Primaquine radical cure of Plasmodium vivax: a critical review of the literature.
Primaquine radical cure of Plasmodium vivax: a critical review of the literature.
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DOI：
10.1186/1475-2875-11-280
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发表时间：
2012-08-17
期刊：
影响因子：
3
通讯作者：
Price RN
中科院分区：
文献类型：
--
作者：
John GK;Douglas NM;von Seidlein L;Nosten F;Baird JK;White NJ;Price RN
伯氨喹是半个世纪来唯一广泛使用的抗疟药。尽管如此，其临床疗效的特点不佳，导致在根治间日疟原虫的最佳方案上缺乏共识。回顾了自1950年以来使用伯氨喹方案预防间日疟原虫复发的已发表研究。数据是从现有文件中系统地提取的。伯氨喹方案根据给药总剂量分类：极低（≤2.5 mg/kg）、低（>2.5 mg/kg- < 5.0 mg/kg）和高（≥ 5.0 mg/kg）。总结了各地理区域的复发性感染风险，并在按总治疗剂量和研究随访持续时间分层后计算了治疗方案之间的比值比。可以从87项临床试验中检索数据，这些试验提供了在20个国家进行的156个治疗组中招募的59，735名患者的数据。在研究设计上有明显的异质性，特别是伯氨喹剂量和随访时间。极低剂量伯氨喹（n = 44）治疗后4-6个月的中位复发率为25%（范围0-90%），而低剂量伯氨喹（n = 82）治疗后的中位复发率为6.7%（范围0-59%）。高剂量伯氨喹方案在28个治疗组中进行了评估，与一个月的中位复发率0%（范围：0-15%）相关。在18项对照组研究中，极低剂量伯氨喹治疗方案的有效性与未接受伯氨喹治疗的患者没有差异（OR = 0.60，95%CI 0.33-1.09，p = 0.09），而对于低剂量方案，50%（6/12）的研究报告了显著差异（总体OR = 0.14，95%CI：0.06-0.35，p < 0.001）。两项纳入171例患者的研究表明，与对照组相比，高剂量伯氨喹的有效性较高（OR = 0.03（95%CI：0.01-0.13）; p < 0.0001）。低剂量方案在某些领域保持了足够的疗效，但这并不一致。实用的高剂量伯氨喹方案的有效性和安全性需要在一系列地方病和地理位置进行评估。此类研究需要长期随访，并与对照组进行比较，以考虑混杂因素。
Primaquine has been the only widely available hypnozoitocidal anti-malarial drug for half a century. Despite this its clinical efficacy is poorly characterized resulting in a lack of consensus over the optimal regimen for the radical cure of Plasmodium vivax. Published studies since 1950 of the use of primaquine regimens for preventing P. vivax relapse were reviewed. Data were extracted systematically from available papers. Primaquine regimens were categorized according to the total dose administered: very low (≤2.5 mg/kg), low (>2.5 mg/kg- < 5.0 mg/kg) and high (≥ 5.0 mg/kg). The risk of recurrent infection were summarized across geographical regions and the odds ratios between treatment regimens calculated after stratifying by total treatment dose and duration of study follow up. Data could be retrieved from 87 clinical trials presenting data in 59,735 patients enrolled into 156 treatment arms, conducted in 20 countries. There was marked heterogeneity in study design, particularly primaquine dosing and duration of follow up. The median rate of recurrence following very low dose of primaquine (n = 44) was 25% (range 0-90%) at 4–6 months, compared to 6.7 % (range 0-59%) following low dose primaquine (n = 82). High dose primaquine regimens were assessed in 28 treatment arms, and were associated with a median recurrence rate of 0% (Range: 0-15%) at one month. In 18 studies with control arms, the effectiveness of a very low dose primaquine regimen was no different from patients who did not receive primaquine (OR = 0.60, 95%CI 0.33-1.09, p = 0.09), whereas for the low dose regimens a significant difference was reported in 50% (6/12) of studies (overall OR = 0.14, 95%CI: 0.06-0.35, p < 0.001). Two studies enrolling 171 patients demonstrated high effectiveness of high dose primaquine compared to a control arm (OR = 0.03 (95%CI: 0.01-0.13); p < 0.0001). Low dose regimens retain adequate efficacy in some areas, but this is not uniform. The efficacy and safety of pragmatic high dose primaquine regimens needs to be assessed in a range of endemic and geographical locations. Such studies will require a prolonged period of follow up and comparison with control arms to account for confounding factors.
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影响因子：
3
作者：
Andersen F;Douglas NM;Bustos D;Galappaththy G;Qi G;Hsiang MS;Kusriastuti R;Mendis K;Taleo G;Whittaker M;Price RN;von Seidlein L
通讯作者：
von Seidlein L
影响因子：
6.4
作者：
Imwong, Mallika;Snounou, Georges;White, Nicholas J.
通讯作者：
White, Nicholas J.
DOI：
10.4269/ajtmh.2001.64.97
发表时间：
2001-01-01
影响因子：
3.3
作者：
Mendis, K;Sina, BJ;Carter, R
通讯作者：
Carter, R
DOI：
10.4269/ajtmh.2010.09-0521
发表时间：
2010-06-01
影响因子：
3.3
作者：
Grietens, Koen Peeters;Soto, Veronica;Gamboa, Dionicia
通讯作者：
Gamboa, Dionicia
影响因子：
6.7
作者：
Barnes, Karen I.;Little, Francesca;White, Nicholas J.
通讯作者：
White, Nicholas J.