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Brito M, Rufatto R, Brito-Sousa JD, Murta F, Sampaio V, Balieiro P, Baía-Silva D, Castro V, Alves B, Alencar A, Duparc S, Grewal Daumerie P, Borghini-Fuhrer I, Jambert E, Peterka C, Edilson Lima F, Carvalho Maia L, Lucena Cruz C, Maciele B, Vasconcelos M, Machado M, Augusto Figueira E, Alcirley Balieiro A, Batista Pereira D, Lacerda M. Operational effectiveness of tafenoquine and primaquine for the prevention of Plasmodium vivax recurrence in Brazil: a retrospective observational study. Lancet Infect Dis 2024; 24:629-638. [PMID: 38452779 PMCID: PMC7615970 DOI: 10.1016/s1473-3099(24)00074-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/15/2024] [Accepted: 01/25/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Prevention of Plasmodium vivax malaria recurrence is essential for malaria elimination in Brazil. We evaluated the real-world effectiveness of an updated treatment algorithm for P vivax radical cure in the Brazilian Amazon. METHODS In this non-interventional observational study, we used retrospective data from the implementation of a P vivax treatment algorithm at 43 health facilities in Manaus and Porto Velho, Brazil. The treatment algorithm consisted of chloroquine (25 mg/kg over 3 days) and point-of-care quantitative glucose-6-phosphate dehydrogenase (G6PD) testing followed by single-dose tafenoquine 300 mg (G6PD normal, aged ≥16 years, not pregnant and not breastfeeding), 7-day primaquine 0·5 mg/kg per day (G6PD intermediate or normal, aged ≥6 months, not pregnant, and not breastfeeding or breastfeeding for >1 month), or primaquine 0·75 mg/kg per week for 8 weeks (G6PD deficient, aged ≥6 months, not pregnant, and not breastfeeding or breastfeeding for >1 month). P vivax recurrences were identified from probabilistic linkage of routine patient records from the Brazilian malaria epidemiological surveillance system. Recurrence-free effectiveness at day 90 and day 180 was estimated using Kaplan-Meier analysis and hazard ratios (HRs) by multivariate analysis. This clinical trial is registered with ClinicalTrials.gov, NCT05096702, and is completed. FINDINGS Records from Sept 9, 2021, to Aug 31, 2022, included 5554 patients with P vivax malaria. In all treated patients of any age and any G6PD status, recurrence-free effectiveness at day 180 was 75·8% (95% CI 74·0-77·6) with tafenoquine, 73·4% (71·9-75·0) with 7-day primaquine, and 82·1% (77·7-86·8) with weekly primaquine. In patients aged at least 16 years who were G6PD normal, recurrence-free effectiveness until day 90 was 88·6% (95% CI 87·2-89·9) in those who were treated with tafenoquine (n=2134) and 83·5% (79·8-87·4) in those treated with 7-day primaquine (n=370); after adjustment for confounding factors, the HR for recurrence following tafenoquine versus 7-day primaquine was 0·65 (95% CI 0·49-0·86; p=0·0031), with similar outcomes between the two treatments at day 180 (log-rank p=0·82). Over 180 days, median time to recurrence in patients aged at least 16 years who were G6PD normal was 92 days (IQR 76-120) in those treated with tafenoquine and 68 days (52-94) in those treated with 7-day primaquine. INTERPRETATION In this real-world setting, single-dose tafenoquine was more effective at preventing P vivax recurrence in patients aged at least 16 years who were G6PD normal compared with 7-day primaquine at day 90, while overall efficacy at 180 days was similar. The public health benefits of the P vivax radical cure treatment algorithm incorporating G6PD quantitative testing and tafenoquine support its implementation in Brazil and potentially across South America. FUNDING Brazilian Ministry of Health, Municipal and State Health Secretariats; Fiocruz; Medicines for Malaria Venture; Bill & Melinda Gates Foundation; Newcrest Mining; and the UK Government. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Marcelo Brito
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Rosilene Rufatto
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | | | - Felipe Murta
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Vanderson Sampaio
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Patrícia Balieiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Djane Baía-Silva
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | | | - Brenda Alves
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Aline Alencar
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | | | | | | | | | | | | | | | | | - Bruna Maciele
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | | | | | | | | | | | - Marcus Lacerda
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil; University of Texas Medical Branch, Galveston, TX, USA.
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Sharma R, Sharma H, Jones S, Borghini-Fuhrer I, Domingo GJ, Gibson RA, Rolfe K, Tan L, Fiţa IG, Chen C, Bird P, Pingle A, Duparc S. Optimal balance of benefit versus risk for tafenoquine in the treatment of Plasmodium vivax malaria. Malar J 2024; 23:145. [PMID: 38741094 DOI: 10.1186/s12936-024-04924-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/29/2024] [Indexed: 05/16/2024] Open
Abstract
A single 300 mg dose of tafenoquine (an 8-aminoquinoline), in combination with a standard 3-day course of chloroquine, is approved in several countries for the radical cure (prevention of relapse) of Plasmodium vivax malaria in patients aged ≥ 16 years. Despite this, questions have arisen on the optimal dose of tafenoquine. Before the availability of tafenoquine, a 3-day course of chloroquine in combination with the 8-aminoquinoline primaquine was the only effective radical cure for vivax malaria. The World Health Organization (WHO)-recommended standard regimen is 14 days of primaquine 0.25 mg/kg/day or 7 days of primaquine 0.5 mg/kg/day in most regions, or 14 days of primaquine 0.5 mg/kg/day in East Asia and Oceania, however the long treatment courses of 7 or 14 days may result in poor adherence and, therefore, low treatment efficacy. A single dose of tafenoquine 300 mg in combination with a 3-day course of chloroquine is an important advancement for the radical cure of vivax malaria in patients without glucose-6-phosphate dehydrogenase (G6PD) deficiency, as the use of a single-dose treatment will improve adherence. Selection of a single 300 mg dose of tafenoquine for the radical cure of P. vivax malaria was based on collective efficacy and safety data from 33 studies involving more than 4000 trial participants who received tafenoquine, including over 800 subjects who received the 300 mg single dose. The safety profile of single-dose tafenoquine 300 mg is similar to that of standard-dosage primaquine 0.25 mg/kg/day for 14 days. Both primaquine and tafenoquine can cause acute haemolytic anaemia in individuals with G6PD deficiency; severe haemolysis can lead to anaemia, kidney damage, and, in some cases, death. Therefore, relapse prevention using an 8-aminoquinoline must be balanced with the need to avoid clinical haemolysis associated with G6PD deficiency. To minimize this risk, the WHO recommends G6PD testing for all individuals before the administration of curative doses of 8-aminoquinolines. In this article, the authors review key efficacy and safety data from the pivotal trials of tafenoquine and argue that the currently approved dose represents a favourable benefit-risk profile.
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Affiliation(s)
- Raman Sharma
- Global Health Medicines R&D, GSK Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
| | | | | | | | | | - Rachel A Gibson
- Global Health Medicines R&D, GSK Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK.
| | - Katie Rolfe
- Global Health Medicines R&D, GSK Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
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Brito M, Rufatto R, Murta F, Sampaio V, Balieiro P, Baía-Silva D, Castro V, Alves B, Alencar A, Duparc S, Grewal Daumerie P, Borghini-Fuhrer I, Jambert E, Peterka C, Edilson Lima F, Carvalho Maia L, Lucena Cruz C, Maciele B, Vasconcelos M, Machado M, Augusto Figueira E, Alcirley Balieiro A, Menezes A, Ataídes R, Batista Pereira D, Lacerda M. Operational feasibility of Plasmodium vivax radical cure with tafenoquine or primaquine following point-of-care, quantitative glucose-6-phosphate dehydrogenase testing in the Brazilian Amazon: a real-life retrospective analysis. Lancet Glob Health 2024; 12:e467-e477. [PMID: 38365417 PMCID: PMC10882209 DOI: 10.1016/s2214-109x(23)00542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND To achieve malaria elimination, Brazil must implement Plasmodium vivax radical cure. We aimed to investigate the operational feasibility of point-of-care, quantitative, glucose-6-phosphate dehydrogenase (G6PD) testing followed by chloroquine plus tafenoquine or primaquine. METHODS This non-interventional, observational study was done at 43 health facilities in Manaus (Amazonas State) and Porto Velho (Rondônia State), Brazil, implementing a new P vivax treatment algorithm incorporating point-of-care quantitative G6PD testing to identify G6PD status and single-dose tafenoquine (G6PD normal, aged ≥16 years, and not pregnant or breastfeeding) or primaquine (intermediate or normal G6PD, aged ≥6 months, not pregnant, or breastfeeding >1 month). Following training of health-care providers, we collated routine patient records from the malaria epidemiological surveillance system (SIVEP-Malaria) retrospectively for all consenting patients aged at least 6 months with parasitologically confirmed P vivax malaria mono-infection or P vivax plus P falciparum mixed infection, presenting between Sept 9, 2021, and Aug 31, 2022. The primary endpoint was the proportion of patients aged at least 16 years with P vivax mono-infection treated or not treated appropriately with tafenoquine in accordance with their G6PD status. The trial is registered with ClinicalTrials.gov, NCT05096702, and is completed. FINDINGS Of 6075 patients enrolled, 6026 (99·2%) had P vivax mono-infection, 2685 (44·6%) of whom were administered tafenoquine. G6PD status was identified in 2685 (100%) of 2685 patients treated with tafenoquine. The proportion of patients aged at least 16 years with P vivax mono-infection who were treated or not treated appropriately with tafenoquine in accordance with their G6PD status was 99·7% (95% CI 99·4-99·8; 4664/4680). INTERPRETATION Quantitative G6PD testing before tafenoquine administration was operationally feasible, with high adherence to the treatment algorithm, supporting deployment throughout the Brazilian health system. FUNDING Brazilian Ministry of Health, Municipal and State Health Secretariats; Fiocruz; Medicines for Malaria Venture; Bill & Melinda Gates Foundation; Newcrest Mining; and the UK Government. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Marcelo Brito
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Rosilene Rufatto
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | - Felipe Murta
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Vanderson Sampaio
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Patrícia Balieiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Djane Baía-Silva
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Universidade do Estado do Amazonas, Manaus, Brazil; Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil; Universidade Nilton Lins, Manaus, Brazil
| | | | - Brenda Alves
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Aline Alencar
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | | | | | | | | | | | | | | | | | - Bruna Maciele
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | | | | | | | | | | | | | | | - Marcus Lacerda
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil; University of Texas Medical Branch, Galveston, TX, USA.
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Ramharter M, Djimde AA, Borghini-Fuhrer I, Miller R, Shin J, Aspinall A, Richardson N, Wibberg M, Fleckenstein L, Arbe-Barnes S, Duparc S. Safety and efficacy of pyronaridine-artesunate paediatric granules in the treatment of uncomplicated malaria in children: insights from randomized clinical trials and a real-world study. Malar J 2024; 23:61. [PMID: 38418982 PMCID: PMC10902982 DOI: 10.1186/s12936-024-04885-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Children are particularly at risk of malaria. This analysis consolidates the clinical data for pyronaridine-artesunate (PA) paediatric granules in children from three randomized clinical trials and a real-world study (CANTAM). METHODS An integrated safety analysis of individual patient data from three randomized clinical trials included patients with microscopically-confirmed Plasmodium falciparum, body weight ≥ 5 kg to < 20 kg, who received at least one dose of study drug (paediatric safety population). PA was administered once daily for 3 days; two trials included the comparator artemether-lumefantrine (AL). PCR-adjusted day 28 adequate clinical and parasitological response (ACPR) was evaluated. Real-world PA granules safety and effectiveness was also considered. RESULTS In the integrated safety analysis, 63.9% (95% CI 60.2, 67.4; 426/667) of patients had adverse events following PA and 62.0% (95% CI 56.9, 66.9; 222/358) with AL. Vomiting was more common with PA (7.8% [95% CI 6.0, 10.1; 52/667]) than AL (3.4% [95% CI 1.9, 5.8; 12/358]), relative risk 2.3 (95% CI 1.3, 4.3; P = 0.004), occurring mainly following the first PA dose (6.7%, 45/667), without affecting re-dosing or adherence. Prolonged QT interval occurred less frequently with PA (3.1% [95% CI 2.1, 4.8; 21/667]) than AL (8.1% [95% CI 5.7, 11.4; 29/358]), relative risk 0.39 (95% CI 0.22, 0.67; P = 0.0007). In CANTAM, adverse events were reported for 17.7% (95% CI 16.3, 19.2; 460/2599) of patients, most commonly vomiting (5.4% [95% CI 4.6, 6.4; 141/2599]), mainly following the first dose, (4.5% [117/2599]), with all patients successfully re-dosed, and pyrexia (5.4% [95% CI 4.6, 6.3; 140/2599]). In the two comparative clinical trials, Day 28 ACPR in the per-protocol population for PA was 97.1% (95% CI 94.6, 98.6; 329/339) and 100% (95% CI 99.3, 100; 514/514) versus 98.8% (95% CI 95.7, 99.9; 165/167) and 98.4% (95% CI 95.5, 99.7; 188/191) for AL, respectively. In CANTAM, PA clinical effectiveness was 98.0% (95% CI 97.3, 98.5; 2273/2320). CONCLUSIONS Anti-malarial treatment with PA paediatric granules administered once daily for 3 days was well tolerated in children and displayed good clinical efficacy in clinical trials, with effectiveness confirmed in a real-world study. Trial registration Clinicaltrials.gov: SP-C-003-05: identifier NCT00331136; SP-C-007-07: identifier NCT0541385; SP-C-021-15: identifier NCT03201770. Pan African Clinical Trials Registry: SP-C-013-11: identifier PACTR201105000286876.
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Affiliation(s)
- Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Abdoulaye A Djimde
- Malaria Research and Training Center (MRTC), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), Bamako, Mali
| | | | | | | | - Adam Aspinall
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Geneva 15, Switzerland
| | | | | | - Lawrence Fleckenstein
- Department of Pharmaceutical Sciences and Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, USA
| | | | - Stephan Duparc
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Geneva 15, Switzerland.
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Groger M, Lutete GT, Assi SB, Bigoga JD, Ntamabyaliro NY, Arbe-Barnes S, Shin J, Adegnika AA, Ntoumi F, Kremsner PG, Ramharter M, Duparc S, Borghini-Fuhrer I, Mombo-Ngoma G. Community health workers in clinical research at the example of a phase IIIb/ IV antimalarial drug trial conducted in five African countries. Int J Infect Dis 2023; 137:114-117. [PMID: 37871675 PMCID: PMC10689247 DOI: 10.1016/j.ijid.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023] Open
Abstract
Global health, particularly in underserved settings can benefit immensely from well-trained community health workers (CHWs) supporting primary healthcare interventions. They can reduce morbidity and mortality of infectious diseases like malaria. Disease control programs can particularly benefit from a tight link between CHWs and communities and several studies have shown the benefit of the participation of non-facility-based CHWs in malaria control program activities for reducing malaria-related mortality in children. Because CHWs are often part of and trusted by served communities, they can also be an important resource to address challenges faced by their communities. Where post-marketing surveillance systems are underserved, they can relay important information about suspected safety signals and factors affecting therapeutic effectiveness in their communities. The CANTAM-Pyramax® trial was a phase IIIb/ IV cohort event monitoring study conducted at six centers in five African countries. To assess real-world effectiveness and safety of the anti-malarial pyronaridine-artesunate in 8560 malaria episodes, follow-up was not primarily conducted by medical staff but by specifically trained CHWs. This perspective paper discusses how the participation of a CHW workforce can be of benefit for effectiveness trials in limited-resource settings, using the example of the CANTAM-Pyramax trial.
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Affiliation(s)
- Mirjam Groger
- Institut für Tropenmedizin, University of Tübingen, Tübingen, Germany; Center of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gaston Tona Lutete
- Unité de Pharmacologie Clinique et Pharmacovigilance (UPC-PV), University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Serge-Brice Assi
- Institut Pierre Richet/Institut National de Santé Publique (IPR/INSP), Bouaké, Côte d'Ivoire
| | - Jude D Bigoga
- The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Nsengi Y Ntamabyaliro
- Unité de Pharmacologie Clinique et Pharmacovigilance (UPC-PV), University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | - Jangsik Shin
- Shin Poong Pharmaceutical, Seoul, Republic of Korea
| | - Ayola A Adegnika
- Institut für Tropenmedizin, University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; German Center for Infection Research (DZIF), Tübingen, Germany
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale (FCRM), WHO-AFRO Campus Djoué, Brazzaville, Hospital of Talangai (North) of Brazzaville, Republic of Congo
| | - Peter G Kremsner
- Institut für Tropenmedizin, University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; German Center for Infection Research (DZIF), Tübingen, Germany
| | - Michael Ramharter
- Institut für Tropenmedizin, University of Tübingen, Tübingen, Germany; Center of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Ghyslain Mombo-Ngoma
- Institut für Tropenmedizin, University of Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine and I. Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Sutanto I, Soebandrio A, Ekawati LL, Chand K, Noviyanti R, Satyagraha AW, Subekti D, Santy YW, Crenna-Darusallam C, Instiaty I, Budiman W, Prasetya CB, Lardo S, Elyazar I, Duparc S, Cedar E, Rolfe K, Fernando D, Berni A, Jones S, Kleim JP, Fletcher K, Sharma H, Martin A, Taylor M, Goyal N, Green JA, Tan LK, Baird JK. Tafenoquine co-administered with dihydroartemisinin-piperaquine for the radical cure of Plasmodium vivax malaria (INSPECTOR): a randomised, placebo-controlled, efficacy and safety study. Lancet Infect Dis 2023; 23:1153-1163. [PMID: 37236221 PMCID: PMC10533414 DOI: 10.1016/s1473-3099(23)00213-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Tafenoquine, co-administered with chloroquine, is approved for the radical cure (prevention of relapse) of Plasmodium vivax malaria. In areas of chloroquine resistance, artemisinin-based combination therapies are used to treat malaria. This study aimed to evaluate tafenoquine plus the artemisinin-based combination therapy dihydroartemisinin-piperaquine for the radical cure of P vivax malaria. METHODS In this double-blind, double-dummy, parallel group study, glucose-6-phosphate dehydrogenase-normal Indonesian soldiers with microscopically confirmed P vivax malaria were randomly assigned by means of a computer-generated randomisation schedule (1:1:1) to dihydroartemisinin-piperaquine alone, dihydroartemisinin-piperaquine plus a masked single 300-mg dose of tafenoquine, or dihydroartemisinin-piperaquine plus 14 days of primaquine (15 mg). The primary endpoint was 6-month relapse-free efficacy following tafenoquine plus dihydroartemisinin-piperaquine versus dihydroartemisinin-piperaquine alone in all randomly assigned patients who received at least one dose of masked treatment and had microscopically confirmed P vivax at baseline (microbiological intention-to-treat population). Safety was a secondary outcome and the safety population comprised all patients who received at least one dose of masked medication. This study is registered with ClinicalTrials.gov, NCT02802501 and is completed. FINDINGS Between April 8, 2018, and Feb 4, 2019, of 164 patients screened for eligibility, 150 were randomly assigned (50 per treatment group). 6-month Kaplan-Meier relapse-free efficacy (microbiological intention to treat) was 11% (95% CI 4-22) in patients treated with dihydroartemisinin-piperaquine alone versus 21% (11-34) in patients treated with tafenoquine plus dihydroartemisinin-piperaquine (hazard ratio 0·44; 95% CI [0·29-0·69]) and 52% (37-65) in the primaquine plus dihydroartemisinin-piperaquine group. Adverse events over the first 28 days were reported in 27 (54%) of 50 patients treated with dihydroartemisinin-piperaquine alone, 29 (58%) of 50 patients treated with tafenoquine plus dihydroartemisinin-piperaquine, and 22 (44%) of 50 patients treated with primaquine plus dihydroartemisinin-piperaquine. Serious adverse events were reported in one (2%) of 50, two (4%) of 50, and two (4%) of 50 of patients, respectively. INTERPRETATION Although tafenoquine plus dihydroartemisinin-piperaquine was statistically superior to dihydroartemisinin-piperaquine alone for the radical cure of P vivax malaria, the benefit was not clinically meaningful. This contrasts with previous studies in which tafenoquine plus chloroquine was clinically superior to chloroquine alone for radical cure of P vivax malaria. FUNDING ExxonMobil, Bill & Melinda Gates Foundation, Newcrest Mining, UK Government all through Medicines for Malaria Venture; and GSK. TRANSLATION For the Indonesian translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Inge Sutanto
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | | | - Lenny L Ekawati
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | - Krisin Chand
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | | | | | - Decy Subekti
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | - Yulia Widya Santy
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | - Chelzie Crenna-Darusallam
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Mochtar Riady Institute for Nanotechnology, Banten, Indonesia
| | | | - Waras Budiman
- Health Service, Army of the Republic of Indonesia, Jakarta, Indonesia
| | | | - Soroy Lardo
- Health Service, Army of the Republic of Indonesia, Jakarta, Indonesia
| | - Iqbal Elyazar
- University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - J Kevin Baird
- Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; University of Oxford Clinical Research Unit-Indonesia, Jakarta, Indonesia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Bachhav SS, Taylor M, Martin A, Green JA, Duparc S, Rolfe K, Sharma H, Tan LK, Goyal N. A pharmacometrics approach to assess the feasibility of capillary microsampling to replace venous sampling in clinical studies: Tafenoquine case study. Br J Clin Pharmacol 2023; 89:1187-1197. [PMID: 36199201 DOI: 10.1111/bcp.15554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/26/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022] Open
Abstract
AIM Microsampling has the advantage of smaller blood sampling volume and suitability in vulnerable populations compared to venous sampling in clinical pharmacokinetics studies. Current regulatory guidance requires correlative studies to enable microsampling as a technique. A post hoc population pharmacokinetic (POPPK) approach was utilized to investigate blood capillary microsampling as an alternative to venous sampling. METHODS Pharmacokinetic data from microsampling and venous sampling techniques during a paediatric study evaluating tafenoquine, a single-dose antimalarial for P. vivax, were used. Separate POPPK models were developed and validated based on goodness of fit and visual predictive checks, with pharmacokinetic data obtained via each sampling technique. RESULTS Each POPPK model adequately described tafenoquine pharmacokinetics using a two-compartment model with body weight based on allometric scaling of clearance and volume of distribution. Tafenoquine pharmacokinetic parameter estimates including clearance (3.4 vs 3.7 L/h) were comparable across models with slightly higher interindividual variability (38.3% vs 27%) in capillary microsampling-based data. A bioavailability/bioequivalence comparison demonstrated that the point estimate (90% CI) of capillary microsample versus venous sample model-based individual post hoc estimates for area under the concentration-time curve from time zero to infinity (AUC0-inf ) (100.7%, 98.0-103.5%) and Cmax (79.7%, 76.9-82.5%) met the 80-125% and 70-143% criteria, respectively. Overall, both POPPK models led to the same dose regimen recommendations across weight bins based on achieving target AUC. CONCLUSIONS This analysis demonstrated that a POPPK approach can be employed to assess the performance of alternative pharmacokinetic sampling techniques. This approach provides a robust solution in scenarios where variability in pharmacokinetic data collected via venous sampling and microsampling may not result in a strong linear relationship. The findings also established that microsampling techniques may replace conventional venous sampling methods.
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Affiliation(s)
- Sagar S Bachhav
- Clinical Pharmacology Modeling and Simulation, GSK, Collegeville, PA, USA
| | - Maxine Taylor
- Drug Metabolism and Pharmacokinetics, In Vitro/In Vivo Translation, R&D GSK, Ware, Herts, UK
| | | | | | | | | | | | | | - Navin Goyal
- Clinical Pharmacology Modeling and Simulation, GSK, Collegeville, PA, USA
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8
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Gansane A, Lingani M, Yeka A, Nahum A, Bouyou-Akotet M, Mombo-Ngoma G, Kaguthi G, Barceló C, Laurijssens B, Cantalloube C, Macintyre F, Djeriou E, Jessel A, Bejuit R, Demarest H, Marrast AC, Debe S, Tinto H, Kibuuka A, Nahum D, Mawili-Mboumba DP, Zoleko-Manego R, Mugenya I, Olewe F, Duparc S, Ogutu B. Randomized, open-label, phase 2a study to evaluate the contribution of artefenomel to the clinical and parasiticidal activity of artefenomel plus ferroquine in African patients with uncomplicated Plasmodium falciparum malaria. Malar J 2023; 22:2. [PMID: 36597076 PMCID: PMC9809015 DOI: 10.1186/s12936-022-04420-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/16/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The contribution of artefenomel to the clinical and parasiticidal activity of ferroquine and artefenomel in combination in uncomplicated Plasmodium falciparum malaria was investigated. METHODS This Phase 2a, randomized, open-label, parallel-group study was conducted from 11th September 2018 to 6th November 2019 across seven centres in Benin, Burkina Faso, Gabon, Kenya, and Uganda. Patients aged ≥ 14-69 years with microscopically confirmed infection (≥ 3000 to ≤ 50,000 parasites/µL blood) were randomized 1:1:1:1 to 400 mg ferroquine, or 400 mg ferroquine plus artefenomel 300, 600, or 1000 mg, administered as a single oral dose. The primary efficacy analysis was a logistic regression evaluating the contribution of artefenomel exposure to Day 28 PCR-adjusted adequate clinical and parasitological response (ACPR). Safety was also evaluated. RESULTS The randomized population included 140 patients. For the primary analysis in the pharmacokinetic/pharmacodynamic efficacy population (N = 121), the contribution of artefenomel AUC0-∞ to Day 28 PCR-adjusted ACPR was not demonstrated when accounting for ferroquine AUC0-d28, baseline parasitaemia, and other model covariates: odds ratio 1.1 (95% CI 0.98, 1.2; P = 0.245). In the per-protocol population, Day 28 PCR-adjusted ACPR was 80.8% (21/26; 95% CI 60.6, 93.4) with ferroquine alone and 90.3% (28/31; 95% CI 74.2, 98.0), 90.9% (30/33; 95% CI 75.7, 98.1) and 87.1% (27/31; 95% CI 70.2, 96.4) with 300, 600, and 1000 mg artefenomel, respectively. Median time to parasite clearance (Kaplan-Meier) was 56.1 h with ferroquine, more rapid with artefenomel, but similar for all doses (30.0 h). There were no deaths. Adverse events (AEs) of any cause occurred in 51.4% (18/35) of patients with ferroquine 400 mg alone, and 58.3% (21/36), 66.7% (24/36), and 72.7% (24/33) with 300, 600, and 1000 mg artefenomel, respectively. All AEs were of mild-to-moderate severity, and consistent with the known profiles of the compounds. Vomiting was the most reported AE. There were no cases of QTcF prolongation ≥ 500 ms or > 60 ms from baseline. CONCLUSION The contribution of artefenomel exposure to the clinical and parasitological activity of ferroquine/artefenomel could not be demonstrated in this study. Parasite clearance was faster with ferroquine/artefenomel versus ferroquine alone. All treatments were well tolerated. TRIAL REGISTRATION ClinicalTrials.gov, NCT03660839 (7 September, 2018).
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Affiliation(s)
- Adama Gansane
- grid.507461.10000 0004 0413 3193Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 220801 BP 2208 Ouagadougou, Burkina Faso
| | - Moussa Lingani
- grid.457337.10000 0004 0564 0509Institut de Recherche en Science de la Santé - Unité de Recherche Clinique de Nanoro (IRSS-URCN), Ouagadougou, Burkina Faso
| | - Adoke Yeka
- grid.463352.50000 0004 8340 3103Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Alain Nahum
- Centre de Recherches Entomologique de Cotonou (CREC), Cotonou, Benin
| | - Marielle Bouyou-Akotet
- grid.502965.dDépartement de Parasitologie-Mycologie-Médecine Tropicale, Faculté de Médecine – Université des Sciences de la Santé, Libreville, Gabon
| | - Ghyslain Mombo-Ngoma
- grid.452268.fCentre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon ,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, and University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,grid.10392.390000 0001 2190 1447Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Grace Kaguthi
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute-Centre for Respiratory Diseases Research (KEMRI-CRDR), Nairobi, Kenya
| | - Catalina Barceló
- grid.452605.00000 0004 0432 5267Medicines for Malaria Venture, Geneva, Switzerland
| | | | | | - Fiona Macintyre
- grid.452605.00000 0004 0432 5267Medicines for Malaria Venture, Geneva, Switzerland
| | | | | | | | - Helen Demarest
- grid.452605.00000 0004 0432 5267Medicines for Malaria Venture, Geneva, Switzerland
| | - Anne Claire Marrast
- grid.452605.00000 0004 0432 5267Medicines for Malaria Venture, Geneva, Switzerland
| | - Siaka Debe
- grid.507461.10000 0004 0413 3193Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 220801 BP 2208 Ouagadougou, Burkina Faso
| | - Halidou Tinto
- grid.457337.10000 0004 0564 0509Institut de Recherche en Science de la Santé - Unité de Recherche Clinique de Nanoro (IRSS-URCN), Ouagadougou, Burkina Faso
| | - Afizi Kibuuka
- grid.463352.50000 0004 8340 3103Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Diolinda Nahum
- Centre de Recherches Entomologique de Cotonou (CREC), Cotonou, Benin
| | - Denise Patricia Mawili-Mboumba
- grid.502965.dDépartement de Parasitologie-Mycologie-Médecine Tropicale, Faculté de Médecine – Université des Sciences de la Santé, Libreville, Gabon
| | - Rella Zoleko-Manego
- grid.452268.fCentre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon ,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, and University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,grid.10392.390000 0001 2190 1447Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Irene Mugenya
- grid.33058.3d0000 0001 0155 5938Kenya Medical Research Institute-Centre for Respiratory Diseases Research (KEMRI-CRDR), Nairobi, Kenya
| | - Frederick Olewe
- grid.33058.3d0000 0001 0155 5938Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya ,grid.442494.b0000 0000 9430 1509Centre for Research in Therapeutic Sciences (CREATES), Strathmore University, Nairobi, Kenya
| | - Stephan Duparc
- grid.452605.00000 0004 0432 5267Medicines for Malaria Venture, Geneva, Switzerland
| | - Bernhards Ogutu
- grid.33058.3d0000 0001 0155 5938Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya ,grid.442494.b0000 0000 9430 1509Centre for Research in Therapeutic Sciences (CREATES), Strathmore University, Nairobi, Kenya
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9
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Drysdale M, Tan L, Martin A, Fuhrer IB, Duparc S, Sharma H. Plasmodium vivax in Children: Hidden Burden and Conspicuous Challenges, a Narrative Review. Infect Dis Ther 2023; 12:33-51. [PMID: 36378465 PMCID: PMC9868225 DOI: 10.1007/s40121-022-00713-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
There has been progress towards decreasing malaria prevalence globally; however, Plasmodium vivax has been less responsive to elimination efforts compared with Plasmodium falciparum. P. vivax malaria remains a serious public health concern in regions where it is the dominant species (South and South-East Asia, the Eastern Mediterranean region, and South America) and is increasingly recognized for its contribution to overall morbidity and mortality worldwide. The incidence of P. vivax decreases with increasing age owing to rapidly acquired clinical immunity and there is a disproportionate burden of P. vivax in infants and children, who remain highly vulnerable to severe disease, recurrence, and anemia with associated developmental impacts. Diagnosis is sometimes difficult owing to the sensitivity of diagnostic tests to detect low levels of parasitemia. Additionally, the propensity of P. vivax to relapse following reactivation of dormant hypnozoites in the liver contributes to disease recurrence in infants and children, and potentiates morbidity and transmission. The 8-aminoquinolines, primaquine and tafenoquine, provide radical cure (relapse prevention). However, the risk of hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency necessitates testing prior to administration of 8-aminoquinolines, which has limited their uptake. Additional challenges include lack of availability of pediatric dose formulations and problems with adherence to primaquine owing to the length of treatment recommended. A paucity of data and studies specific to pediatric P. vivax malaria impacts the ability to deliver targeted interventions. It is imperative that P. vivax in infants and children be the focus of future research, control initiatives, and anti-malarial drug development.
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Affiliation(s)
| | - Lionel Tan
- GSK, 980 Great West Road, Brentford, TW8 9GS Middlesex UK
| | - Ana Martin
- GSK, 980 Great West Road, Brentford, TW8 9GS Middlesex UK
| | | | | | - Hema Sharma
- GSK, 980 Great West Road, Brentford, TW8 9GS Middlesex UK
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10
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Mohammed R, Asres MS, Gudina EK, Adissu W, Johnstone H, Marrast AC, Donini C, Duparc S, Yilma D. Efficacy, Safety, Tolerability, and Pharmacokinetics of MMV390048 in Acute Uncomplicated Malaria. Am J Trop Med Hyg 2023; 108:81-84. [PMID: 36509063 PMCID: PMC9833083 DOI: 10.4269/ajtmh.22-0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/29/2022] [Indexed: 12/12/2022] Open
Abstract
An open label, phase IIa study conducted in Ethiopia evaluated the efficacy, safety, tolerability, and pharmacokinetics of a single 120-mg dose of the phosphatidylinositol 4-kinase inhibitor MMV390048 in Plasmodium vivax malaria. The study was not completed for operational reasons and emerging teratotoxicity data. For the eight adult male patients enrolled, adequate clinical and parasitological response at day 14 (primary endpoint) was 100% (8/8). Asexual parasites and gametocytes were cleared in all patients by 66 and 78 hours postdose, respectively. There were two recurrent P. vivax infections (days 20 and 28) and a new Plasmodium falciparum infection (day 22). MMV390048 exposure in P. vivax patients was lower than previously observed for healthy volunteers. Mild adverse events, mainly headache and gastrointestinal symptoms, were reported by eight patients. Single-dose MMV390048 (120 mg) rapidly cleared asexual parasites and gametocytes in patients with P. vivax malaria and was well tolerated.
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Affiliation(s)
- Rezika Mohammed
- Department of Internal Medicine, University of Gondar Hospital, Gondar, Ethiopia
| | | | - Esayas Kebede Gudina
- Jimma University Clinical Trial Unit, Jimma University Institute of Health, Jimma, Ethiopia;,Department of Internal Medicine, Jimma University Institute of Health, Jimma, Ethiopia
| | - Wondimagegn Adissu
- Jimma University Clinical Trial Unit, Jimma University Institute of Health, Jimma, Ethiopia;,School of Medical Laboratory Sciences, Jimma University Institute of Health, Jimma, Ethiopia
| | | | | | | | - Stephan Duparc
- Medicines for Malaria Venture, Geneva, Switzerland,Address correspondence to Stephan Duparc, Medicines for Malaria Venture, 20 Route de Pré-Bois, 1215 Geneva 15, Switzerland. E-mail:
| | - Daniel Yilma
- Jimma University Clinical Trial Unit, Jimma University Institute of Health, Jimma, Ethiopia;,Department of Internal Medicine, Jimma University Institute of Health, Jimma, Ethiopia
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11
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Chandiwana N, Kruger C, Johnstone H, Chughlay MF, Ju C, Kim B, Dineka Y, Arbe-Barnes S, Miller R, Owen A, Hill A, Windgassen D, Abla N, Marrast AC, Duparc S, Francois Venter WD. Safety and efficacy of four drug regimens versus standard-of-care for the treatment of symptomatic outpatients with COVID-19: A randomised, open-label, multi-arm, phase 2 clinical trial. EBioMedicine 2022; 86:104322. [PMID: 36332361 PMCID: PMC9624152 DOI: 10.1016/j.ebiom.2022.104322] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/09/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background This exploratory study investigated four repurposed anti-infective drug regimens in outpatients with COVID-19. Methods This phase 2, single centre, randomised, open-label, clinical trial was conducted in South Africa between 3rd September 2020 and 23rd August 2021. Symptomatic outpatients aged 18–65 years, with RT-PCR confirmed SARS-CoV-2 infection were computer randomised (1:1:1:1:1) to standard-of-care (SOC) with paracetamol, or SOC plus artesunate-amodiaquine (ASAQ), pyronaridine-artesunate (PA), favipiravir plus nitazoxanide (FPV + NTZ), or sofosbuvir-daclatasvir (SOF-DCV). The primary endpoint was the incidence of viral clearance, i.e., the proportion of patients with a negative SARS-CoV-2 RT-PCR on day 7, compared to SOC using a log-binomial model in the modified intention-to-treat (mITT) population. Findings The mITT population included 186 patients: mean age (SD) 34.9 (10.3) years, body weight 78.2 (17.1) kg. Day 7 SARS-CoV-2 clearance rates (n/N; risk ratio [95% CI]) were: SOC 34.2% (13/38), ASAQ 38.5% (15/39; 0.80 [0.44, 1.47]), PA 30.3% (10/33; 0.69 [0.37, 1.29]), FPV + NTZ 27.0% (10/37; 0.60 [0.31, 1.18]) and SOF-DCV 23.5% (8/34; 0.47 [0.22, 1.00]). Three lower respiratory tract infections occurred (PA 6.1% [2/33]; SOF-DCV 2.9% [1/34]); two required hospitalisation (PA, SOF-DCV). There were no deaths. Adverse events occurred in 55.3% (105/190) of patients, including one serious adverse event (pancytopenia; FPV + NTZ). Interpretation There was no statistical difference in viral clearance for any regimen compared to SOC. All treatments were well tolerated. Funding 10.13039/501100004167Medicines for Malaria Venture, with funding from the UK Foreign, Commonwealth and Development Office, within the Covid-19 Therapeutics Accelerator in partnership with 10.13039/100004440Wellcome, the 10.13039/100000865Bill and Melinda Gates Foundation, and Mastercard.
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Affiliation(s)
- Nomathemba Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Corresponding author. Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Building C, Sunnyside Office Park, 32 Princess of Wales Terrace, Parktown, Johannesburg, South Africa
| | - Chelsea Kruger
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Chung Ju
- Shin Poong Pharm. Co. Ltd., Seoul, Republic of Korea,Graduate School of Clinical Pharmacy, CHA University, Pocheon-si, Gyeonggi-do, Republic of Korea
| | - Byungsu Kim
- Shin Poong Pharm. Co. Ltd., Seoul, Republic of Korea
| | - Yengiwe Dineka
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool, United Kingdom
| | - Andrew Hill
- Department of Molecular and Clinical Pharmacology, Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool, United Kingdom
| | | | - Nada Abla
- Medicines for Malaria Venture, Geneva, Switzerland
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12
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Groger M, Tona Lutete G, Mombo-Ngoma G, Ntamabyaliro NY, Kahunu Mesia G, Muena Mujobu TB, Dimessa Mbadinga LB, Zoleko Manego R, Egger-Adam D, Borghini-Fuhrer I, Shin J, Miller R, Arbe-Barnes S, Duparc S, Ramharter M. Effectiveness of pyronaridine-artesunate against Plasmodium malariae, Plasmodium ovale spp, and mixed-Plasmodium infections: a post-hoc analysis of the CANTAM-Pyramax trial. The Lancet Microbe 2022; 3:e598-e605. [PMID: 35654079 PMCID: PMC9329129 DOI: 10.1016/s2666-5247(22)00092-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/20/2022] [Accepted: 04/08/2022] [Indexed: 12/21/2022] Open
Abstract
Background Methods Findings Interpretation Funding
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13
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Pradhan MM, Pradhan S, Dutta A, Shah NK, Valecha N, Joshi PL, Pradhan K, Grewal Daumerie P, Banerji J, Duparc S, Mendis K, Sharma SK, Murugasampillay S, Anvikar AR. Impact of the malaria comprehensive case management programme in Odisha, India. PLoS One 2022; 17:e0265352. [PMID: 35324920 PMCID: PMC8947122 DOI: 10.1371/journal.pone.0265352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
Abstract
Background
The Comprehensive Case Management Project (CCMP), was a collaborative implementation research initiative to strengthen malaria early detection and complete treatment in Odisha State, India.
Methods
A two-arm quasi-experimental design was deployed across four districts in Odisha, representing a range of malaria endemicity: Bolangir (low), Dhenkanal (moderate), Angul (high), and Kandhamal (hyper). In each district, a control block received routine malaria control measures, whereas a CCMP block received a range of interventions to intensify surveillance, diagnosis, and case management. Impact was evaluated by difference-in-difference (DID) analysis and interrupted time-series (ITS) analysis of monthly blood examination rate (MBER) and monthly parasite index (MPI) over three phases: phase 1 pre-CCMP (2009–2012) phase 2 CCMP intervention (2013–2015), and phase 3 post-CCMP (2016–2017).
Results
During CCMP implementation, adjusting for control blocks, DID and ITS analysis indicated a 25% increase in MBER and a 96% increase in MPI, followed by a –47% decline in MPI post-CCMP, though MBER was maintained. Level changes in MPI between phases 1 and 2 were most marked in Dhenkanal and Angul with increases of 976% and 287%, respectively, but declines in Bolangir (−57%) and Kandhamal (−22%). Between phase 2 and phase 3, despite the MBER remaining relatively constant, substantial decreases in MPI were observed in Dhenkanal (−78%), and Angul (−59%), with a more modest decline in Bolangir (−13%), and an increase in Kandhamal (14%).
Conclusions
Overall, CCMP improved malaria early detection and treatment through the enhancement of the existing network of malaria services which positively impacted case incidence in three districts. In Kandhamal, which is hyperendemic, the impact was not evident. However, in Dhenkanal and Angul, areas of moderate-to-high malaria endemicity, CCMP interventions precipitated a dramatic increase in case detection and a subsequent decline in malaria incidence, particularly in previously difficult-to-reach communities.
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Affiliation(s)
- Madan M. Pradhan
- National Vector Borne Disease Control Programme, Government of Odisha, Bhubaneswar, India
- * E-mail:
| | - Sreya Pradhan
- National Vector Borne Disease Control Programme, Government of Odisha, Bhubaneswar, India
| | - Ambarish Dutta
- Indian Institute of Public Health, Bhubaneswar, India
- Kalinga Institute of Industrial Technology, Deemed to be University, Bhubaneswar, India
| | - Naman K. Shah
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Neena Valecha
- National Institute of Malaria Research, New Delhi, India
| | - Pyare L. Joshi
- Independent Malariologist, Gallup, Washington, D.C., United States of America
| | | | | | - Jaya Banerji
- Medicines for Malaria Venture, Geneva, Switzerland
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14
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Mansoor R, Commons RJ, Douglas NM, Abuaku B, Achan J, Adam I, Adjei GO, Adjuik M, Alemayehu BH, Allan R, Allen EN, Anvikar AR, Arinaitwe E, Ashley EA, Ashurst H, Asih PBS, Bakyaita N, Barennes H, Barnes KI, Basco L, Bassat Q, Baudin E, Bell DJ, Bethell D, Bjorkman A, Boulton C, Bousema T, Brasseur P, Bukirwa H, Burrow R, Carrara VI, Cot M, D’Alessandro U, Das D, Das S, Davis TME, Desai M, Djimde AA, Dondorp AM, Dorsey G, Drakeley CJ, Duparc S, Espié E, Etard JF, Falade C, Faucher JF, Filler S, Fogg C, Fukuda M, Gaye O, Genton B, Ghulam Rahim A, Gilayeneh J, Gonzalez R, Grais RF, Grandesso F, Greenwood B, Grivoyannis A, Hatz C, Hodel EM, Humphreys GS, Hwang J, Ishengoma D, Juma E, Kachur SP, Kager PA, Kamugisha E, Kamya MR, Karema C, Kayentao K, Kazienga A, Kiechel JR, Kofoed PE, Koram K, Kremsner PG, Lalloo DG, Laman M, Lee SJ, Lell B, Maiga AW, Mårtensson A, Mayxay M, Mbacham W, McGready R, Menan H, Ménard D, Mockenhaupt F, Moore BR, Müller O, Nahum A, Ndiaye JL, Newton PN, Ngasala BE, Nikiema F, Nji AM, Noedl H, Nosten F, Ogutu BR, Ojurongbe O, Osorio L, Ouédraogo JB, Owusu-Agyei S, Pareek A, Penali LK, Piola P, Plucinski M, Premji Z, Ramharter M, Richmond CL, Rombo L, Roper C, Rosenthal PJ, Salman S, Same-Ekobo A, Sibley C, Sirima SB, Smithuis FM, Somé FA, Staedke SG, Starzengruber P, Strub-Wourgaft N, Sutanto I, Swarthout TD, Syafruddin D, Talisuna AO, Taylor WR, Temu EA, Thwing JI, Tinto H, Tjitra E, Touré OA, Tran TH, Ursing J, Valea I, Valentini G, van Vugt M, von Seidlein L, Ward SA, Were V, White NJ, Woodrow CJ, Yavo W, Yeka A, Zongo I, Simpson JA, Guerin PJ, Stepniewska K, Price RN. Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data. BMC Med 2022; 20:85. [PMID: 35249546 PMCID: PMC8900374 DOI: 10.1186/s12916-022-02265-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/18/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. METHODS Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. RESULTS A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0-19.7 g/dL) in Africa, 11.6 g/dL (range 5.0-20.0 g/dL) in Asia and 12.3 g/dL (range 6.9-17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39-3.05], p < 0.001). CONCLUSIONS In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery.
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Dabira ED, Hachizovu S, Conteh B, Mendy A, Nyang H, Lawal B, Ndiath MO, Mulenga JM, Mwanza S, Borghini-Fuhrer I, Arbe-Barnes S, Miller R, Shin J, Duparc S, D'Alessandro U, Manyando C, Achan J. Efficacy, Safety and Tolerability of Pyronaridine-artesunate in Asymptomatic Malaria-infected Individuals: a Randomized Controlled Trial. Clin Infect Dis 2022; 74:180-188. [PMID: 33983371 PMCID: PMC8800175 DOI: 10.1093/cid/ciab425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pyronaridine-artesunate (PA) is a registered artemisinin-based combination therapy, potentially useful for mass drug administration campaigns. However, further data are needed to evaluate its efficacy, safety and tolerability as full or incomplete treatment in asymptomatic Plasmodium falciparum-infected individuals. METHODS This phase II, multi-center, open label, randomized clinical trial was conducted in The Gambia and Zambia. Participants with microscopically confirmed asymptomatic P. falciparum infection were randomly assigned (1:1:1) to receive a 3-day, 2-day, or 1-day treatment regimen of PA (180:60 mg), dosed according to bodyweight. The primary efficacy outcome was polymerase chain reaction (PCR)-adjusted adequate parasitological response (APR) at day 28 in the per-protocol population. RESULTS A total of 303 participants were randomized. Day 28 PCR-adjusted APR was 100% for both the 3-day (98/98) and 2-day regimens (96/96), and 96.8% (89/94) for the 1-day regimen. Efficacy was maintained at 100% until day 63 for the 3-day and 2-day regimens but declined to 94.4% (84/89) with the 1-day regimen. Adverse event frequency was similar between the 3-day (51.5% [52/101]), 2-day (52.5% [52/99]), and 1-day (54.4% [56/103]) regimens; the majority of adverse events were of grade 1 or 2 severity (85% [136/160]). Asymptomatic, transient increases (>3 times the upper limit of normal) in alanine aminotransferase/aspartate aminotransferase were observed for 6/301 (2.0%) participants. CONCLUSIONS PA had high efficacy and good tolerability in asymptomatic P. falciparum-infected individuals, with similar efficacy for the full 3-day and incomplete 2-day regimens. Although good adherence to the 3-day regimen should be encouraged, these results support the further investigation of PA for mass drug administration campaigns. CLINICAL TRIALS REGISTRATION NCT03814616.
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Affiliation(s)
- Edgard D Dabira
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | | | - Bakary Conteh
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Alieu Mendy
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Haddy Nyang
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Bolarinde Lawal
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Mamadou Ousmane Ndiath
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | | | | | | | | | | | | | - Stephan Duparc
- Medicines for Malaria Venture (MMV), Geneva, Switzerland
| | - Umberto D'Alessandro
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | | | - Jane Achan
- Disease Control and Elimination Theme, Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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16
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Anvikar AR, Sahu P, Pradhan MM, Sharma S, Ahmed N, Yadav CP, Pradhan S, Duparc S, Daumerie PG, Valecha N. Active Pharmacovigilance for Primaquine Radical Cure of Plasmodium vivax Malaria in Odisha, India. Am J Trop Med Hyg 2022; 106:831-840. [PMID: 35008062 PMCID: PMC8922502 DOI: 10.4269/ajtmh.21-0816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022] Open
Abstract
Plasmodium vivax malaria elimination requires radical cure with chloroquine/primaquine. However, primaquine causes hemolysis in glucose-6-phosphate dehydrogenase-deficient (G6PDd) individuals. Between February 2016 and July 2017 in Odisha State, India, a prospective, observational, active pharmacovigilance study assessed the hematologic safety of directly observed 25 mg/kg chloroquine over 3 days plus primaquine 0.25 mg/kg/day for 14 days in 100 P. vivax patients (≥ 1 year old) with hemoglobin (Hb) ≥ 7 g/dL. Pretreatment G6PDd screening was not done, but patients were advised on hemolysis signs and symptoms using a visual aid. For evaluable patients, the mean absolute change in Hb between day 0 and day 7 was −0.62 g/dL (95% confidence interval [CI]: −0.93, −0.31) for males (N = 53) versus −0.24 g/dL (95%CI: −0.59, 0.10) for females (N = 45; P = 0.034). Hemoglobin declines ≥ 3 g/dL occurred in 5/99 (5.1%) patients (three males, two females); none had concurrent clinical symptoms of hemolysis. Based on G6PD qualitative testing after study completion, three had a G6PD-normal phenotype, one female was confirmed by genotyping as G6PDd heterozygous, and one male had an unknown phenotype. A G6PDd prevalence survey was conducted between August 2017 and March 2018 in the same region using qualitative G6PD testing, confirmed by genotyping. G6PDd prevalence was 12.0% (14/117) in tribal versus 3.1% (16/509) in nontribal populations, with G6PD Orissa identified in 29/30 (96.7%) of G6PDd samples. Following chloroquine/primaquine, notable Hb declines were observed in this population that were not recognized by patients based on clinical signs and symptoms.
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Affiliation(s)
| | - Prajyoti Sahu
- National Vector Borne Disease Control Programme (NVBDCP), Odisha, India
| | - Madan M Pradhan
- National Vector Borne Disease Control Programme (NVBDCP), Odisha, India
| | - Supriya Sharma
- National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Naseem Ahmed
- National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Chander P Yadav
- National Institute of Malaria Research, Dwarka, New Delhi, India
| | - Sreya Pradhan
- National Vector Borne Disease Control Programme (NVBDCP), Odisha, India
| | | | | | - Neena Valecha
- National Institute of Malaria Research, Dwarka, New Delhi, India
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17
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Tona Lutete G, Mombo-Ngoma G, Assi SB, Bigoga JD, Koukouikila-Koussounda F, Ntamabyaliro NY, Ntoumi F, Agnandji ST, Groger M, Shin J, Borghini-Fuhrer I, Arbe-Barnes S, Allen SJ, Kremsner PG, Miller R, Duparc S, Ramharter M. Pyronaridine-artesunate real-world safety, tolerability, and effectiveness in malaria patients in 5 African countries: A single-arm, open-label, cohort event monitoring study. PLoS Med 2021; 18:e1003669. [PMID: 34129601 PMCID: PMC8205155 DOI: 10.1371/journal.pmed.1003669] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Phase II/III randomized controlled clinical trials for the treatment of acute uncomplicated malaria, pyronaridine-artesunate demonstrated high efficacy and a safety profile consistent with that of comparators, except that asymptomatic, mainly mild-to-moderate transient increases in liver aminotransferases were reported for some patients. Hepatic safety, tolerability, and effectiveness have not been previously assessed under real-world conditions in Africa. METHODS AND FINDINGS This single-arm, open-label, cohort event monitoring study was conducted at 6 health centers in Cameroon, Democratic Republic of Congo, Gabon, Ivory Coast, and Republic of Congo between June 2017 and April 2019. The trial protocol as closely as possible resembled real-world clinical practice for the treatment of malaria at the centers. Eligible patients were adults or children of either sex, weighing at least 5 kg, with acute uncomplicated malaria who did not have contraindications for pyronaridine-artesunate treatment as per the summary of product characteristics. Patients received fixed-dose pyronaridine-artesunate once daily for 3 days, dosed by body weight, without regard to food intake. A tablet formulation was used in adults and adolescents and a pediatric granule formulation in children and infants under 20 kg body weight. The primary outcome was the hepatic event incidence, defined as the appearance of the clinical signs and symptoms of hepatotoxicity confirmed by a >2× rise in alanine aminotransferase/aspartate aminotransferase (ALT/AST) versus baseline in patients with baseline ALT/AST >2× the upper limit of normal (ULN). As a secondary outcome, this was assessed in patients with ALT/AST >2× ULN prior to treatment versus a matched cohort of patients with normal baseline ALT/AST. The safety population comprised 7,154 patients, of mean age 13.9 years (standard deviation (SD) 14.6), around half of whom were male (3,569 [49.9%]). Patients experienced 8,560 malaria episodes; 158 occurred in patients with baseline ALT/AST elevations >2×ULN. No protocol-defined hepatic events occurred following pyronaridine-artesunate treatment of malaria patients with or without baseline hepatic dysfunction. Thus, no cohort comparison could be undertaken. Also, as postbaseline clinical chemistry was only performed where clinically indicated, postbaseline ALT/AST levels were not systematically assessed for all patients. Adverse events of any cause occurred in 20.8% (1,490/7,154) of patients, most frequently pyrexia (5.1% [366/7,154]) and vomiting (4.2% [303/7,154]). Adjusting for Plasmodium falciparum reinfection, clinical effectiveness at day 28 was 98.6% ([7,369/7,746] 95% confidence interval (CI) 98.3 to 98.9) in the per-protocol population. There was no indication that comorbidities or malnutrition adversely affected outcomes. The key study limitation was that postbaseline clinical biochemistry was only evaluated when clinically indicated. CONCLUSIONS Pyronaridine-artesunate had good tolerability and effectiveness in a representative African population under conditions similar to everyday clinical practice. These findings support pyronaridine-artesunate as an operationally useful addition to the management of acute uncomplicated malaria. TRIAL REGISTRATION ClinicalTrials.gov NCT03201770.
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Affiliation(s)
- Gaston Tona Lutete
- Unité de Pharmacologie Clinique et Pharmacovigilance (UPC-PV), University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Reisemedizin und Humanparasitologie, University of Tübingen, Tübingen, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Serge-Brice Assi
- Institut Pierre Richet/Institut National de Santé Publique (IPR/INSP), Bouaké, Ivory Coast
| | - Jude D. Bigoga
- The Biotechnology Center, University of Yaounde I, Yaounde, Cameroon
| | | | - Nsengi Y. Ntamabyaliro
- Unité de Pharmacologie Clinique et Pharmacovigilance (UPC-PV), University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Francine Ntoumi
- Institut für Tropenmedizin, Reisemedizin und Humanparasitologie, University of Tübingen, Tübingen, Germany
- Fondation Congolaise pour la Recherche Médicale (FCRM), WHO-AFRO Campus Djoué, Brazzaville, Republic of Congo
| | - Selidji T. Agnandji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Reisemedizin und Humanparasitologie, University of Tübingen, Tübingen, Germany
| | - Mirjam Groger
- Institut für Tropenmedizin, Reisemedizin und Humanparasitologie, University of Tübingen, Tübingen, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Stephen J. Allen
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter G. Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Reisemedizin und Humanparasitologie, University of Tübingen, Tübingen, Germany
| | | | | | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Reisemedizin und Humanparasitologie, University of Tübingen, Tübingen, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- * E-mail:
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Han KT, Lin K, Han ZY, Myint MK, Aye KH, Thi A, Thapa B, Bustos MD, Borghini-Fuhrer I, Ringwald P, Duparc S. Efficacy and Safety of Pyronaridine-Artesunate for the Treatment of Uncomplicated Plasmodium falciparum and Plasmodium vivax Malaria in Myanmar. Am J Trop Med Hyg 2020; 103:1088-1093. [PMID: 32524960 PMCID: PMC7470518 DOI: 10.4269/ajtmh.20-0185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Four single-arm, prospective, clinical studies of pyronaridine–artesunate efficacy in uncomplicated Plasmodium falciparum or Plasmodium vivax malaria were conducted in Myanmar between 2017 and 2019. Eligible subjects were aged at least 6 years, with microscopically confirmed P. falciparum (n = 196) or P. vivax mono-infection (n = 206). Patients received pyronaridine–artesunate once daily for 3 days with follow-up until day 42 for P. falciparum or day 28 for P. vivax. For the primary efficacy analysis, adequate clinical and parasitological response (ACPR) in the per-protocol population at day 42 for P. falciparum malaria was 100% (88/88; 95% CI: 95.9, 100) in northern Myanmar (Kachin State and northern Shan State), and 100% (101/101; 95% CI: 96.4, 100) in southern Myanmar (Tanintharyi Region and Kayin State). Plasmodium falciparum day-3 parasite clearance was observed for 96.9% (190/196) of patients. Mutations in the P. falciparum Kelch propeller domain (K13) were detected in 39.0% (69/177) of isolates: F446I (14.7% [26/177]), R561H (13.0% [23/177]), C580Y (10.2% [18/177]), and P574L (1.1% [2/177]). For P. vivax, the day-28 ACPR was 100% (104/104; 95% CI: 96.5, 100) in northern Myanmar and 100% (97/97; 95% CI: 96.3, 100) in southern Myanmar. Across both P. vivax studies, 100% (206/206) of patients had day-3 parasite clearance. There were no adverse events. Pyronaridine–artesunate had excellent efficacy in Myanmar against P. falciparum and P. vivax and was well tolerated. This study supports the inclusion of pyronaridine–artesunate in national malaria treatment guidelines for Myanmar.
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Affiliation(s)
- Kay Thwe Han
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Khin Lin
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Pyin Oo Lwin Township, Myanmar
| | - Zay Yar Han
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Moe Kyaw Myint
- Department of Medical Research (Pyin Oo Lwin Branch), Ministry of Health and Sports, Pyin Oo Lwin Township, Myanmar
| | - Kyin Hla Aye
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Aung Thi
- National Malaria Control Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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20
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Ackert J, Mohamed K, Slakter JS, El-Harazi S, Berni A, Gevorkyan H, Hardaker E, Hussaini A, Jones SW, Koh GCKW, Patel J, Rasmussen S, Kelly DS, Barañano DE, Thompson JT, Warren KA, Sergott RC, Tonkyn J, Wolstenholme A, Coleman H, Yuan A, Duparc S, Green JA. Randomized Placebo-Controlled Trial Evaluating the Ophthalmic Safety of Single-Dose Tafenoquine in Healthy Volunteers. Drug Saf 2020; 42:1103-1114. [PMID: 31187437 PMCID: PMC6689320 DOI: 10.1007/s40264-019-00839-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Tafenoquine has been recently registered for the prevention of relapse in Plasmodium vivax malaria. Objective This study assessed the pharmacodynamic effects of 300-mg single-dose tafenoquine on the retina. Methods This phase I, prospective, multicenter, randomized, single-masked, placebo-controlled, parallel-group study was conducted between 2 February 2016 and 14 September 2017 at three US study centers. Adult healthy volunteers were randomized (2:1) to receive either a single 300-mg oral dose of tafenoquine or matched placebo on day 1. Ophthalmic assessments, including spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF), were conducted at baseline and day 90 and evaluated for pre-determined endpoints by an independent, masked reading center. Results One subject in each group met the composite primary endpoint for retinal changes identified with SD-OCT or FAF, i.e., one out of 306 (0.3%) with tafenoquine, one out of 161 (0.6%) with placebo. Both cases had unilateral focal ellipsoid zone disruption at day 90 with no effect on best-corrected visual acuity. The tafenoquine-treated subject had this abnormality at baseline, and was enrolled in error. There was no difference in ophthalmic safety between tafenoquine and placebo. Conclusion There was no evidence of any pharmacodynamic effect of 300-mg single-dose tafenoquine on the retina or any short-term clinically relevant effects on ophthalmic safety. This clinical trial is registered with ClinicalTrials.gov (identifier: NCT02658435). Electronic supplementary material The online version of this article (10.1007/s40264-019-00839-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jessica Ackert
- Clinical Research and Development, GlaxoSmithKline, Collegeville, PA, USA
| | - Khadeeja Mohamed
- Quantitative Sciences, GlaxoSmithKline Research and Development, Stockley Park West, Uxbridge, Middlesex, UK
| | - Jason S Slakter
- Digital Angiography Reading Center (DARC), Great Neck, New York, NY, USA
| | | | - Alessandro Berni
- Global Health, GlaxoSmithKline Research and Development Ltd., Stockley Park West, Uxbridge, Middlesex, UB11 1BT, UK
| | - Hakop Gevorkyan
- California Clinical Trials Medical Group in affiliation with Parexel International, Glendale, CA, USA
| | - Elizabeth Hardaker
- Safety Evaluation and Risk Management, GlaxoSmithKline Research and Development, Stockley Park West, Uxbridge, Middlesex, UK
| | - Azra Hussaini
- PAREXEL, Harbor Hospital, Baltimore, Baltimore, MD, USA
| | - Siôn W Jones
- Safety Evaluation and Risk Management, GlaxoSmithKline Research and Development, Stockley Park West, Uxbridge, Middlesex, UK
| | - Gavin C K W Koh
- Global Health, GlaxoSmithKline Research and Development Ltd., Stockley Park West, Uxbridge, Middlesex, UB11 1BT, UK
| | - Jyoti Patel
- Clinical Data Management, GlaxoSmithKline Research and Development, Collegeville, PA, USA
| | | | - Deborah S Kelly
- Global Clinical Safety and Pharmacovigilance, GlaxoSmithKline, Collegeville, PA, USA
| | | | | | | | - Robert C Sergott
- Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - John Tonkyn
- GSK Medicines Research Centre, GlaxoSmithKline, Stevenage, Hertfordshire, UK
| | | | - Hanna Coleman
- Digital Angiography Reading Center (DARC), Great Neck, New York, NY, USA
| | - Alex Yuan
- Digital Angiography Reading Center (DARC), Great Neck, New York, NY, USA
| | - Stephan Duparc
- Research and Development, Medicines for Malaria Venture, Geneva, Switzerland
| | - Justin A Green
- Global Health, GlaxoSmithKline Research and Development Ltd., Stockley Park West, Uxbridge, Middlesex, UB11 1BT, UK.
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21
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Duparc S, Chalon S, Miller S, Richardson N, Toovey S. Neurological and psychiatric safety of tafenoquine in Plasmodium vivax relapse prevention: a review. Malar J 2020; 19:111. [PMID: 32169086 PMCID: PMC7071640 DOI: 10.1186/s12936-020-03184-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/06/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Tafenoquine is an 8-aminoquinoline anti-malarial drug recently approved as a single-dose (300 mg) therapy for Plasmodium vivax relapse prevention, when co-administered with 3-days of chloroquine or other blood schizonticide. Tafenoquine 200 mg weekly after a loading dose is also approved as travellers' prophylaxis. The development of tafenoquine has been conducted over many years, using various dosing regimens in diverse populations. METHODS This review brings together all the preclinical and clinical data concerning tafenoquine central nervous system safety. Data were assembled from published sources. The risk of neuropsychiatric adverse events (NPAEs) with single-dose tafenoquine (300 mg) in combination with chloroquine to achieve P. vivax relapse prevention is particularly examined. RESULTS There was no evidence of neurotoxicity with tafenoquine in preclinical animal models. In clinical studies in P. vivax relapse prevention, nervous system adverse events, mainly headache and dizziness, occurred in 11.4% (36/317) of patients with tafenoquine (300 mg)/chloroquine versus 10.2% (19/187) with placebo/chloroquine; and in 15.5% (75/483) of patients with tafenoquine/chloroquine versus 13.3% (35/264) with primaquine (15 mg/day for 14 days)/chloroquine. Psychiatric adverse events, mainly insomnia, occurred in 3.8% (12/317) of patients with tafenoquine/chloroquine versus 2.7% (5/187) with placebo/chloroquine; and in 2.9% (14/483) of patients with tafenoquine/chloroquine versus 3.4% (9/264) for primaquine/chloroquine. There were no serious or severe NPAEs observed with tafenoquine (300 mg)/chloroquine in these studies. CONCLUSIONS The risk:benefit of single-dose tafenoquine/chloroquine in P. vivax relapse prevention is favourable in the presence of malaria, with a low risk of NPAEs, similar to that seen with chloroquine alone or primaquine/chloroquine.
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Affiliation(s)
- Stephan Duparc
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Geneva 15, Switzerland.
| | - Stephan Chalon
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Geneva 15, Switzerland
| | | | | | - Stephen Toovey
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Geneva 15, Switzerland.,Pegasus Research, London, UK
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Mombo-Ngoma G, Remppis J, Sievers M, Zoleko Manego R, Endamne L, Kabwende L, Veletzky L, Nguyen TT, Groger M, Lötsch F, Mischlinger J, Flohr L, Kim J, Cattaneo C, Hutchinson D, Duparc S, Moehrle J, Velavan TP, Lell B, Ramharter M, Adegnika AA, Mordmüller B, Kremsner PG. Efficacy and Safety of Fosmidomycin-Piperaquine as Nonartemisinin-Based Combination Therapy for Uncomplicated Falciparum Malaria: A Single-Arm, Age De-escalation Proof-of-Concept Study in Gabon. Clin Infect Dis 2019; 66:1823-1830. [PMID: 29293893 PMCID: PMC5982710 DOI: 10.1093/cid/cix1122] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/23/2017] [Indexed: 12/03/2022] Open
Abstract
Background Fosmidomycin–piperaquine is being developed as nonartemisinin-based combination therapy to meet the challenge of emerging artemisinin resistance. Methods The study was a phase 2, single-arm, proof-of-concept study of the efficacy, tolerability, and safety of fosmidomycin–piperaquine for the treatment of uncomplicated Plasmodium falciparum monoinfection in Gabon. Adults and children of both sexes with initial parasite counts between 1000 and 150000/µL received oral treatment with fosmidomycin (twice daily doses of 30 mg/kg) and piperaquine (once daily dose of 16 mg/kg) for 3 days and followed-up for 63 days. The primary efficacy endpoint was the per-protocol polymerase chain reaction (PCR)–corrected day 28 adequate clinical and parasitological response (ACPR). Results One hundred patients were enrolled. The PCR-corrected day 28 ACPR rate was 83/83, or 100% (95% confidence interval, 96–100). Fourteen patients had asexual parasitaemia between day 28 and day 63; all were typed by PCR as new infections. Fosmidomycin–piperaquine therapy led to rapid parasite clearance (median, 36 hours; interquartile range [IQR], 6–60) and fever clearance time (median, 12 hours; IQR, 6–48). The electrocardiogram assessments showed 2 patients with prolonged QT interval >500 msec following study drug administration. The majority of adverse events affected the gastrointestinal and respiratory tracts and were transient and mild to moderate in severity. Conclusions This is the first report of the use of the combination fosmidomycin–piperaquine. The combination appeared to have high efficacy and be safe and well tolerated despite observed transient changes in electrocardiogram with prolongation of the QT interval. Clinical Trials Registration. NCT02198807.
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Affiliation(s)
- Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Département de Parasitologie-Mycologie, Université des Sciences de la Santé, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Jonathan Remppis
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Moritz Sievers
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Rella Zoleko Manego
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Lilian Endamne
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Lumeka Kabwende
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon
| | - Luzia Veletzky
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - The Trong Nguyen
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Mirjam Groger
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Felix Lötsch
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Johannes Mischlinger
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Lena Flohr
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Johanna Kim
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Chiara Cattaneo
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - David Hutchinson
- DMG Deutsche Malaria GmbH, formerly Jomaa Pharma GmbH, Hamburg, Germany
| | | | | | - Thirumalaisamy P Velavan
- Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany.,Vietnamese-German Center for Medical Research, Hanoi and Faculty of Medicine, Duy Tan University DaNang, Vietnam
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany.,Bernhard Nocht Hospital for Tropical Diseases, Bernhard Nocht Institute for Tropical Medicine and University Medical Center Hamburg-Eppendorf, Germany
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Benjamin Mordmüller
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Libreville, Gabon.,Institute of Tropical Medicine, University of Tübingen, and German Centre for Infection Research, Hamburg, Germany
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24
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Pradhan MM, Anvikar AR, Daumerie PG, Pradhan S, Dutta A, Shah NK, Joshi PL, Banerji J, Duparc S, Mendis K, Murugasampillay S, Valecha N. Comprehensive case management of malaria: Operational research informing policy. J Vector Borne Dis 2019; 56:56-59. [PMID: 31070167 DOI: 10.4103/0972-9062.257776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In 2013, the Odisha state Vector Borne Disease Control Programme led a five year operational research project, under programmatic conditions, in close collaboration with several partners. This Comprehensive Case Management Project covered a population of 900,000 across paired control and intervention blocks in four districts, each with different transmission intensities. Key gaps in access to malaria services were identified through household surveys and a detailed situation analysis. The interventions included ensuring adequate stocks of rapid diagnostic tests and antimalarial drugs at the village level, the capacity building of health workers and ASHAs, setting up microscopy centres at the primary health care level, and conducting mass screening and treatment in poorly accessible areas. The programme strengthened the routine health system, and improved malaria surveillance as well as the access to and quality of care. Initially, the programme led to increased case reporting due to improved detection, followed by a decline in malaria incidence. Lessons from the project were then scaled up statewide in the form of a new initiative-Durgama Anchalare Malaria Nirakaran (DAMaN).
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Affiliation(s)
- M M Pradhan
- National Vector Borne Disease Control Programme, Government of Odisha, Bhubaneswar, Odisha, India
| | | | | | - S Pradhan
- National Vector Borne Disease Control Programme, Government of Odisha, Bhubaneswar, Odisha, India
| | - A Dutta
- Indian Institute of Public Health, Bhubaneswar, Odisha, India
| | - N K Shah
- Independent Malariologist, Ganiyari, India
| | - P L Joshi
- Independent Malariologist, New Delhi, India
| | - J Banerji
- Medicines for Malaria Venture, Geneva, Switzerland
| | - S Duparc
- Medicines for Malaria Venture, Geneva, Switzerland
| | - K Mendis
- Independent Malariologist, Colombo, Sri Lanka
| | | | - N Valecha
- ICMR-National Institute of Malaria Research, New Delhi, India
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25
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Murphy SC, Duke ER, Shipman KJ, Jensen RL, Fong Y, Ferguson S, Janes HE, Gillespie K, Seilie AM, Hanron AE, Rinn L, Fishbaugher M, VonGoedert T, Fritzen E, Kappe SH, Chang M, Sousa JC, Marcsisin SR, Chalon S, Duparc S, Kerr N, Möhrle JJ, Andenmatten N, Rueckle T, Kublin JG. A Randomized Trial Evaluating the Prophylactic Activity of DSM265 Against Preerythrocytic Plasmodium falciparum Infection During Controlled Human Malarial Infection by Mosquito Bites and Direct Venous Inoculation. J Infect Dis 2019; 217:693-702. [PMID: 29216395 DOI: 10.1093/infdis/jix613] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background DSM265 is a selective inhibitor of Plasmodium dihydroorotate dehydrogenase that fully protected against controlled human malarial infection (CHMI) by direct venous inoculation of Plasmodium falciparum sporozoites when administered 1 day before challenge and provided partial protection when administered 7 days before challenge. Methods A double-blinded, randomized, placebo-controlled trial was performed to assess safety, tolerability, pharmacokinetics, and efficacy of 1 oral dose of 400 mg of DSM265 before CHMI. Three cohorts were studied, with DSM265 administered 3 or 7 days before direct venous inoculation of sporozoites or 7 days before 5 bites from infected mosquitoes. Results DSM265-related adverse events consisted of mild-to-moderate headache and gastrointestinal symptoms. DSM265 concentrations were consistent with pharmacokinetic models (mean area under the curve extrapolated to infinity, 1707 µg*h/mL). Placebo-treated participants became positive by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and were treated 7-10 days after CHMI. Among DSM265-treated subjects, 2 of 6 in each cohort were sterilely protected. DSM265-treated recipients had longer times to development of parasitemia than placebo-treated participants (P < .004). Conclusions This was the first CHMI study of a novel antimalarial compound to compare direct venous inoculation of sporozoites and mosquito bites. Times to qRT-PCR positivity and treatment were comparable for both routes. DSM265 given 3 or 7 days before CHMI was safe and well tolerated but sterilely protected only one third of participants.
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Affiliation(s)
- Sean C Murphy
- Department of Laboratory Medicine, University of Washington, Seattle, Washington.,Department of Microbiology, University of Washington, Seattle, Washington.,Center for Emerging and Re-emerging Infectious Diseases, Seattle, Washington.,Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Human Challenge Center, Center for Infectious Disease Research, Seattle, Washington
| | - Elizabeth R Duke
- Department of Medicine, University of Washington, Seattle, Washington.,Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kelly J Shipman
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ryan L Jensen
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Youyi Fong
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sue Ferguson
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Holly E Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kevin Gillespie
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Annette M Seilie
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Amelia E Hanron
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Laurie Rinn
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Matthew Fishbaugher
- Human Challenge Center, Center for Infectious Disease Research, Seattle, Washington
| | - Tracie VonGoedert
- Human Challenge Center, Center for Infectious Disease Research, Seattle, Washington
| | - Emma Fritzen
- Human Challenge Center, Center for Infectious Disease Research, Seattle, Washington
| | - Stefan H Kappe
- Human Challenge Center, Center for Infectious Disease Research, Seattle, Washington
| | - Ming Chang
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Jason C Sousa
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | | | | | | | - Nicola Kerr
- Medicines for Malaria Venture, Geneva, Switzerland
| | | | | | | | - James G Kublin
- Department of Global Health, University of Washington, Seattle, Washington.,Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Djimde A, Grobusch MP, Zoleko Manego R, Mombo-Ngoma G, Picot S, Sagara I, Sutherland C, Kone A, Doumbo OK, Pedro Gil J, Björkman A, Borrmann S, Soulama I, Fofana B, Duparc S, Dicko A, Hughes D, Winnips C, Sirima SB, Adehossi E, Ouedraogo JB, Dembele L, Zongo I, Biguenet S, Ilboudo-Sanogo E, Fofana A. OC 8721 WANECAM II – A CLINICAL TRIAL PROGRAMME TO ASSESS SAFETY, EFFICACY AND TRANSMISSION-BLOCKING PROPERTIES OF A NEW ANTIMALARIAL KAF156 (GANAPLACIDE) IN UNCOMPLICATED MALARIA IN WEST AND CENTRAL AFRICA. BMJ Glob Health 2019. [DOI: 10.1136/bmjgh-2019-edc.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundDespite major progress in the past decade, malaria remains a major public health problem in sub-Saharan Africa. West and Central Africa account for nearly 2/3 of the burden currently attributable to falciparum malaria. Artemisinin-based combination therapies (ACT) are a cornerstone of our strategy for controlling and eventually eliminating malaria. However, reduced responsiveness/resistance to artemisinin derivatives and to ACTs, an increasing problem in South-East Asia is a major concern. It is of utmost importance to develop new antimalarial drugs from novel chemical classes that can replace ACTs. KAF156, an imidazolepiperazine, is a leading candidate in the antimalarial drug development pipeline. Combination of KAF156 with a Solid Dispersion Formulation of lumefantrine (LUM-SDF) is expected to be fast acting, fully curative, improve patient adherence and can potentially reduce malaria transmission.MethodsWANECAM II proposes to advance the clinical development of KAF156 through clinical trials in adults and children, with integrated capacity building and infrastructure development activities. The trial programme will be undertaken in the context of networking, team-building, leadership development and community engagement schemes that will involve intra-European, European-African and intra-African collaborative activities. WANECAM II will accelerate the clinical study of children less than 2 years of age which are the key target for new antimalarial treatments.ResultsBy the end of the project, the results are expected to contribute to the registration of KAF156/LUM-SDF through stringent regulatory health authorities, increase biomedical research capacity in the consortium and effectively promote networking among the respective teams. A new clinical research team in Niger, a grossly underrepresented country in the African research landscape, will be developed and further increase capacity and infrastructure in the consortium.ConclusionProviding a new antimalarial drug combination that does not contain an artemisinin derivative and is effective against resistant P. falciparum strains as well as gametocytes and that is likely to be taken in 3 or fewer single doses will be a major advance in the field. The new combination of KAF156 with LUM-SDF is expected to provide such major advance upon successful conclusion of the WANECAM II project.
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Funck-Brentano C, Ouologuem N, Duparc S, Felices M, Sirima SB, Sagara I, Soulama I, Ouedraogo JB, Beavogui AH, Borghini-Fuhrer I, Khan Y, Djimdé AA, Voiriot P. Evaluation of the effects on the QT-interval of 4 artemisinin-based combination therapies with a correction-free and heart rate-free method. Sci Rep 2019; 9:883. [PMID: 30696921 PMCID: PMC6351684 DOI: 10.1038/s41598-018-37113-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 12/04/2018] [Indexed: 12/04/2022] Open
Abstract
Several antimalarial drugs are known to prolong ventricular repolarization as evidenced by QT/QTc interval prolongation. This can lead to Torsades de Pointes, a potentially lethal ventricular arrhythmia. Whether this is the case with artemisinin-based combination therapies (ACTs) remains uncertain. Assessment of the extent of QTc prolongation with antimalarials is hampered by important variations of heart rate during malaria crises and previous studies have reported highly variable values of QTc prolongations with ACTs. We assessed QTc prolongation with four ACTs, using high quality ECG recording and measurement techniques, during the first episode of malaria in 2,091 African patients enrolled in the WANECAM study which also monitored clinical safety. Using an original and robust method of QTc assessment, independent from heart rate changes and from the method of QT correction, we were able to accurately assess the extent of mean maximum QTc prolongation with the four ACTs tested. There was no evidence of proarrhythmia with any treatment during the study although dihydroartemisinin-piperaquine, artesunate-amodiaquine and artemether-lumefantrine significantly prolonged QTc. The extent of prolongation of ventricular repolarization can be accurately assessed in studies where heart rate changes impede QTc assessment.
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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.
| | - Nouhoum Ouologuem
- Malaria research and training center. Département d'épidémiologie des affections parasitaires, Faculté de médecine de pharmacie et d'odonto-stomatologie. P.O. Box 1805, Point G, Bamako, Mali
| | - Stephan Duparc
- Medicines for Malaria Venture, International Center Cointrin, 20 route de Pré-Bois, 1215, Geneva 15, Switzerland
| | - Mathieu Felices
- Phinc Development, Immeuble Genavenir 8, 5 rue Henri Desbruères, 91030, Evry Cedex, France
| | - Sodiomon B Sirima
- Centre national de recherche et de formation sur le paludisme, 01 P.O. Box 2208, Ouagadougou 01, Burkina Faso
| | - Issaka Sagara
- Malaria research and training center. Département d'épidémiologie des affections parasitaires, Faculté de médecine de pharmacie et d'odonto-stomatologie. P.O. Box 1805, Point G, Bamako, Mali
| | - Issiaka Soulama
- Centre national de recherche et de formation sur le paludisme, 01 P.O. Box 2208, Ouagadougou 01, Burkina Faso
| | - Jean-Bosco Ouedraogo
- IRSS, Direction Régionale de l'Ouest, 399, Avenue de la Liberté 01, P.O. Box 545, Bobo-Dioulasso 01, Burkina Faso
| | - Abdoul H Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Mafèrinyah, P.O. Box 2649, Conakry, Guinea
| | - Isabelle Borghini-Fuhrer
- Medicines for Malaria Venture, International Center Cointrin, 20 route de Pré-Bois, 1215, Geneva 15, Switzerland
| | - Yasmin Khan
- Cardiabase, 84 avenue du XXème Corps, 54000, Nancy, France
| | - Abdoulaye A Djimdé
- Malaria research and training center. Département d'épidémiologie des affections parasitaires, Faculté de médecine de pharmacie et d'odonto-stomatologie. P.O. Box 1805, Point G, Bamako, Mali
| | - Pascal Voiriot
- Cardiabase, 84 avenue du XXème Corps, 54000, Nancy, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Llanos-Cuentas A, Lacerda MVG, Hien TT, Vélez ID, Namaik-Larp C, Chu CS, Villegas MF, Val F, Monteiro WM, Brito MAM, Costa MRF, Chuquiyauri R, Casapía M, Nguyen CH, Aruachan S, Papwijitsil R, Nosten FH, Bancone G, Angus B, Duparc S, Craig G, Rousell VM, Jones SW, Hardaker E, Clover DD, Kendall L, Mohamed K, Koh GCKW, Wilches VM, Breton JJ, Green JA. Tafenoquine versus Primaquine to Prevent Relapse of Plasmodium vivax Malaria. N Engl J Med 2019; 380:229-241. [PMID: 30650326 PMCID: PMC6657225 DOI: 10.1056/nejmoa1802537] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Tafenoquine, a single-dose therapy for Plasmodium vivax malaria, has been associated with relapse prevention through the clearance of P. vivax parasitemia and hypnozoites, termed "radical cure." METHODS We performed a phase 3, prospective, double-blind, double-dummy, randomized, controlled trial to compare tafenoquine with primaquine in terms of safety and efficacy. The trial was conducted at seven hospitals or clinics in Peru, Brazil, Colombia, Vietnam, and Thailand and involved patients with normal glucose-6-phosphate dehydrogenase (G6PD) enzyme activity and female patients with moderate G6PD enzyme deficiency; all patients had confirmed P. vivax parasitemia. The patients were randomly assigned, in a 2:1 ratio, to receive a single 300-mg dose of tafenoquine or 15 mg of primaquine once daily for 14 days (administered under supervision); all patients received a 3-day course of chloroquine and were followed for 180 days. The primary safety outcome was a protocol-defined decrease in the hemoglobin level (>3.0 g per deciliter or ≥30% from baseline or to a level of <6.0 g per deciliter). Freedom from recurrence of P. vivax parasitemia at 6 months was the primary efficacy outcome in a planned patient-level meta-analysis of the current trial and another phase 3 trial of tafenoquine and primaquine (per-protocol populations), and an odds ratio for recurrence of 1.45 (tafenoquine vs. primaquine) was used as a noninferiority margin. RESULTS A protocol-defined decrease in the hemoglobin level occurred in 4 of 166 patients (2.4%; 95% confidence interval [CI], 0.9 to 6.0) in the tafenoquine group and in 1 of 85 patients (1.2%; 95% CI, 0.2 to 6.4) in the primaquine group, for a between-group difference of 1.2 percentage points (95% CI, -4.2 to 5.0). In the patient-level meta-analysis, the percentage of patients who were free from recurrence at 6 months was 67.0% (95% CI, 61.0 to 72.3) among the 426 patients in the tafenoquine group and 72.8% (95% CI, 65.6 to 78.8) among the 214 patients in the primaquine group. The efficacy of tafenoquine was not shown to be noninferior to that of primaquine (odds ratio for recurrence, 1.81; 95% CI, 0.82 to 3.96). CONCLUSIONS Among patients with normal G6PD enzyme activity, the decline in hemoglobin level with tafenoquine did not differ significantly from that with primaquine. Tafenoquine showed efficacy for the radical cure of P. vivax malaria, although tafenoquine was not shown to be noninferior to primaquine. (Funded by GlaxoSmithKline and Medicines for Malaria Venture; GATHER ClinicalTrials.gov number, NCT02216123 .).
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Affiliation(s)
- Alejandro Llanos-Cuentas
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Marcus V G Lacerda
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Tran T Hien
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Iván D Vélez
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Chayadol Namaik-Larp
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Cindy S Chu
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Maria F Villegas
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Fernando Val
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Wuelton M Monteiro
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Marcelo A M Brito
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Mônica R F Costa
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Raul Chuquiyauri
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Martín Casapía
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Chau H Nguyen
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Sandra Aruachan
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Ratchadaporn Papwijitsil
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - François H Nosten
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Germana Bancone
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Brian Angus
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Stephan Duparc
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Graham Craig
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Victoria M Rousell
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Siôn W Jones
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Elizabeth Hardaker
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Donna D Clover
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Lindsay Kendall
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Khadeeja Mohamed
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Gavin C K W Koh
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Viviana M Wilches
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - John J Breton
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
| | - Justin A Green
- From Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), and Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.) - both in Brazil; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (T.T.H., C.H.N.); Universidad de Antioquia, Medellin (I.D.V.), Centro de Investigaciones Clinicas S.A.S de Cali, Cali (M.F.V.), and IMAT Oncomedica, Monteria (S.A.) - all in Colombia; Umphang Hospital, Tak (C.N.-l., R.P.), and Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot (C.S.C., F.H.N., G.B.) - both in Thailand; the Centre for Tropical Medicine and Global Health (C.S.C., F.H.N., G.B.) and the Oxford Centre for Clinical Tropical Medicine (B.A.), Nuffield Department of Medicine, University of Oxford, Oxford, GlaxoSmithKline, Stockley Park West (G.C., V.M.R., S.W.J., E.H., D.D.C., K.M., G.C.K.W.K., J.A.G.), and GlaxoSmithKline, Stevenage (L.K.) - all in the United Kingdom; Medicines for Malaria Venture, Geneva (S.D.); and GlaxoSmithKline, Collegeville, PA (V.M.W., J.J.B.)
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Lacerda MVG, Llanos-Cuentas A, Krudsood S, Lon C, Saunders DL, Mohammed R, Yilma D, Batista Pereira D, Espino FEJ, Mia RZ, Chuquiyauri R, Val F, Casapía M, Monteiro WM, Brito MAM, Costa MRF, Buathong N, Noedl H, Diro E, Getie S, Wubie KM, Abdissa A, Zeynudin A, Abebe C, Tada MS, Brand F, Beck HP, Angus B, Duparc S, Kleim JP, Kellam LM, Rousell VM, Jones SW, Hardaker E, Mohamed K, Clover DD, Fletcher K, Breton JJ, Ugwuegbulam CO, Green JA, Koh GCKW. Single-Dose Tafenoquine to Prevent Relapse of Plasmodium vivax Malaria. N Engl J Med 2019; 380:215-228. [PMID: 30650322 PMCID: PMC6657226 DOI: 10.1056/nejmoa1710775] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Treatment of Plasmodium vivax malaria requires the clearing of asexual parasites, but relapse can be prevented only if dormant hypnozoites are cleared from the liver (a treatment termed "radical cure"). Tafenoquine is a single-dose 8-aminoquinoline that has recently been registered for the radical cure of P. vivax. METHODS This multicenter, double-blind, double-dummy, parallel group, randomized, placebo-controlled trial was conducted in Ethiopia, Peru, Brazil, Cambodia, Thailand, and the Philippines. We enrolled 522 patients with microscopically confirmed P. vivax infection (>100 to <100,000 parasites per microliter) and normal glucose-6-phosphate dehydrogenase (G6PD) activity (with normal activity defined as ≥70% of the median value determined at each trial site among 36 healthy male volunteers who were otherwise not involved in the trial). All patients received a 3-day course of chloroquine (total dose of 1500 mg). In addition, patients were assigned to receive a single 300-mg dose of tafenoquine on day 1 or 2 (260 patients), placebo (133 patients), or a 15-mg dose of primaquine once daily for 14 days (129 patients). The primary outcome was the Kaplan-Meier estimated percentage of patients who were free from recurrence at 6 months, defined as P. vivax clearance without recurrent parasitemia. RESULTS In the intention-to-treat population, the percentage of patients who were free from recurrence at 6 months was 62.4% in the tafenoquine group (95% confidence interval [CI], 54.9 to 69.0), 27.7% in the placebo group (95% CI, 19.6 to 36.6), and 69.6% in the primaquine group (95% CI, 60.2 to 77.1). The hazard ratio for the risk of recurrence was 0.30 (95% CI, 0.22 to 0.40) with tafenoquine as compared with placebo (P<0.001) and 0.26 (95% CI, 0.18 to 0.39) with primaquine as compared with placebo (P<0.001). Tafenoquine was associated with asymptomatic declines in hemoglobin levels, which resolved without intervention. CONCLUSIONS Single-dose tafenoquine resulted in a significantly lower risk of P. vivax recurrence than placebo in patients with phenotypically normal G6PD activity. (Funded by GlaxoSmithKline and Medicines for Malaria Venture; DETECTIVE ClinicalTrials.gov number, NCT01376167 .).
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Affiliation(s)
- Marcus V G Lacerda
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Alejandro Llanos-Cuentas
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Srivicha Krudsood
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Chanthap Lon
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - David L Saunders
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Rezika Mohammed
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Daniel Yilma
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Dhelio Batista Pereira
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Fe E J Espino
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Reginaldo Z Mia
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Raul Chuquiyauri
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Fernando Val
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Martín Casapía
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Wuelton M Monteiro
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Marcelo A M Brito
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Mônica R F Costa
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Nillawan Buathong
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Harald Noedl
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Ermias Diro
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Sisay Getie
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Kalehiwot M Wubie
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Alemseged Abdissa
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Ahmed Zeynudin
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Cherinet Abebe
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Mauro S Tada
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Françoise Brand
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Hans-Peter Beck
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Brian Angus
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Stephan Duparc
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Jörg-Peter Kleim
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Lynda M Kellam
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Victoria M Rousell
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Siôn W Jones
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Elizabeth Hardaker
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Khadeeja Mohamed
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Donna D Clover
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Kim Fletcher
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - John J Breton
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Cletus O Ugwuegbulam
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Justin A Green
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
| | - Gavin C K W Koh
- From Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus (M.V.G.L., F.V., W.M.M., M.A.M.B., M.R.F.C.), Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro (M.V.G.L.), and Centro de Pesquisa em Medicina Tropical Rondônia, Porto Velho (D.B.P., M.S.T.) - all in Brazil; Universidad Peruana Cayetano Heredia, Lima, Peru (A.L.-C., R.C., M.C.); Mahidol University (S.K.) and the Armed Forces Research Institute of Medical Sciences (C.L., D.L.S., N.B.), Bangkok, Thailand; the University of Gondar, Gondar (R.M., E.D., S.G., K.M.W.), and Jimma University, Jimma (D.Y., A.A., A.Z., C.A.) - both in Ethiopia; Research Institute for Tropical Medicine, Manila (F.E.J.E.), and Rio Tuba Nickel Foundation Hospital, Palawan (R.Z.M.) - both in the Philippines; Medical University of Vienna, Vienna (H.N.); Swiss Tropical and Public Health Institute and University of Basel, Basel (F.B., H.-P.B.), and Medicines for Malaria Venture, Geneva (S.D.) - both in Switzerland; Oxford University, Oxford (B.A.), and GlaxoSmithKline, Stockley Park West (J.-P.K., L.M.K., V.M.R., S.W.J., E.H., K.M., D.D.C., K.F., C.O.U., J.A.G., G.C.K.W.K.) - both in the United Kingdom; and GlaxoSmithKline, Collegeville, PA (J.J.B.)
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Pradhan S, Pradhan MM, Dutta A, Shah NK, Joshi PL, Pradhan K, Sharma SK, Grewal Daumerie P, Banerji J, Duparc S, Mendis K, Murugasampillay S, Valecha N, Anvikar AR. Improved access to early diagnosis and complete treatment of malaria in Odisha, India. PLoS One 2019; 14:e0208943. [PMID: 30601833 PMCID: PMC6314604 DOI: 10.1371/journal.pone.0208943] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/26/2018] [Indexed: 11/18/2022] Open
Abstract
Background In 2013, the Comprehensive Case Management Programme (CCMP) was initiated to assess the impact of universal access to diagnosis and treatment and improved surveillance on malaria transmission in different settings in Odisha state, India. Methods Pairs of intervention and control sub-districts (blocks), matched on malaria incidence were selected in four districts with different transmission intensities. CCMP activities included training and supervision, ensuring no stock-outs of malaria tests and drugs, analysing verified surveillance data, stratifying areas based on risk factors, and appointing alternative providers to underserved areas. Composite risk scores were calculated for each sub-centre using principal component analysis. Post−pre changes (2013–2015 versus 2011–2012) for annual blood examination rates (ABER) and annual parasite incidence (API) across intervention and control groups were assessed using difference-in-difference (DID) estimates, adjusted for malaria transmission risk. Results In the intervention sub-centres, the mean increase in ABER was 6.41 tests/sub-centre (95%CI 4.69, 8.14; p<0.01) and in API was 9.2 cases diagnosed/sub-centre (95%CI 5.18, 13.21; p<0.01). The control sub-centres reported lower increases in ABER (2.84 [95%CI 0.35, 5.34]; p<0.05) and API (3.68 [95%CI 0.45, 6.90]; p<0.05). The control-adjusted post–pre changes in API showed that 5.52 more cases (95%CI 0.34, 10.70; p<0.05) were diagnosed, and a 3.6 more cases (95%CI 0.58, 6.56; p<0.05) were tested per sub-centre in the intervention versus control areas. Larger differences in post–pre changes in API between intervention and control sub-centres were registered in the higher transmission-risk areas compared with the lower risk areas. All the changes were statistically significant. Conclusions Intensive intervention activities targeted at improved access to malaria diagnosis and treatment produced a substantial increase in blood examination and case notification, especially in inaccessible, hard-to-reach pockets. CCMP provides insights into how to achieve universal coverage of malaria services through a routine, state-run programme.
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Affiliation(s)
- Sreya Pradhan
- National Vector Borne Disease Control Programme, Government of Odisha, Bhubaneswar, India
| | - Madan Mohan Pradhan
- National Vector Borne Disease Control Programme, Government of Odisha, Bhubaneswar, India
| | - Ambarish Dutta
- Indian Institute of Public Health, Bhubaneswar, India
- Kalinga Institute of Industrial Technology, Deemed to be University, Bhubaneswar, India
| | - Naman K. Shah
- University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | | | - S. K. Sharma
- National Institute of Malaria Research, New Delhi, India
| | | | - Jaya Banerji
- Medicines for Malaria Venture, Geneva, Switzerland
| | | | | | | | - Neena Valecha
- National Institute of Malaria Research, New Delhi, India
- * E-mail: (ARA); (NV)
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32
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Wells T, Samby K, Ramachandruni H, Banerji J, Burrows J, Daumerie P, Hooft van Huijsduijnen R, Duparc S. Partnering to fight malaria in India: Past, present and future. J Vector Borne Dis 2019; 56:15-24. [DOI: 10.4103/0972-9062.257769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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33
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Burrows J, Slater H, Macintyre F, Rees S, Thomas A, Okumu F, Hooft van Huijsduijnen R, Duparc S, Wells TNC. A discovery and development roadmap for new endectocidal transmission-blocking agents in malaria. Malar J 2018; 17:462. [PMID: 30526594 PMCID: PMC6287360 DOI: 10.1186/s12936-018-2598-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/24/2018] [Indexed: 11/10/2022] Open
Abstract
Reaching the overall goal of eliminating malaria requires halting disease transmission. One approach to blocking transmission is to prevent passage of the parasite to a mosquito, by preventing formation or transmission of gametocytes. An alternative approach, pioneered in the veterinary field, is to use endectocides, which are molecules that render vertebrate blood meals toxic for the mosquito vector, also killing the parasite. Field studies and modelling suggest that reducing the lifespan of the mosquito may significantly reduce transmission, given the lengthy maturation process of the parasite. To guide the development of new endectocides, or the reformulation of existing molecules, it is important to construct a framework of the required attributes, commonly called the target candidate profile. Here, using a combination of insights from current endectocides, mathematical models of the malaria transmission dynamics, and known impacts of vector control, a target candidate profile (TCP-6) and a regulatory strategy are proposed for a transmission reducing agent. The parameters chosen can be used to assess the potential of a new medicine, independent of whether it has classical endectocide activity, reduces the insect and parasite lifespan or any combination of all three, thereby constituting an ‘endectocidal transmission blocking’ paradigm.
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Affiliation(s)
- Jeremy Burrows
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva 15, Switzerland.
| | - Hannah Slater
- PATH, 2201 Westlake Avenue, Seattle, WA, 98121, USA.,Department of Infectious Disease Epidemiology, MRC Centre for Global Disease Analysis, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Fiona Macintyre
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva 15, Switzerland
| | - Sarah Rees
- Innovative Vector Control Consortium, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Anna Thomas
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva 15, Switzerland
| | - Fredros Okumu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, Off Mlabani Passage, Ifakara, Morogoro, United Republic of Tanzania.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Republic of South Africa.,Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | | | - Stephan Duparc
- 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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34
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Macintyre F, Ramachandruni H, Burrows JN, Holm R, Thomas A, Möhrle JJ, Duparc S, Hooft van Huijsduijnen R, Greenwood B, Gutteridge WE, Wells TNC, Kaszubska W. Injectable anti-malarials revisited: discovery and development of new agents to protect against malaria. Malar J 2018; 17:402. [PMID: 30384848 PMCID: PMC6211409 DOI: 10.1186/s12936-018-2549-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/24/2018] [Indexed: 12/20/2022] Open
Abstract
Over the last 15 years, the majority of malaria drug discovery and development efforts have focused on new molecules and regimens to treat patients with uncomplicated or severe disease. In addition, a number of new molecular scaffolds have been discovered which block the replication of the parasite in the liver, offering the possibility of new tools for oral prophylaxis or chemoprotection, potentially with once-weekly dosing. However, an intervention which requires less frequent administration than this would be a key tool for the control and elimination of malaria. Recent progress in HIV drug discovery has shown that small molecules can be formulated for injections as native molecules or pro-drugs which provide protection for at least 2 months. Advances in antibody engineering offer an alternative approach whereby a single injection could potentially provide protection for several months. Building on earlier profiles for uncomplicated and severe malaria, a target product profile is proposed here for an injectable medicine providing long-term protection from this disease. As with all of such profiles, factors such as efficacy, cost, safety and tolerability are key, but with the changing disease landscape in Africa, new clinical and regulatory approaches are required to develop prophylactic/chemoprotective medicines. An overall framework for these approaches is suggested here.
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Affiliation(s)
- Fiona Macintyre
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva, Switzerland
| | - Hanu Ramachandruni
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva, Switzerland
| | - Jeremy N Burrows
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva, Switzerland
| | - René Holm
- Drug Product Development, Janssen R&D, Johnson & Johnson, Turnhoutseweg 30, 2340, Beerse, Belgium.,Department of Science and Environment, Roskilde University, 4000, Roskilde, Denmark
| | - Anna Thomas
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva, Switzerland
| | - Jörg J Möhrle
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva, Switzerland
| | - Stephan Duparc
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva, Switzerland
| | | | - Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Timothy N C Wells
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva, Switzerland.
| | - Wiweka Kaszubska
- Medicines for Malaria Venture, Route de Pré Bois 20, 1215, Geneva, Switzerland
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35
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Llanos-Cuentas A, Casapia M, Chuquiyauri R, Hinojosa JC, Kerr N, Rosario M, Toovey S, Arch RH, Phillips MA, Rozenberg FD, Bath J, Ng CL, Cowell AN, Winzeler EA, Fidock DA, Baker M, Möhrle JJ, Hooft van Huijsduijnen R, Gobeau N, Araeipour N, Andenmatten N, Rückle T, Duparc S. Antimalarial activity of single-dose DSM265, a novel plasmodium dihydroorotate dehydrogenase inhibitor, in patients with uncomplicated Plasmodium falciparum or Plasmodium vivax malaria infection: a proof-of-concept, open-label, phase 2a study. Lancet Infect Dis 2018; 18:874-883. [PMID: 29909069 PMCID: PMC6060173 DOI: 10.1016/s1473-3099(18)30309-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/27/2018] [Accepted: 05/09/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND DSM265 is a novel, long-duration inhibitor of plasmodium dihydroorotate dehydrogenase (DHODH) with excellent selectivity over human DHODH and activity against blood and liver stages of Plasmodium falciparum. This study aimed to assess the efficacy of DSM265 in patients with P falciparum or Plasmodium vivax malaria infection. METHODS This proof-of-concept, open-label, phase 2a study was conducted at the Asociación Civil Selva Amazónica in Iquitos, Peru. Patients aged 18-70 years, weighing 45-90 kg, who had clinical malaria (P falciparum or P vivax monoinfection) and fever within the previous 24 h were eligible. Exclusion criteria were clinical or laboratory signs of severe malaria, inability to take oral medicine, and use of other antimalarial treatment in the preceding 14 days. Patients were divided into cohorts of those with P falciparum (cohort a) or P vivax (cohort b) infection. Two initial cohorts received single oral doses of 400 mg DSM265. Patients were followed up for efficacy for 28 days and safety for 35 days. Further cohorts received escalated or de-escalated doses of DSM265, after safety and efficacy assessment of the initial dose. The primary endpoints were the proportion of patients achieving PCR-adjusted adequate clinical and parasitological response (ACPR) by day 14 for patients infected with P falciparum and the proportion of patients achieving a crude cure by day 14 for those infected with P vivax. Cohort success, the criteria for dose escalation, was defined as ACPR (P falciparum) or crude cure (P vivax) in at least 80% of patients in the cohort. The primary analysis was done in the intention-to-treat population (ITT) and the per-protocol population, and safety analyses were done in all patients who received the study drug. This study is registered at ClinicalTrials.gov (NCT02123290). FINDINGS Between Jan 12, 2015, and Dec 2, 2015, 45 Peruvian patients (24 with P falciparum [cohort a] and 21 with P vivax [cohort b] infection) were sequentially enrolled. For patients with P falciparum malaria in the per-protocol population, all 11 (100%) in the 400 mg group and eight (80%) of ten in the 250 mg group achieved ACPR on day 14. In the ITT analysis, 11 (85%) of 13 in the 400 mg group and eight (73%) of 11 in the 250 mg group achieved ACPR at day 14. For the patients with P vivax malaria, the primary endpoint was not met. In the per-protocol analysis, none of four patients who had 400 mg, three (50%) of six who had 600 mg, and one (25%) of four who had 800 mg DSM265 achieved crude cure at day 14. In the ITT analysis, none of five in the 400 mg group, three (33%) of nine in the 600 mg group, and one (14%) of seven in the 800 mg group achieved crude cure at day 14. During the 28-day extended observation of P falciparum patients, a resistance-associated mutation in the gene encoding the DSM265 target DHODH was observed in two of four recurring patients. DSM265 was well tolerated. The most common adverse events were pyrexia (20 [44%] of 45) and headache (18 [40%] of 45), which are both common symptoms of malaria, and no patients had any treatment-related serious adverse events or adverse events leading to study discontinuation. INTERPRETATION After a single dose of DSM265, P falciparum parasitaemia was rapidly cleared, whereas against P vivax, DSM265 showed less effective clearance kinetics. Its long duration of action provides the potential to prevent recurrence of P falciparum after treatment with a single dose, which should be further assessed in future combination studies. FUNDING The Global Health Innovative Technology Fund, the Bill & Melinda Gates Foundation, the National Institutes of Health (R01 AI103058), the Wellcome Trust, and the UK Department of International Development.
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Affiliation(s)
| | | | - Raúl Chuquiyauri
- Universidad Peruana Cayetano Heredia, Lima, Peru; Asociación Civil Selva Amazónica, Iquitos, Peru
| | | | - Nicola Kerr
- Medicines for Malaria Venture, Geneva, Switzerland
| | - Maria Rosario
- Takeda Development Center Americas Inc, Cambridge, MA, USA
| | | | - Robert H Arch
- Takeda Development Center Americas Inc, Cambridge, MA, USA
| | - Margaret A Phillips
- Department of Biochemistry, University of Texas Southwestern Medical Centre, Dallas, TX, USA
| | - Felix D Rozenberg
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, USA
| | - Jade Bath
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, USA
| | - Caroline L Ng
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, USA
| | - Annie N Cowell
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Elizabeth A Winzeler
- School of Medicine, University of California San Diego, La Jolla, CA, USA; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - David A Fidock
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY, USA; Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Mark Baker
- GlaxoSmithKline Consumer Healthcare Switzerland AG, Rotkreuz, Switzerland
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36
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Thriemer K, Bobogare A, Ley B, Gudo CS, Alam MS, Anstey NM, Ashley E, Baird JK, Gryseels C, Jambert E, Lacerda M, Laihad F, Marfurt J, Pasaribu AP, Poespoprodjo JR, Sutanto I, Taylor WR, van den Boogaard C, Battle KE, Dysoley L, Ghimire P, Hawley B, Hwang J, Khan WA, Mudin RNB, Sumiwi ME, Ahmed R, Aktaruzzaman MM, Awasthi KR, Bardaji A, Bell D, Boaz L, Burdam FH, Chandramohan D, Cheng Q, Chindawongsa K, Culpepper J, Das S, Deray R, Desai M, Domingo G, Duoquan W, Duparc S, Floranita R, Gerth-Guyette E, Howes RE, Hugo C, Jagoe G, Sariwati E, Jhora ST, Jinwei W, Karunajeewa H, Kenangalem E, Lal BK, Landuwulang C, Le Perru E, Lee SE, Makita LS, McCarthy J, Mekuria A, Mishra N, Naket E, Nambanya S, Nausien J, Duc TN, Thi TN, Noviyanti R, Pfeffer D, Qi G, Rahmalia A, Rogerson S, Samad I, Sattabongkot J, Satyagraha A, Shanks D, Sharma SN, Sibley CH, Sungkar A, Syafruddin D, Talukdar A, Tarning J, ter Kuile F, Thapa S, Theodora M, Huy TT, Waramin E, Waramori G, Woyessa A, Wongsrichanalai C, Xa NX, Yeom JS, Hermawan L, Devine A, Nowak S, Jaya I, Supargiyono S, Grietens KP, Price RN. Quantifying primaquine effectiveness and improving adherence: a round table discussion of the APMEN Vivax Working Group. Malar J 2018; 17:241. [PMID: 29925430 PMCID: PMC6011582 DOI: 10.1186/s12936-018-2380-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/08/2018] [Indexed: 01/13/2023] Open
Abstract
The goal to eliminate malaria from the Asia-Pacific by 2030 will require the safe and widespread delivery of effective radical cure of malaria. In October 2017, the Asia Pacific Malaria Elimination Network Vivax Working Group met to discuss the impediments to primaquine (PQ) radical cure, how these can be overcome and the methodological difficulties in assessing clinical effectiveness of radical cure. The salient discussions of this meeting which involved 110 representatives from 18 partner countries and 21 institutional partner organizations are reported. Context specific strategies to improve adherence are needed to increase understanding and awareness of PQ within affected communities; these must include education and health promotion programs. Lessons learned from other disease programs highlight that a package of approaches has the greatest potential to change patient and prescriber habits, however optimizing the components of this approach and quantifying their effectiveness is challenging. In a trial setting, the reactivity of participants results in patients altering their behaviour and creates inherent bias. Although bias can be reduced by integrating data collection into the routine health care and surveillance systems, this comes at a cost of decreasing the detection of clinical outcomes. Measuring adherence and the factors that relate to it, also requires an in-depth understanding of the context and the underlying sociocultural logic that supports it. Reaching the elimination goal will require innovative approaches to improve radical cure for vivax malaria, as well as the methods to evaluate its effectiveness.
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Affiliation(s)
- Kamala Thriemer
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia
| | - Albino Bobogare
- Ministry of Health and Medical Services, National Vector-Borne Disease Control Programme, Honiara, Solomon Islands
| | - Benedikt Ley
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia
| | | | - Mohammad Shafiul Alam
- 0000 0004 0600 7174grid.414142.6International Center for Diarrheal Diseases (ICDDR,B), Dhaka, Bangladesh
| | - Nick M. Anstey
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia
| | - Elizabeth Ashley
- Myanmar-Oxford Clinical Research Unit, Yangon, Myanmar ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - J. Kevin Baird
- 0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK ,0000 0004 1795 0993grid.418754.bEijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Charlotte Gryseels
- 0000 0001 2153 5088grid.11505.30Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Elodie Jambert
- 0000 0004 0432 5267grid.452605.0Medicines for Malaria Venture (MMV), Geneva, Switzerland
| | - Marcus Lacerda
- Instituto Leônidas & Maria Deane (Fiocruz), Manaus, Amazonas Brazil ,0000 0004 0486 0972grid.418153.aFundação de Medicina Tropical Dr, Heitor Vieira Dourado, Manaus, Amazonas Brazil
| | - Ferdinand Laihad
- National Forum on Indonesia RBM/National Forum on Gebrak Malaria, Jakarta, Indonesia
| | - Jutta Marfurt
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia
| | | | | | - Inge Sutanto
- 0000000120191471grid.9581.5University of Indonesia, Jakarta, Indonesia
| | - Walter R. Taylor
- 0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK ,Mahidol Oxford Clinical Research Unit (MORU), Bangkok, Thailand
| | - Christel van den Boogaard
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia
| | - Katherine E. Battle
- 0000 0004 1936 8948grid.4991.5Malaria Atlas Project (MAP), Big Data Institute, University of Oxford, Oxford, UK
| | - Lek Dysoley
- grid.452707.3National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia ,grid.436334.5School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Prakash Ghimire
- 0000 0001 2114 6728grid.80817.36Microbiology Department, Tribhuvan University, Kathmandu, Nepal
| | - Bill Hawley
- 0000 0001 2163 0069grid.416738.fEntomology Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, USA
| | - Jimee Hwang
- 0000 0001 2163 0069grid.416738.fPresident’s Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, USA ,0000 0001 2297 6811grid.266102.1Global Health Group, University of California San Francisco, San Francisco, USA
| | - Wasif Ali Khan
- 0000 0004 0600 7174grid.414142.6International Center for Diarrheal Diseases (ICDDR,B), Dhaka, Bangladesh
| | - Rose Nani Binti Mudin
- 0000 0001 0690 5255grid.415759.bDisease Control Division, Ministry of Health, Putrajaya, Malaysia
| | | | - Rukhsana Ahmed
- 0000 0004 1936 9764grid.48004.38Liverpool School of Tropical Medicine, Liverpool, UK
| | - M. M. Aktaruzzaman
- grid.466907.aDirectorate General of Health Services, Ministry of Health & Family Welfare Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | | | - Azucena Bardaji
- 0000 0000 9635 9413grid.410458.cISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - David Bell
- 0000 0004 0406 7608grid.471104.7Intellectual Ventures Global Good Fund, Bellevue, USA
| | - Leonard Boaz
- Ministry of Health and Medical Services, National Vector-Borne Disease Control Programme, Honiara, Solomon Islands
| | | | - Daniel Chandramohan
- 0000 0004 0425 469Xgrid.8991.9The London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Qin Cheng
- Australian Defence Force Malaria and Infectious Disease Institute, Enoggera, Australia
| | | | - Janice Culpepper
- 0000 0000 8990 8592grid.418309.7Bill & Melinda Gates Foundation, Seattle, USA
| | - Santasabuj Das
- 0000 0004 1767 225Xgrid.19096.37Indian Council of Medical Research, New Delhi, India
| | - Raffy Deray
- Department of Health, National Centre for Disease Control & Prevention, Manila, Philippines
| | - Meghna Desai
- 0000 0001 2163 0069grid.416738.fMalaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Wang Duoquan
- 0000 0000 8803 2373grid.198530.6National Institute of Parasitic Diseases, China CDC, Shanghai, China
| | - Stephan Duparc
- 0000 0004 0432 5267grid.452605.0Medicines for Malaria Venture (MMV), Geneva, Switzerland
| | | | | | - Rosalind E. Howes
- 0000 0004 1936 8948grid.4991.5Malaria Atlas Project (MAP), Big Data Institute, University of Oxford, Oxford, UK
| | | | - George Jagoe
- 0000 0004 0432 5267grid.452605.0Medicines for Malaria Venture (MMV), Geneva, Switzerland
| | - Elvieda Sariwati
- 0000 0004 0470 8161grid.415709.eMinistry of Health, National Malaria Control Program, Jakarta, Indonesia
| | - Sanya Tahmina Jhora
- grid.466907.aDirectorate General of Health Services, Ministry of Health & Family Welfare Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Wu Jinwei
- Tengchong Center for Disease Control and Prevention, Tengchong, China
| | - Harin Karunajeewa
- grid.1042.7Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Enny Kenangalem
- Yayasan Pengembangan Kesehatan dan Masyarakat, Papua (YPKMP), Papua, Indonesia
| | - Bibek Kumar Lal
- Epidemiology & Disease Control Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | | | | | - Sang-Eun Lee
- 0000 0004 1763 8617grid.418967.5Division of Vectors and Parasitic Diseases, Korea Centers for Disease Control and Prevention, Seoul, South Korea
| | - Leo Sora Makita
- Ministry of Health, National Malaria Control Programme, Port Mosby, Papua New Guinea
| | - James McCarthy
- 0000 0001 2294 1395grid.1049.cQIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Asrat Mekuria
- 0000 0001 1250 5688grid.7123.7School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Neelima Mishra
- 0000 0004 1767 225Xgrid.19096.37Indian Council of Medical Research, New Delhi, India
| | - Esau Naket
- Ministry of Health, Malaria and Other Vector-Borne Diseases Control Program (MOVBDCP), Port Vila, Vanuatu
| | - Simone Nambanya
- Center of Malariology, Parasitology and Entomology, Communicable Diseases Control, Vientiane, Lao PDR
| | - Johnny Nausien
- Ministry of Health, Malaria and Other Vector-Borne Diseases Control Program (MOVBDCP), Port Vila, Vanuatu
| | - Thang Ngo Duc
- grid.452658.8National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Thuan Nguyen Thi
- grid.452658.8National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Rinitis Noviyanti
- 0000 0004 1795 0993grid.418754.bEijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Daniel Pfeffer
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia ,0000 0004 1936 8948grid.4991.5Malaria Atlas Project (MAP), Big Data Institute, University of Oxford, Oxford, UK
| | - Gao Qi
- grid.452515.2Jiangsu Institute of Parasitic Diseases, Wuxi, China ,WHO Collaborative Centre for Research and Training of Malaria Elimination, Wuxi, China
| | - Annisa Rahmalia
- 0000 0004 1796 1481grid.11553.33Tuberculosis-HIV Research Center Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia ,0000000122931605grid.5590.9Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Stephen Rogerson
- 0000 0001 2179 088Xgrid.1008.9Department of Medicine at the Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Iriani Samad
- 0000 0004 0470 8161grid.415709.eMinistry of Health, National Malaria Control Program, Jakarta, Indonesia
| | - Jetsumon Sattabongkot
- 0000 0004 1937 0490grid.10223.32Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Bangok, Thailand
| | - Ari Satyagraha
- 0000 0004 1795 0993grid.418754.bEijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Dennis Shanks
- Australian Defence Force Malaria and Infectious Disease Institute, Enoggera, Australia
| | - Surender Nath Sharma
- grid.415820.aNational Vector Borne Disease Control Programme Directorate General of Health Services Ministry of Health & Family Welfare, New Delhi, India
| | - Carol Hopkins Sibley
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,0000000122986657grid.34477.33University of Washington, Seattle, WA USA
| | - Ali Sungkar
- 0000 0004 0470 8161grid.415709.eFamily Health Directorate, Ministry of Health, Jakarta, Indonesia
| | - Din Syafruddin
- 0000 0004 1795 0993grid.418754.bEijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Arunansu Talukdar
- 0000 0004 1768 2335grid.413204.0Medicine Department, Medical College Kolkata, Kolkata, India
| | - Joel Tarning
- Mahidol Oxford Clinical Research Unit (MORU), Bangkok, Thailand
| | - Feiko ter Kuile
- 0000 0004 1936 9764grid.48004.38Liverpool School of Tropical Medicine, Liverpool, UK ,0000 0001 0155 5938grid.33058.3dKenya Medical Research Institute (KEMRI) Centre for Global Health Research, Kisumu, Kenya
| | | | - Minerva Theodora
- 0000 0004 0470 8161grid.415709.eMinistry of Health, National Malaria Control Program, Jakarta, Indonesia
| | - Tho Tran Huy
- grid.452658.8National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Edward Waramin
- Family Health Services, Ministry of Health, Port Mosby, Papua New Guinea
| | | | - Adugna Woyessa
- grid.452387.fEthiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | | | - Nguyen Xuan Xa
- grid.452658.8National Institute of Malariology, Parasitology and Entomology (NIMPE), Hanoi, Vietnam
| | - Joon Sup Yeom
- 0000 0004 0470 5454grid.15444.30Yonsei University College of Medicine, Seoul, South Korea
| | - Lukas Hermawan
- 0000 0004 0470 8161grid.415709.eFamily Health Directorate, Ministry of Health, Jakarta, Indonesia
| | - Angela Devine
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK ,Mahidol Oxford Clinical Research Unit (MORU), Bangkok, Thailand
| | - Spike Nowak
- 0000 0000 8940 7771grid.415269.dPATH, Seattle, USA
| | - Indra Jaya
- Program and Information Department, Directorate General of Disease Prevention and Control, Jakarta, Indonesia
| | | | - Koen Peeters Grietens
- 0000 0001 2153 5088grid.11505.30Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Ric N. Price
- 0000 0000 8523 7955grid.271089.5Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Darwin, NT 0810 Australia ,0000 0004 1936 8948grid.4991.5Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Goyal N, Mohamed K, Rolfe K, Sahota S, Ernest T, Duparc S, Taylor M, Casillas L, Koh GCKW. Application of the Stable Isotope Label Approach in Clinical Development-Supporting Dissolution Specifications for a Commercial Tablet Product with Tafenoquine, a Long Half-life Compound. AAPS J 2018; 20:74. [PMID: 29869298 DOI: 10.1208/s12248-018-0234-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/16/2018] [Indexed: 12/16/2022]
Abstract
Bioavailability/bioequivalence studies supporting clinical drug development or commercial supply of drug formulations are often time, cost, and resource intensive. The drug's pharmacokinetic (PK) variability, systemic half-life, and safety issues may pose additional challenges. The stable isotope label (SIL) approach provides a useful tool to significantly reduce the study size in clinical PK studies. Tafenoquine (TQ) is an 8-aminoquinoline under development for preventing Plasmodium vivax malaria relapse. This SIL study assessed the impact of differences in the in vitro dissolution profiles on in vivo exposure of TQ tablets. Fourteen healthy volunteers received a single dose of 300 mg TQ Intermediate Aged or 300 mg TQ Control formulations in this single-center, two-arm, randomized, open-label, parallel-group study. Endpoints included the geometric means ratio of the area under the concentration-time curve (AUC(0-t) and AUC(0-∞); primary endpoint) and maximum plasma concentration (Cmax) for Intermediate Aged versus Control TQ; correlation of PK parameters for venous versus peripheral (via microsample) blood samples; and safety and tolerability endpoints. Geometric mean ratios for PK parameters (AUC and Cmax) and their 90% confidence intervals fell well within standard bioequivalence limits (0.80-1.25). Only one mild adverse event (skin abrasion) was reported. In summary, this SIL methodology-based study demonstrates that the observed differences in the in vitro dissolution profiles between the Control and Intermediate Aged TQ tablets have no clinically relevant effect on systemic TQ exposure. The SIL approach was successfully implemented to enable the setting of a clinically relevant dissolution specification. CLINICAL TRIAL This study (GSK study number 201780) is registered at clinicaltrials.gov with identifier NCT02751294.
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Affiliation(s)
- Navin Goyal
- Clinical Pharmacology, GlaxoSmithKline US, Swedeland Road, King of Prussia, Pennsylvania, 19406, USA.
| | - Khadeeja Mohamed
- Statistics, Programming and Data Strategy, GlaxoSmithKline, Uxbridge, Middlesex, UK
| | - Katie Rolfe
- Statistics, Programming and Data Strategy, GlaxoSmithKline, Uxbridge, Middlesex, UK
| | - Satty Sahota
- Product Development, GlaxoSmithKline, Ware, Hertfordshire, UK
| | - Terry Ernest
- Product Development, GlaxoSmithKline, Ware, Hertfordshire, UK
| | | | - Maxine Taylor
- Mechanistic Safety and Disposition, GlaxoSmithKline, Ware, Hertfordshire, UK
| | - Linda Casillas
- Clinical Pharmacology, GlaxoSmithKline US, Swedeland Road, King of Prussia, Pennsylvania, 19406, USA
| | - Gavin C K W Koh
- Diseases of the Developing World, GlaxoSmithKline, Uxbridge, Middlesex, UK
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38
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Mtove G, Kimani J, Kisinza W, Makenga G, Mangesho P, Duparc S, Nakalembe M, Phiri KS, Orrico R, Rojo R, Vandenbroucke P. Multiple-level stakeholder engagement in malaria clinical trials: addressing the challenges of conducting clinical research in resource-limited settings. Trials 2018; 19:190. [PMID: 29566732 PMCID: PMC5863846 DOI: 10.1186/s13063-018-2563-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/07/2018] [Indexed: 01/07/2023] Open
Abstract
Background Multinational clinical trials are logistically complex and require close coordination between various stakeholders. They must comply with global clinical standards and are accountable to multiple regulatory and ethical bodies. In resource-limited settings, it is challenging to understand how to apply global clinical standards to international, national, and local factors in clinical trials, making multiple-level stakeholder engagement an important element in the successful conduct of these clinical trials. Main body During the planning and implementation of a large multinational clinical trial for intermittent preventive treatment of malaria in pregnancy in resource-limited areas of sub-Saharan Africa, we encountered numerous challenges, which required implementation of a range of engagement measures to ensure compliance with global clinical and regulatory standards. These challenges included coordination with ongoing global malaria efforts, heterogeneity in national regulatory structures, sub-optimal healthcare infrastructure, local practices and beliefs, and perspectives that view healthcare providers with undue trust or suspicion. In addition to engagement with international bodies, such as the World Health Organization, the Malaria in Pregnancy Consortium, the Steve Biko Centre for Bioethics, and the London School of Hygiene and Tropical Medicine, in order to address the challenges just described, Pfizer Inc. and Medicines for Malaria Venture (the “Sponsoring Entities” for these studies) and investigators liaised with national- and district-level stakeholders such as health ministers and regional/local community health workers. Community engagement measures undertaken by investigators included local meetings with community leaders to explain the research aims and answer questions and concerns voiced by the community. The investigators also engaged with family members of prospective trial participants in order to be sensitive to local practices and beliefs. Conclusion Engagement with key stakeholders at international and national levels enabled the Sponsoring Entities to address challenges by aligning the study design with the requirements of health and regulatory agencies and to understand and address healthcare infrastructure needs prior to trial initiation. Local stakeholder engagement, including community members, study participants, and family enabled the investigators to address challenges by ensuring that study design and conduct were adapted to local considerations and ensuring accurate information about the study aims was shared with the public. Trial registration ClinicalTrials.gov, ID: NCT01103063. Registered on 7 April 2010.
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Affiliation(s)
- George Mtove
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania.
| | - Joshua Kimani
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - William Kisinza
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania
| | - Geofrey Makenga
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania
| | - Peter Mangesho
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania
| | | | | | - Kamija S Phiri
- College of Medicine, University of Malawi, Blantyre, Malawi
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39
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Macintyre F, Adoke Y, Tiono AB, Duong TT, Mombo-Ngoma G, Bouyou-Akotet M, Tinto H, Bassat Q, Issifou S, Adamy M, Demarest H, Duparc S, Leroy D, Laurijssens BE, Biguenet S, Kibuuka A, Tshefu AK, Smith M, Foster C, Leipoldt I, Kremsner PG, Phuc BQ, Ouedraogo A, Ramharter M. A randomised, double-blind clinical phase II trial of the efficacy, safety, tolerability and pharmacokinetics of a single dose combination treatment with artefenomel and piperaquine in adults and children with uncomplicated Plasmodium falciparum malaria. BMC Med 2017; 15:181. [PMID: 28988541 PMCID: PMC5632828 DOI: 10.1186/s12916-017-0940-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical development of a single encounter treatment for uncomplicated malaria has the potential to significantly improve the effectiveness of antimalarials. Exploratory data suggested that the combination of artefenomel and piperaquine phosphate (PQP) has the potential to achieve satisfactory cure rates as a single dose therapy. The primary objective of the study was to determine whether a single dose of artefenomel (800 mg) plus PQP in ascending doses is an efficacious treatment for uncomplicated Plasmodium falciparum malaria in the 'target' population of children ≤ 5 years of age in Africa as well as Asian patients of all ages. METHODS Patients in six African countries and in Vietnam were randomised to treatment with follow-up for 42-63 days. Efficacy, tolerability, safety and pharmacokinetics were assessed. Additional key objectives were to characterise the exposure-response relationship for polymerase chain reaction (PCR)-adjusted adequate clinical and parasitological response at day 28 post-dose (ACPR28) and to further investigate Kelch13 mutations. Patients in Africa (n = 355) and Vietnam (n = 82) were included, with 85% of the total population being children < 5 years of age. RESULTS ACPR28 in the per protocol population (95% confidence interval) was 70.8% (61.13-79.19), 68.4% (59.13-76.66) and 78.6% (70.09-85.67) for doses of 800 mg artefenomel with 640 mg, 960 mg and 1440 mg of PQP respectively. ACPR28 was lower in Vietnamese than in African patients (66.2%; 54.55-76.62 and 74.5%; 68.81-79.68) respectively. Within the African population, efficacy was lowest in the youngest age group of ≥ 0.5 to ≤ 2 years, 52.7% (38.80-66.35). Initial parasite clearance was twice as long in Vietnam than in Africa. Within Vietnam, the frequency of the Kelch13 mutation was 70.1% and was clearly associated with parasite clearance half-life (PCt1/2). The most significant tolerability finding was vomiting (28.8%). CONCLUSIONS In this first clinical trial evaluating a single encounter antimalarial therapy, none of the treatment arms reached the target efficacy of > 95% PCR-adjusted ACPR at day 28. Achieving very high efficacy following single dose treatment is challenging, since > 95% of the population must have sufficient concentrations to achieve cure across a range of parasite sensitivities and baseline parasitaemia levels. While challenging, the development of tools suitable for deployment as single encounter curative treatments for adults and children in Africa and to support elimination strategies remains a key development goal. TRIAL REGISTRATION ClinicalTrials.gov, NCT02083380 . Registered on 7 March 2014.
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Affiliation(s)
| | - Yeka Adoke
- Infectious Diseases Research Collaboration, Tororo Hospital, Tororo, Uganda
| | - Alfred B Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Tran Thanh Duong
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Universite des Sciences de la Sante Gabon, Département de Parasitology, Malaria Clinical and Operational Research Unit, Melen Hospital, Libreville, Gabon
| | - Marielle Bouyou-Akotet
- Universite des Sciences de la Sante Gabon, Département de Parasitology, Malaria Clinical and Operational Research Unit, Melen Hospital, Libreville, Gabon
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé - Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Quique Bassat
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Universidad Europea de Madrid, Madrid, Spain
| | - Saadou Issifou
- Centre de Recherche sur le Paludisme Associé à la Grossesse et l'Enfance, Faculte Des Sciences De La Sante, Cotonou, Benin
| | - Marc Adamy
- Medicines for Malaria Venture, Geneva, Switzerland
| | | | | | - Didier Leroy
- Medicines for Malaria Venture, Geneva, Switzerland
| | | | | | - Afizi Kibuuka
- Infectious Diseases Research Collaboration, Tororo Hospital, Tororo, Uganda
| | - Antoinette Kitoto Tshefu
- Centre de Recherche du Centre Hospitalier de Mont Amba, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Melnick Smith
- QuintilesIMS, Department: Biostatistics, Bloemfontein, South Africa
| | - Chanelle Foster
- QuintilesIMS, Department: Biostatistics, Bloemfontein, South Africa
| | - Illse Leipoldt
- QuintilesIMS, Department: Biostatistics, Bloemfontein, South Africa
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Bui Quang Phuc
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Alphonse Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon. .,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany. .,Department of Medicine I, Division of Infectious Diseases, Medical University of Vienna, Vienna, Austria. .,Bernhard Nocht Hospital for Tropical Diseases, Bernhard Nocht Institute for Tropical Medicine and University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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40
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Schallig HD, Tinto H, Sawa P, Kaur H, Duparc S, Ishengoma DS, Magnussen P, Alifrangis M, Sutherland CJ. Randomised controlled trial of two sequential artemisinin-based combination therapy regimens to treat uncomplicated falciparum malaria in African children: a protocol to investigate safety, efficacy and adherence. BMJ Glob Health 2017; 2:e000371. [PMID: 29082016 PMCID: PMC5656137 DOI: 10.1136/bmjgh-2017-000371] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Management of uncomplicated Plasmodium falciparum malaria relies on artemisinin-based combination therapies (ACTs). These highly effective regimens have contributed to reductions in malaria morbidity and mortality. However, artemisinin resistance in Asia and changing parasite susceptibility to ACT in Africa have now been well documented. Strategies that retain current ACT as efficacious treatments are urgently needed. METHODS We present an open-label, randomised three-arm clinical trial protocol in three African settings representative of varying malaria epidemiology to investigate whether prolonged ACT-based regimens using currently available formulations can eliminate potentially resistant parasites. The protocol investigates whether a sequential course of two licensed ACT in 1080 children aged 6-120 months exhibits superior efficacy against acute P. falciparum malaria and non-inferior safety compared with standard single-course ACT given to 540 children. The primary endpoint is PCR-corrected clinical and parasitological response at day 42 or day 63 of follow-up. Persistence of PCR-detectable parasitaemia at day 3 is analysed as a key covariate. Secondary endpoints include gametocytaemia, occurrence of treatment-related adverse events in the double-ACT versus single-ACT arms, carriage of molecular markers of drug resistance, drug kinetics and patient adherence to treatment. DISCUSSION This protocol addresses efficacy and safety of sequential ACT regimens in P. falciparum malaria in Africa. The approach is designed to extend the useful life of this class of antimalarials with maximal impact and minimal delay, by deploying licensed medicines that could be swiftly implemented as sequential double ACT by National Malaria Control Programmes, before emerging drug resistance in Africa becomes a major threat to public health.
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Affiliation(s)
- Henk Dfh Schallig
- Department of Medical Microbiology-Parasitology Unit, Academic Medical Centre, Amsterdam, The Netherlands
| | - Halidou Tinto
- Institute for Health Sciences Research-Clinical Research Unit (IRSS-CRUN), Nanoro, Burkina Faso
| | - Patrick Sawa
- International Centre for Insect Physiology and Ecology, Mbita Point, Kenya
| | - Harparkash Kaur
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Immunology & Infection Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Pascal Magnussen
- Department of International Health, Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Michael Alifrangis
- Department of International Health, Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Colin J Sutherland
- Immunology & Infection Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Public Health England Malaria Reference Laboratory, London School of Hygiene & Tropical Medicine, London, UK
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41
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Rueangweerayut R, Bancone G, Harrell EJ, Beelen AP, Kongpatanakul S, Möhrle JJ, Rousell V, Mohamed K, Qureshi A, Narayan S, Yubon N, Miller A, Nosten FH, Luzzatto L, Duparc S, Kleim JP, Green JA. Hemolytic Potential of Tafenoquine in Female Volunteers Heterozygous for Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency ( G6PD Mahidol Variant) versus G6PD-Normal Volunteers. Am J Trop Med Hyg 2017; 97:702-711. [PMID: 28749773 PMCID: PMC5590573 DOI: 10.4269/ajtmh.16-0779] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Tafenoquine is an 8-aminoquinoline under investigation for the prevention of relapse in Plasmodium vivax malaria. This open-label, dose-escalation study assessed quantitatively the hemolytic risk with tafenoquine in female healthy volunteers heterozygous for the Mahidol487A glucose-6-phosphate dehydrogenase (G6PD)-deficient variant versus G6PD-normal females, and with reference to primaquine. Six G6PD-heterozygous subjects (G6PD enzyme activity 40-60% of normal) and six G6PD-normal subjects per treatment group received single-dose tafenoquine (100, 200, or 300 mg) or primaquine (15 mg × 14 days). All participants had pretreatment hemoglobin levels ≥ 12.0 g/dL. Tafenoquine dose escalation stopped when hemoglobin decreased by ≥ 2.5 g/dL (or hematocrit decline ≥ 7.5%) versus pretreatment values in ≥ 3/6 subjects. A dose-response was evident in G6PD-heterozygous subjects (N = 15) receiving tafenoquine for the maximum decrease in hemoglobin versus pretreatment values. Hemoglobin declines were similar for tafenoquine 300 mg (-2.65 to -2.95 g/dL [N = 3]) and primaquine (-1.25 to -3.0 g/dL [N = 5]). Two further cohorts of G6PD-heterozygous subjects with G6PD enzyme levels 61-80% (N = 2) and > 80% (N = 5) of the site median normal received tafenoquine 200 mg; hemolysis was less pronounced at higher G6PD enzyme activities. Tafenoquine hemolytic potential was dose dependent, and hemolysis was greater in G6PD-heterozygous females with lower G6PD enzyme activity levels. Single-dose tafenoquine 300 mg did not appear to increase the severity of hemolysis versus primaquine 15 mg × 14 days.
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Affiliation(s)
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Emma J Harrell
- GlaxoSmithKline Research and Development Ltd., Uxbridge, United Kingdom
| | | | | | | | - Vicki Rousell
- GlaxoSmithKline Research and Development Ltd., Uxbridge, United Kingdom
| | - Khadeeja Mohamed
- GlaxoSmithKline Research and Development Ltd., Uxbridge, United Kingdom
| | - Ammar Qureshi
- GlaxoSmithKline Research and Development Ltd., Uxbridge, United Kingdom
| | - Sushma Narayan
- GlaxoSmithKline Research and Development Ltd., Uxbridge, United Kingdom
| | | | - Ann Miller
- GlaxoSmithKline, King of Prussia, Pennsylvania
| | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Lucio Luzzatto
- Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,Istituto Toscano Tumori, Florence, Italy
| | | | - Jörg-Peter Kleim
- GlaxoSmithKline Research and Development Ltd., Uxbridge, United Kingdom
| | - Justin A Green
- GlaxoSmithKline Research and Development Ltd., Uxbridge, United Kingdom
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Burrows JN, Duparc S, Gutteridge WE, van Huijsduijnen RH, Kaszubska W, Macintyre F, Mazzuri S, Möhrle JJ, Wells TNC. Erratum to: New developments in anti-malarial target candidate and product profiles. Malar J 2017; 16:151. [PMID: 28420400 PMCID: PMC5395931 DOI: 10.1186/s12936-017-1809-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
The diagnosis and treatment of Plasmodium vivax malaria differs from that of Plasmodium falciparum malaria in fundamentally important ways. This article reviews the guiding principles, practices, and evidence underpinning the diagnosis and treatment of P. vivax malaria.
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Affiliation(s)
- J Kevin Baird
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Neena Valecha
- National Institute for Malaria Research, New Delhi, India
| | | | - Nicholas J White
- Mahidol Oxford 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
| | - Ric N Price
- Division of Global and Tropical Health, Menzies School of Health Research-Charles Darwin University, Darwin, Australia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Phiri K, Kimani J, Mtove GA, Zhao Q, Rojo R, Robbins J, Duparc S, Ayoub A, Vandenbroucke P. Parasitological Clearance Rates and Drug Concentrations of a Fixed Dose Combination of Azithromycin-Chloroquine in Asymptomatic Pregnant Women with Plasmodium Falciparum Parasitemia: An Open-Label, Non-Comparative Study in Sub-Saharan Africa. PLoS One 2016; 11:e0165692. [PMID: 27861509 PMCID: PMC5115659 DOI: 10.1371/journal.pone.0165692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/14/2016] [Indexed: 12/31/2022] Open
Abstract
Background Malaria remains one of the most important causes of morbidity and mortality in pregnant women and their newborn babies in sub-Saharan Africa. Intermittent preventive treatment in pregnancy (IPTp) is recommended by the World Health Organization (WHO) to reduce the burden of disease and improve maternal and neonatal survival and general health. Due to the growing resistance to sulfadoxine-pyrimethamine (SP), the current WHO-recommended drug for IPTp, identification of new and effective drugs is an urgent priority. Methods and Findings This was an open-label, non-comparative study (NCT01103713) in 5 countries in East and sub-Saharan Africa (Benin, Kenya, Malawi, Tanzania, and Uganda) to assess parasitological response and drug concentrations of a single, 3-day course of four tablets of a fixed-dose combination of azithromycin-chloroquine (AZCQ) 250/155 mg given during the second or third trimester to women with asymptomatic Plasmodium falciparum parasitemia in their first or second pregnancy. Parasitemia was determined by microscopy and molecular genotyping was performed to characterize parasites relative to the baseline infection. Weekly follow-up visits took place until day 42 after first dose and additional follow-up occurred after delivery. Systemic concentrations of azithromycin (AZ), chloroquine (CQ), and the CQ metabolite, desethyl CQ (DECQ) were evaluated at Day 0 (pre-dose), at Day 2 (pre-dose, 2 and 8 hours) and randomly at Days 7 and 14. Systemic concentrations of CQ and DECQ were also measured randomly at Day 21 and Day 28. In total, 404 women were screened for eligibility and 168 were treated, 155 of whom completed the study. PCR-adjusted parasitological response in the modified intent-to-treat population at day 28 (the primary efficacy endpoint) was estimated by the Kaplan-Meier method as 99.35% (95% confidence interval [CI]: 97.76, 100.00). PCR-adjusted parasitological response remained high at day 42 (95.19%; 95% CI: 91.35, 99.03). In general, the mean concentrations of serum AZ, plasma CQ, and plasma DECQ showed large CV% values (ranges of 33–156%, 42–228%, and 57–109%, respectively). There were 157 live births, three stillbirths, and eight pregnancies of unknown outcome: 7 due to withdrawal of participant consent and 1 lost to follow-up. The most frequent treatment-emergent adverse events were vomiting (20.8%) and dizziness (19.6%). Conclusions These results suggest that a 3-day course of AZCQ can lead to an adequate 28-day parasitological response.
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Affiliation(s)
- Kamija Phiri
- College of Medicine, University of Malawi, Blantyre, Malawi
- * E-mail:
| | - Joshua Kimani
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - George A. Mtove
- National Institute for Medical Research, Amani Medical Research Centre, Tanga, Tanzania
| | - Qinying Zhao
- Pfizer Inc., Groton, Connecticut, United States of America
| | - Ricardo Rojo
- Pfizer Inc., Groton, Connecticut, United States of America
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Kimani J, Phiri K, Kamiza S, Duparc S, Ayoub A, Rojo R, Robbins J, Orrico R, Vandenbroucke P. Efficacy and Safety of Azithromycin-Chloroquine versus Sulfadoxine-Pyrimethamine for Intermittent Preventive Treatment of Plasmodium falciparum Malaria Infection in Pregnant Women in Africa: An Open-Label, Randomized Trial. PLoS One 2016; 11:e0157045. [PMID: 27326859 PMCID: PMC4915657 DOI: 10.1371/journal.pone.0157045] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 05/24/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The World Health Organization recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) in African regions with moderate to high malaria transmission. However, growing resistance to SP threatens the effectiveness of IPTp-SP, and alternative drugs are needed. This study tested the efficacy, tolerability, and safety of a fixed-dose combination azithromycin-chloroquine (AZCQ; 250 mg AZ/155 mg CQ base) for IPTp relative to IPTp-SP. METHODS AND FINDINGS A randomized, Phase 3, open-label, multi-center study was conducted in sub-Saharan Africa (Benin, Kenya, Malawi, Tanzania, and Uganda) between October 2010 and November 2013. Pregnant women received 3 IPTp courses with AZCQ (each course: 1,000/620 mg AZCQ QD for 3 days) or SP (each course 1,500/75 mg SP QD for 1 day) at 4- to 8-week intervals during the second and third trimester. Long-lasting insecticide-treated bednets were also provided at enrollment. Study participants were followed up until day 28 post delivery (time window: day 28-42). The primary endpoint was the proportion of participants with sub-optimal pregnancy outcomes (a composite endpoint comprising live-borne neonates with low birth weight [LBW, <2,500 g], premature birth [<37 weeks], still birth [>28 weeks], abortion [≤28 weeks], lost to follow-up prior to observation of pregnancy outcome, or missing birth weight). The study was terminated early after recruitment of 2,891 of the planned 5,044 participants, due to futility observed in a pre-specified 35% interim analysis. In the final intent-to-treat dataset, 378/1,445 (26.2%) participants in the AZCQ and 342/1,445 (23.7%) in the SP group had sub-optimal pregnancy outcomes, with an estimated risk ratio (RR) of 1.11 (95% CI: 0.97, 1.25; p = 0.12). There was no significant difference in the incidence of LBW between treatment groups (57/1138 [5.0%] in the AZCQ group, 68/1188 [5.7%] in the SP group, RR 0.87 [95% CI: 0.62, 1.23]; p = 0.44). IPTp-AZCQ was less well-tolerated in mothers than IPTp-SP. Occurrences of congenital anomalies, deaths, and serious adverse events were comparable in neonates for both groups. Limitations included the open-label design and early study termination. CONCLUSIONS IPTp-AZCQ was not superior to IPTp-SP in this study and alternatives for IPTp-SP remain to be identified. The proportions of sub-optimal pregnancy outcomes and LBW were lower than expected, which may be linked to insecticide-treated bednet use throughout the study. Reduced incidences of symptomatic malaria infection and peripheral parasitemia in the AZCQ group relative to SP suggest that AZCQ warrants further investigation as an alternative treatment of uncomplicated malaria. TRIAL REGISTRATION ClinicalTrials.gov (NCT01103063).
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Affiliation(s)
- Joshua Kimani
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
- * E-mail:
| | - Kamija Phiri
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Steve Kamiza
- College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | - Ricardo Rojo
- Pfizer Inc., Groton, CT, United States of America
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St Jean PL, Xue Z, Carter N, Koh GCKW, Duparc S, Taylor M, Beaumont C, Llanos-Cuentas A, Rueangweerayut R, Krudsood S, Green JA, Rubio JP. Tafenoquine treatment of Plasmodium vivax malaria: suggestive evidence that CYP2D6 reduced metabolism is not associated with relapse in the Phase 2b DETECTIVE trial. Malar J 2016; 15:97. [PMID: 26888075 PMCID: PMC4757974 DOI: 10.1186/s12936-016-1145-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/04/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Tafenoquine (TQ) and primaquine (PQ) are 8-aminoquinolines (8-AQ) with anti-hypnozoite activity against vivax malaria. PQ is the only FDA-approved medicine for preventing relapsing Plasmodium vivax infection and TQ is currently in phase 3 clinical trials for the same indication. Recent studies have provided evidence that cytochrome P450 (CYP) metabolism via CYP2D6 plays a role in PQ efficacy against P. vivax and have suggested that this effect may extend to other 8-AQs, including TQ. Here, a retrospective pharmacogenetic (PGx) investigation was performed to assess the impact of CYP2D6 metabolism on TQ and PQ efficacy in the treatment of P. vivax in the DETECTIVE study (TAF112582), a recently completed, randomized, phase 2b dose-ranging clinical trial. The impact of CYP2D6 on TQ pharmacokinetics (PK) was also investigated in TAF112582 TQ-treated subjects and in vitro CYP metabolism of TQ was explored. A limitation of the current study is that TAF112582 was not designed to be well powered for PGx, thus our findings are based on TQ or PQ efficacy in CYP2D6 intermediate metabolizers (IM), as there were insufficient poor metabolizers (PM) to draw any conclusion on the impact of the PM phenotype on efficacy. METHODS The impact of genetically-predicted CYP2D6 reduced metabolism on relapse-free efficacy six months post-dosing of TQ or PQ, both administered in conjunction with chloroquine (CQ), was assessed using exact statistical methods in 198 P. vivax-infected study participants comparing IM to extensive metabolizers (EM). The influence of CYP2D6 metabolizer phenotypes on TQ PK was assessed comparing median TQ area under the curve (AUC). In vitro metabolism of TQ was investigated using recombinant, over-expressed human CYP enzymes and human hepatocytes. Metabolite identification experiments were performed using liquid chromatography-mass spectrometry. RESULTS Reduction of CYP2D6 activity was not associated with an increase in relapse-rate in TQ-treated subjects (p = 0.57). In contrast, and in accordance with recent literature, CYP2D6 IMs were more common (p = 0.05) in PQ-treated subjects who relapsed (50 %) than in subjects who remained relapse-free (17 %). Further, CYP2D6 metabolizer phenotypes had no significant effect on TQ AUC, and only minimal metabolism of TQ could be detected in hepatic in vitro systems. CONCLUSION Together, these data provide preliminary evidence that in CYP2D6 IMs, TQ efficacy in P. vivax-infected individuals is not diminished to the same extent as PQ. As there were no PMs in either the TQ or PQ treatment arms of TAF112582, no conclusions could be drawn on potential differences in PMs. These findings suggest that differential effects of CYP2D6 metabolism on TQ and PQ efficacy could be a differentiation factor between these 8-AQs, but results remain to be confirmed prospectively in the ongoing phase 3 studies.
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Affiliation(s)
- Pamela L St Jean
- PAREXEL International, 2520 Meridian Parkway, Durham, NC, 27713, USA.
| | - Zhengyu Xue
- PAREXEL International, 2520 Meridian Parkway, Durham, NC, 27713, USA.
| | - Nick Carter
- GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex, UK.
| | - Gavin C K W Koh
- GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex, UK.
| | | | | | | | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical, Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | | | - Srivicha Krudsood
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Justin A Green
- GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex, UK.
| | - Justin P Rubio
- Department of Pathology, University of Melbourne, Melbourne, VIC, Australia.
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Nelwan EJ, Ekawati LL, Tjahjono B, Setiabudy R, Sutanto I, Chand K, Ekasari T, Djoko D, Basri H, Taylor WR, Duparc S, Subekti D, Elyazar I, Noviyanti R, Sudoyo H, Baird JK. Randomized trial of primaquine hypnozoitocidal efficacy when administered with artemisinin-combined blood schizontocides for radical cure of Plasmodium vivax in Indonesia. BMC Med 2015; 13:294. [PMID: 26654101 PMCID: PMC4676167 DOI: 10.1186/s12916-015-0535-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/25/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Safety and efficacy of primaquine against repeated attacks of Plasmodium vivax depends upon co-administered blood schizontocidal therapy in radical cure. We assessed primaquine (PQ) as hypnozoitocide when administered with dihydroartemisinin-piperaquine (Eurartesim®, DHA-PP) or artesunate-pyronaridine (Pyramax®, AS-PYR) to affirm its good tolerability and efficacy. A third arm, artesunate followed by primaquine, was not intended as therapy for practice, but addressed a hypothesis concerning primaquine efficacy without co-administration of blood schizontocide. METHODS During March to July 2013, an open-label, randomized trial enrolled Indonesian soldiers with vivax malaria at Sragen, Central Java, after six months duty in malarious Papua, Indonesia. No malaria transmission occurred at the study site and P. vivax recurrences in the 12 months following therapy were classified as relapses. A historic relapse control derived from a cohort of soldiers who served in the same area of Papua was applied to estimate risk of relapse among randomized treatment groups. Those were: 1) AS followed 2d later by PQ (0.5 mg/kg daily for 14d); 2) co-formulated AS-PYR concurrent with the same regimen of PQ; or 3) co-formulated DHA-PP concurrent with the same regimen of PQ. RESULTS Among 532 soldiers, 219 had vivax malaria during the four months following repatriation to Java; 180 of these were otherwise healthy and G6PD-normal and enrolled in the trial. Subjects in all treatment groups tolerated the therapies well without untoward events and cleared parasitemia within three days. First relapse appeared at day 39 post-enrollment, and the last at day 270. Therapeutic efficacy of PQ against relapse by incidence density analysis was 92 % (95 %CI = 83-97 %), 94 %(95 %CI = 86-97 %), and 95 %(95 %CI = 88-98 %) when combined with AS, AS-PYR, or DHA-PP, respectively. CONCLUSIONS This trial offers evidence of good tolerability and efficacy of PQ against P. vivax relapse when administered concurrently with DHA-PP or AS-PYR. These offer alternative partner drugs for radical cure with primaquine. The AS arm demonstrated efficacy with a total dose of 7 mg/kg PQ without concurrently administered blood schizontocide, another option when primaquine therapy is removed in time from the treatment of the acute malaria or applied presumptively without an attack. TRIAL REGISTRATION Current Controlled Trials ISRCTN82366390, assigned 20 March 2013.
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Affiliation(s)
- Erni J Nelwan
- Faculty of Medicine, University of Indonesia, Jalan Salemba Raya No. 6, Jakarta, 10430, Indonesia.
| | - Lenny L Ekawati
- Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, 10430, Indonesia.
| | - Bagus Tjahjono
- Health Services, Army of the Republic of Indonesia, Jalan Letjen Soetoyo, Jakarta, 13640, Indonesia.
| | - Rianto Setiabudy
- Faculty of Medicine, University of Indonesia, Jalan Salemba Raya No. 6, Jakarta, 10430, Indonesia.
| | - Inge Sutanto
- Faculty of Medicine, University of Indonesia, Jalan Salemba Raya No. 6, Jakarta, 10430, Indonesia.
| | - Krisin Chand
- Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, 10430, Indonesia.
| | - Tyas Ekasari
- Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, 10430, Indonesia.
| | - Dwi Djoko
- Health Services, Army of the Republic of Indonesia, Jalan Letjen Soetoyo, Jakarta, 13640, Indonesia.
| | - Hasan Basri
- Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, 10430, Indonesia.
| | - W Robert Taylor
- Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, 10430, Indonesia.
| | - Stephan Duparc
- Medicines for Malaria Venture, Route de Pré-Bois 20, 1215, Meyrin, Switzerland.
| | - Decy Subekti
- Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, 10430, Indonesia.
| | - Iqbal Elyazar
- Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, 10430, Indonesia.
| | - Rintis Noviyanti
- Eijkman Institute for Molecular Biology, Jalan Diponegoro No. 69, Jakarta, 10430, Indonesia.
| | - Herawati Sudoyo
- Eijkman Institute for Molecular Biology, Jalan Diponegoro No. 69, Jakarta, 10430, Indonesia.
| | - J Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, 10430, Indonesia. .,The Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK.
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Sagara I, Beavogui AH, Zongo I, Soulama I, Borghini-Fuhrer I, Fofana B, Camara D, Somé AF, Coulibaly AS, Traore OB, Dara N, Kabore MJT, Thera I, Compaore YD, Sylla MM, Nikiema F, Diallo MS, Dicko A, Gil JP, Borrmann S, Duparc S, Miller RM, Doumbo OK, Shin J, Bjorkman A, Ouedraogo JB, Sirima SB, Djimdé AA. Safety and efficacy of re-treatments with pyronaridine-artesunate in African patients with malaria: a substudy of the WANECAM randomised trial. Lancet Infect Dis 2015; 16:189-98. [PMID: 26601738 PMCID: PMC4726763 DOI: 10.1016/s1473-3099(15)00318-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 07/28/2015] [Accepted: 09/03/2015] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sparse data on the safety of pyronaridine-artesunate after repeated treatment of malaria episodes restrict its clinical use. We therefore compared the safety of pyronaridine-artesunate after treatment of the first episode of malaria versus re-treatment in a substudy analysis. METHODS This planned substudy analysis of the randomised, open-label West African Network for Clinical Trials of Antimalarial Drugs (WANECAM) phase 3b/4 trial was done at six health facilities in Mali, Burkina Faso, and Guinea in patients (aged ≥6 months and bodyweight ≥5 kg) with uncomplicated microscopically confirmed Plasmodium spp malaria (parasite density <200 000 per μL blood) and fever or history of fever. The primary safety endpoint was incidence of hepatotoxicity: alanine aminotransferase of greater than five times the upper limit of normal (ULN) or Hy's criteria (alanine aminotransferase or aspartate aminotransferase greater than three times the ULN and total bilirubin more than twice the ULN) after treatment of the first episode of malaria and re-treatment (≥28 days after first treatment) with pyronaridine-artesunate. Pyronaridine-artesunate efficacy was compared with artemether-lumefantrine with the adequate clinical and parasitological response (ACPR) in an intention-to-treat analysis. WANECAM is registered with PACTR.org, number PACTR201105000286876. FINDINGS Following first treatment, 13 (1%) of 996 patients had hepatotoxicity (including one [<1%] possible Hy's law case) versus two (1%) of 311 patients on re-treatment (neither a Hy's law case). No evidence was found that pyronaridine-artesunate re-treatment increased safety risk based on laboratory values, reported adverse event frequencies, or electrocardiograph findings. For all first treatment or re-treatment episodes, pyronaridine-artesunate (n=673) day 28 crude ACPR was 92·7% (95% CI 91·0-94·3) versus 80·4% (77·8-83·0) for artemether-lumefantrine (n=671). After exclusion of patients with PCR-confirmed new infections, ACPR was similar on treatment and re-treatment and greater than 95% at day 28 and greater than 91% at day 42 in both treatment groups. INTERPRETATION The findings that pyronaridine-artesunate safety and efficacy were similar on first malaria treatment versus re-treatment of subsequent episodes lend support for the wider access to pyronaridine-artesunate as an alternative artemisinin-based combination treatment for malaria in sub-Saharan Africa. FUNDING European and Developing Countries Clinical Trial Partnership, Medicines for Malaria Venture (Geneva, Switzerland), UK Medical Research Council, Swedish International Development Cooperation Agency, German Ministry for Education and Research, University Claude Bernard (Lyon, France), Malaria Research and Training Centre (Bamako, Mali), Centre National de Recherche et de Formation sur le Paludisme (Burkina Faso), Institut de Recherche en Sciences de la Santé (Bobo-Dioulasso, Burkina Faso), and Centre National de Formation et de Recherche en Santé Rurale (Republic of Guinea).
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Affiliation(s)
- Issaka Sagara
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science, Techniques and Technologies of Bamako, Mali
| | | | - Issaka Zongo
- Institut de Recherche en Science de la Santé, Bobo Dioulasso, Burkina Faso
| | - Issiaka Soulama
- National Center for Research and Training on Malaria, Ouagadougou, Burkina Faso
| | | | - Bakary Fofana
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science, Techniques and Technologies of Bamako, Mali
| | - Daouda Camara
- Centre de Formation et de Recherche en Santé Rurale de Mafèrinyah, Conakry, Guinea
| | - Anyirékun F Somé
- Institut de Recherche en Science de la Santé, Bobo Dioulasso, Burkina Faso
| | | | - Oumar B Traore
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science, Techniques and Technologies of Bamako, Mali
| | - Niawanlou Dara
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science, Techniques and Technologies of Bamako, Mali
| | - Moïse J T Kabore
- National Center for Research and Training on Malaria, Ouagadougou, Burkina Faso
| | - Ismaila Thera
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science, Techniques and Technologies of Bamako, Mali
| | - Yves D Compaore
- Institut de Recherche en Science de la Santé, Bobo Dioulasso, Burkina Faso
| | - Malick Minkael Sylla
- Centre de Formation et de Recherche en Santé Rurale de Mafèrinyah, Conakry, Guinea
| | - Frederic Nikiema
- Institut de Recherche en Science de la Santé, Bobo Dioulasso, Burkina Faso
| | | | - Alassane Dicko
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science, Techniques and Technologies of Bamako, Mali
| | - Jose Pedro Gil
- Department of Physiology and Pharmacology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Steffen Borrmann
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infection Research (DZIF), Tübingen, Germany
| | | | | | - Ogobara K Doumbo
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science, Techniques and Technologies of Bamako, Mali
| | - Jangsik Shin
- Shin Poong Pharmaceutical Company, Seoul, South Korea
| | - Anders Bjorkman
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | | | - Sodiomon B Sirima
- National Center for Research and Training on Malaria, Ouagadougou, Burkina Faso
| | - Abdoulaye A Djimdé
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Science, Techniques and Technologies of Bamako, Mali.
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