three serious cases of transient extrapyramidal disorders, identified as AEs of special interest were reported in three patients. Conclusion The fixed dose artesunate–amodiaquine combination ASAQ Winthrop® for the unsupervised treatment of uncomplicated falciparum malaria under real-life conditions of care in Côte d’Ivoire is well tolerated. The study emphasizes the interest of involving properly trained community health workers to collect pharmacovigilance data in the field in order to document rare AEs. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1655-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Serge-Brice Assi
- Institut Pierre Richet (IPR)/Institut National de Santé Publique (INSP), Bouaké, Ivory Coast. .,National Malaria Control Programme, Abidjan, Ivory Coast.
| | - Yapo Thomas Aba
- Infectious and Tropical Diseases Department, Bouaké University Hospital, Bouaké, Ivory Coast
| | - Jean Claude Yavo
- Pharmacovigilance Unit, Medical Sciences, Felix Houphouët-Boigny, Abidjan, Ivory Coast
| | - Abouo Franklin Nguessan
- Infectious and Tropical Diseases Unit, Treichville University Hospital, Abidjan, Ivory Coast
| | - N'cho Bertin Tchiekoi
- Institut Pierre Richet (IPR)/Institut National de Santé Publique (INSP), Bouaké, Ivory Coast
| | | | - Emmanuel Bissagnéné
- Infectious and Tropical Diseases Unit, Treichville University Hospital, Abidjan, Ivory Coast
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Kabanywanyi AM, Baiden R, Ali AM, Mahende MK, Ogutu BR, Oduro A, Tinto H, Gyapong M, Sie A, Sevene E, Macete E, Owusu-Agyei S, Adjei A, Compaoré G, Valea I, Osei I, Yawson A, Adjuik M, Akparibo R, Kakolwa MA, Abdulla S, Binka F. Multi-Country Evaluation of Safety of Dihydroartemisinin/Piperaquine Post-Licensure in African Public Hospitals with Electrocardiograms. PLoS One 2016; 11:e0164851. [PMID: 27764178 PMCID: PMC5072600 DOI: 10.1371/journal.pone.0164851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/28/2016] [Indexed: 01/06/2023] Open
Abstract
The antimalarial drug piperaquine is associated with delayed ventricular depolarization, causing prolonged QT interval (time taken for ventricular de-polarisation and re-polarisation). There is a lack of safety data regarding dihydroartemisinin/piperaquine (DHA/PPQ) for the treatment of uncomplicated malaria, which has limited its use. We created a platform where electrocardiograms (ECG) were performed in public hospitals for the safety assessment of DHA/PPQ, at baseline before the use of dihydroartemisinin/piperaquine (Eurartesim®), and on day 3 (before and after administration of the final dose) and day 7 post-administration. Laboratory analyses included haematology and clinical chemistry. The main objective of the ECG assessment in this study was to evaluate the effect of administration of DHA/PPQ on QTc intervals and the association of QTc intervals with changes in blood biochemistry, full and differential blood count over time after the DHA/PPQ administration. A total of 1315 patients gave consent and were enrolled of which 1147 (87%) had complete information for analyses. Of the enrolled patients 488 (42%), 323 (28%), 213 (19%) and 123 (11%) were from Ghana, Burkina Faso, Tanzania and Mozambique, respectively. Median (lower—upper quartile) age was 8 (5–14) years and a quarter of the patients were children under five years of age (n = 287). Changes in blood biochemistry, full and differential blood count were temporal which remained within clinical thresholds and did not require any intervention. The mean QTcF values were significantly higher than on day 1 when measured on day 3 before and after administration of the treatment as well as on day 7, four days after completion of treatment (12, 22 and 4 higher, p < 0.001). In all age groups the values of QT, QTcF and QTcB were highest on day 3 after drug intake. The mean extreme QTcF prolongation from baseline was lowest on day 3 before drug intake (33 ms, SD = 19) and highest on day 3 after the last dose (60 ms, SD = 31). There were 79 (7%) events of extreme mean QTcF prolongation which were not clinically significant. Nearly a half of them (n = 37) were grade 3 and mainly among males (33/37). Patients in Burkina Faso, Mozambique and Tanzania had significantly lower mean QTcF than patients in Ghana by an average of 3, 4 and 11 ms, respectively. We found no evidence that Eurartesim® administered in therapeutic doses in patients with uncomplicated malaria and no predisposing cardiac conditions in Africa was associated with adverse clinically significant QTc prolongation.
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Affiliation(s)
| | | | - Ali M. Ali
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | | | | | | | - Ali Sie
- Nouna Health Research Centre, Nouna, Burkina Faso
| | - Esperanca Sevene
- Centro de Investigaçãoem Saúde de Manhiça(CISM), Manhiça, Mozambique
| | - Eusebio Macete
- Centro de Investigaçãoem Saúde de Manhiça(CISM), Manhiça, Mozambique
| | | | - Alex Adjei
- Dodowa Health Research Centre, Dodowa, Ghana
| | | | | | - Isaac Osei
- Navrongo Health Research Centre, Navrongo, Ghana
| | - Abena Yawson
- Kintampo Health Research Centre, Kintampo, Ghana
| | | | | | | | | | - Fred Binka
- University for Health and Allied Sciences, Ho, Ghana
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Suku CK, Hill G, Sabblah G, Darko M, Muthuri G, Abwao E, Pandit J, Osakwe AI, Elagbaje C, Nyambayo P, Khoza S, Dodoo AN, Pal SN. Experiences and Lessons From Implementing Cohort Event Monitoring Programmes for Antimalarials in Four African Countries: Results of a Questionnaire-Based Survey. Drug Saf 2016; 38:1115-26. [PMID: 26267842 PMCID: PMC4608977 DOI: 10.1007/s40264-015-0331-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction Cohort event monitoring (CEM) is an intensive method of post-marketing surveillance for medicines safety. The method is based on prescription event monitoring, which began in the 1970s, and has since been adapted by WHO for monitoring the safety of medicines used in Public Health Programmes. CEM aims to capture all adverse events that occur in a defined group of patients after starting treatment with a specific medicine during the course of routine clinical practice. Objective The aims of this study were to describe the experiences of National Pharmacovigilance Centres (NCs) that have used CEM to monitor artemisinin-based combination therapy (ACT) for uncomplicated malaria in the African setting, to raise awareness of some of the challenges encountered during implementation and to highlight aspects of the method that require further consideration. Method A questionnaire-based survey was conducted to capture the experiences of NCs that have implemented CEM for active post-marketing surveillance of antimalarial medicines in sub-Saharan Africa. Six NCs were identified as having implemented CEM programmes and were invited to participate in the survey; five NCs indicated willingness to participate and were sent the questionnaire to complete. Results Four NCs responded to the survey—Ghana, Kenya, Nigeria and Zimbabwe—providing information on the implementation of a total of six CEM programmes. Their experiences indicate that CEM has helped to build pharmacovigilance capacity within the participating NCs and at the monitoring sites, and that healthcare providers (HCPs) are generally willing to participate in implementing the CEM method. All of the programmes took longer than expected to complete: contributing factors included a prolonged enrolment period and unexpectedly slow data entry. All of the programmes exceeded their budget by 11.1–63.2 %. Data management was identified as a challenge for all participating NCs. Conclusions The reported experiences of four NCs that have undertaken CEM studies on ACTs indicate that CEM has helped to build pharmacovigilance capacity within NCs and monitoring sites and that HCPs are willing to participate in CEM programmes; however, the method was found to be labour intensive and data management was identified as a challenge. Reducing the workload associated with CEM, particularly in relation to data management, and integrating the method into the routine work of HCPs and NCs should be considered for future implementation. Electronic supplementary material The online version of this article (doi:10.1007/s40264-015-0331-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Comfort Kunak Suku
- National Pharmacovigilance Centre, National Agency for Food and Drug Administration and Control (NAFDAC), Abuja, FCT, Nigeria.
| | | | - George Sabblah
- National Pharmacovigilance Centre, Food and Drug Authority (FDA), Accra, Ghana
| | - Mimi Darko
- National Pharmacovigilance Centre, Food and Drug Authority (FDA), Accra, Ghana
| | - George Muthuri
- National Pharmacovigilance Centre, Pharmacy and Poison Board (PPB), Nairobi, Kenya
| | - Edward Abwao
- National Pharmacovigilance Centre, Pharmacy and Poison Board (PPB), Nairobi, Kenya
| | - Jayesh Pandit
- National Pharmacovigilance Centre, Pharmacy and Poison Board (PPB), Nairobi, Kenya.,Bayer HealthCare, Middle Africa Region, Nairobi, Kenya
| | - Adeline Ijeoma Osakwe
- National Pharmacovigilance Centre, National Agency for Food and Drug Administration and Control (NAFDAC), Abuja, FCT, Nigeria
| | - Cassandra Elagbaje
- National Pharmacovigilance Centre, National Agency for Food and Drug Administration and Control (NAFDAC), Abuja, FCT, Nigeria
| | - Priscilla Nyambayo
- National Pharmacovigilance Centre, Medicine Control Authority of Zimbabwe (MCAZ), Harare, Zimbabwe
| | - Star Khoza
- National Pharmacovigilance Centre, Medicine Control Authority of Zimbabwe (MCAZ), Harare, Zimbabwe.,Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Alexander N Dodoo
- WHO Collaborating Centre (WHO CC) for Advocacy and Training in Pharmacovigilance, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
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Adjei A, Narh-Bana S, Amu A, Kukula V, Nagai RA, Owusu-Agyei S, Oduro A, Macete E, Abdulla S, Halidou T, Sie A, Osei I, Sevene E, Asante KP, Mulokozi A, Compaore G, Valea I, Adjuik M, Baiden R, Ogutu B, Binka F, Gyapong M. Treatment outcomes in a safety observational study of dihydroartemisinin/piperaquine (Eurartesim(®)) in the treatment of uncomplicated malaria at public health facilities in four African countries. Malar J 2016; 15:43. [PMID: 26818128 PMCID: PMC4729128 DOI: 10.1186/s12936-016-1099-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 01/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Dihydroartemisinin-piperaquine (DHA-PQ) is one of five WHO recommended artemisinin combination therapy (ACT) for the treatment of uncomplicated malaria. However, little was known on its post-registration safety and effectiveness in sub-Saharan Africa. DHA-PQ provides a long post-treatment prophylactic effect against re-infection; however, new infections have been reported within a few weeks of treatment, especially in children. This paper reports the clinical outcomes following administration of DHQ-PQ in real-life conditions in public health facilities in Burkina Faso, Ghana, Mozambique, and Tanzania for the treatment of confirmed uncomplicated malaria. Methods An observational, non-comparative, longitudinal study was conducted on 10,591 patients with confirmed uncomplicated malaria visiting public health facilities within seven health and demographic surveillance system sites in four African countries (Ghana, Tanzania, Burkina Faso, Mozambique) between September 2013 and April 2014. Patients were treated with DHA-PQ based on body weight and followed up for 28 days to assess the clinical outcome. A nested cohort of 1002 was intensely followed up. Clinical outcome was assessed using the proportion of patients who reported signs and symptoms of malaria after completing 3 days of treatment. Results A total of 11,097 patients were screened with 11,017 enrolled, 94 were lost to follow-up, 332 withdrew and 10,591 (96.1 %) patients aged 6 months–85 years met protocol requirements for analysis. Females were 52.8 and 48.5 % were <5 years of age. Malaria was diagnosed by microscopy and rapid diagnostic test in 69.8 % and 29.9 %, respectively. At day 28, the unadjusted risk of recurrent symptomatic parasitaemia was 0.5 % (51/10,591). Most of the recurrent symptomatic malaria patients (76 %) were children <5 years. The mean haemoglobin level decreased from 10.6 g/dl on day 1 to 10.2 g/dl on day 7. There was no significant renal impairment in the nested cohort during the first 7 days of follow-up with minimal non-clinically significant changes noted in the liver enzymes. Conclusion DHA-PQ was effective and well tolerated in the treatment of uncomplicated malaria and provides an excellent alternative first-line ACT in sub-Saharan Africa.
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Affiliation(s)
| | | | - Alberta Amu
- Dodowa Health Research Centre, Dodowa, Ghana.
| | - Vida Kukula
- Dodowa Health Research Centre, Dodowa, Ghana.
| | | | | | | | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.
| | | | - Tinto Halidou
- Nanoro Health Research Centre, Nanoro, Burkina Faso.
| | - Ali Sie
- Nouna Health Research Centre, Nouna, Burkina Faso.
| | - Isaac Osei
- Navrongo Health Research Centre, Navrongo, Ghana.
| | - Esperance Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique.
| | | | | | | | | | | | | | | | - Fred Binka
- INDEPTH-Network, Accra, Ghana. .,University of Science and Allied Sciences, Ho, Ghana.
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Wiysonge CS, Wiysonge CS, Zani B, Mbacham W, Hodel EM, Terlouw DJ. Cochrane Column. Int J Epidemiol 2015; 44:1502-5. [PMID: 26320106 DOI: 10.1093/ije/dyv163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Charles S Wiysonge
- Centre for Evidence-based Health Care, Stellenbosch University, Stellenbosch, South Africa and Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa. E-mail:
| | - Charles S Wiysonge
- Centre for Evidence-based Health Care, Stellenbosch University, Stellenbosch, South Africa and Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa. E-mail:
| | | | | | - Eva Maria Hodel
- Centre for Evidence-based Health Care, Stellenbosch University, Stellenbosch, South Africa and
| | - Dianne J Terlouw
- Liverpool School of Tropical Medicine, Liverpool, UK and Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi
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