Efficacy of artesunate-mefloquine for chloroquine-resistant Plasmodium vivax malaria in Malaysia: An open-label, randomized, controlled trial.Report as inadecuate




Efficacy of artesunate-mefloquine for chloroquine-resistant Plasmodium vivax malaria in Malaysia: An open-label, randomized, controlled trial. - Download this document for free, or read online. Document in PDF available to download.

Reference: Grigg, MJ, William, T, Menon, J et al., (2016). Efficacy of artesunate-mefloquine for chloroquine-resistant Plasmodium vivax malaria in Malaysia: An open-label, randomized, controlled trial. Clinical Infectious Diseases, ciw121.Citable link to this page:

 

Efficacy of artesunate-mefloquine for chloroquine-resistant Plasmodium vivax malaria in Malaysia: An open-label, randomized, controlled trial.

Abstract: BackgroundChloroquine (CQ)-resistant Plasmodium vivaxis increasingly reported throughout southeast Asia. The efficacy of CQ and alternative artemisinin combination therapies (ACTs) for vivax malaria in Malaysia is unknown.MethodsA randomized, controlled trial of CQ vs artesunate-mefloquine (AS-MQ) for uncomplicated vivax malaria was conducted in 3 district hospitals in Sabah, Malaysia. Primaquine was administered on day 28. The primary outcome was the cumulative risk of treatment failure by day 28 by Kaplan–Meier analysis.ResultsFrom 2012 to 2014, 103 adults and children were enrolled. Treatment failure by day 28 was 61.1% (95% confidence interval [CI], 46.8–75.6) after CQ and 0% (95% CI, 0–.08) following AS-MQ (P< .001), of which 8.2% (95% CI, 2.5–9.6) were early treatment failures. All patients with treatment failure had therapeutic plasma CQ concentrations at day 7. Compared with CQ, AS-MQ was associated with faster parasite clearance (normalized clearance slope, 0.311 vs 0.127;P< .001) and fever clearance (mean, 19.0 vs 37.7 hours;P=.001) and with lower risk of anemia at day 28 (odds ratio = 3.7; 95% CI, 1.5–9.3;P=.005). Gametocytes were present at day 28 in 23.8% (10/42) of patients following CQ vs none with AS-MQ (P< .001). AS-MQ resulted in lower bed occupancy: 4037 vs 6510 days/1000 patients (incidence rate ratio 0.62; 95% CI, .60–.65; P< .001). One patient developed severe anemia not regarded as related to their AS-MQ treatment.ConclusionsHigh-grade CQ-resistant P. vivax is prevalent in eastern Malaysia. AS-MQ is an efficacious ACT for all malaria species. Wider CQ-efficacy surveillance is needed in vivax-endemic regions with earlier replacement with ACT when treatment failure is detected.

Peer Review status:Peer reviewedPublication status:PublishedVersion:Publisher's version Funder: Malaysian Ministry of Health   Funder: AusAlD Asia-Pacific Malaria Elimination Network   Funder: Australian National Health and Medical Research Council   Notes:© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Bibliographic Details

Publisher: Oxford University Press

Publisher Website: http://www.oxfordjournals.org/

Journal: Clinical Infectious Diseasessee more from them

Publication Website: http://cid.oxfordjournals.org/

Issue Date: 2016-04

pages:ciw121Identifiers

Urn: uuid:1b72d3ef-9452-4b27-a46f-eee49cc5f62e

Source identifier: 619916

Eissn: 1537-6591

Doi: https://doi.org/10.1093/cid/ciw121

Issn: 1058-4838 Item Description

Type: Journal article;

Language: eng

Version: Publisher's versionKeywords: Plasmodium vivax Malaria Randomized, controlled trial Artesunate-mefloquine Chloroquine Tiny URL: pubs:619916

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Author: Grigg, MJ - - - William, T - - - Menon, J - - - Barber, BE - - - Wilkes, CS - - - Rajahram, GS - - - Edstein, MD - - - Auburn, S

Source: https://ora.ox.ac.uk/objects/uuid:1b72d3ef-9452-4b27-a46f-eee49cc5f62e



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