Darwin, Australia: A team of malaria experts from a large international research collaboration has today published results supporting the need fora radical cure strategy to tackle one of the most debilitating forms of malaria caused by the Plasmodium vivaxparasite.
Vivax malaria affects more than 13 million people each year, with an estimated 40% of the world’s population at risk of contracting the infection across all continents from South America to South-East Asia. In some regionsP. vivax has become resistant to standard treatment with chloroquine. The problem is compounded by vivax’s ability to lie dormant in the liver for long periods of time before causing recurrent infections that have anenduring impact on people’s lives and livelihoods.
Led by a team at Menzies School of Health Research in Australia, the study has assembled individual patient data from clinical trials conducted since 2000, investigating the effect of chloroquine dosing, combined with the partner drug primaquine, and the risk of recurrent malaria across different settings. The study published today in the international journalThe Lancet Infectious Diseasesis the result of acollaborationbetweenmore than 50 international researchers under the auspices of the Worldwide Antimalarial Resistance Network (WWARN).
“Our findings highlight the substantial benefit of a modest increasein the dose of chloroquine in children aged under 5 years andthe importance of combining primaquine with chloroquine to have a better chance of curing patients.”explains Dr Rob Commons, PhD student at the Menzies School of Health Research and part of the WWARN Clinical Group.
“Thisanalysis of more than 5,000 patients from 37 studies, across 17 countries, is the largest individual patient data meta-analysis of P. vivax clinical trials to date. Our results showchloroquine is currently given in lower doses than recommended, withas many as 35% of patients in trials given less than the WHO recommended 25 mg/kg. We also know from our analysis that these patients are more likely to fail treatment” confirms Dr Commons.
“The study highlights the need for clinicians in affected areas to provide radical cure to kill the blood and liver stageof the vivax parasite and ensure patients can recover quickly. We alsowant to prevent transmission of the parasite to other people and reduce the global burden of this disease”addsProfessor Ric Price, Head of the Clinical Group at the Worldwide Antimalarial Resistance Network (WWARN).
“This research team has highlighted some important potential adjustments are needed to ensure all patients, especially small children, are given the best chance of recovery from vivax malaria.” concludes Prof Kevin Baird, Head of the Eijkman-Oxford Clinical Research Unit (EOCRU) in Jakarta, Indonesia.
The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WWARN systematic review and individual patient pooled meta-analysis. The Lancet Infectious Diseases. THELANCETID-D-18-00317R1.
The paper is available here from 19/ 20 July depending on your time zonehttp://dx.doi.org/10.1016/S1473-3099(18)30348-7
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The Worldwide Antimalarial Resistance Network mission is to generate innovative tools and reliable evidence to inform the malaria community on the factors affecting the efficacy of antimalarial medicines. WWARN works with collaborators from 270 institutions to analyse and interpret data that will help to optimise treatment regimens, especially for vulnerable groups including pregnant women, infants and malnourished children. The network provides comprehensive, timely, quality-assured data to track the emergence and spread of malaria drug resistance, and also contributes data to inform new drugs in development. Our international partnerships play an essential role in supporting the drive to eliminate malaria WWARN is part of the Infectious Diseases Data Observatory (IDDO).
Menzies School of Health Research is one of Australia’s leading medical research institutes dedicated to improving Indigenous, global and tropical health. Menzies has a history of over 30 years of scientific discovery and public health achievement. Menzies works at the frontline, joining with partners across the Asia-Pacific as well as Indigenous communities across northern and central Australia. Menzies collaborates to create new knowledge, grow local skills and find enduring solutions to problems that matter.
This research team at Menzies is supported with funding from the Bill& Melinda Gates Foundation, The Wellcome Trust and the Australian National Health andMedical Research Council. WWARN is funded by the Bill & Melinda Gates Foundation and the Exxon Foundation.