Efficacy of Single-Dose Primaquine With Artemisinin Combination Therapy on Plasmodium falciparum Gametocytes and Transmission: An Individual Patient Meta-Analysis.
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Stepniewska Kasia, Humphreys Georgina S, Gonçalves Bronner P, Craig Elaine, Gosling Roly, Guerin Philippe J, Price Ric N, Barnes Karen I, Raman Jaishree, Smit Menno R, D'Alessandro Umberto, Stone Will J R, Bjorkman Anders, Samuels Aaron M, Arroyo-Arroyo Maria I, Bastiaens Guido J H, Brown Joelle M, Dicko Alassane, El-Sayed Badria B, Elzaki Salah-Eldin G, Eziefula Alice C, Kariuki Simon, Kwambai Titus K, Maestre Amanda E, Martensson Andreas, Mosha Dominic, Mwaiswelo Richard O, Ngasala Billy E, Okebe Joseph, Roh Michelle E, Sawa Patrick, Tiono Alfred B, Chen Ingrid, Drakeley Chris J, Bousema Teun
Аннотация
METHODS: An individual patient meta-analysis to assess gametocytocidal and transmission-blocking efficacy of PQ in combination with different ACTs was conducted. Random effects logistic regression was used to quantify PQ effect on (1) gametocyte carriage in the first 2 weeks post treatment; and (2) the probability of infecting at least 1 mosquito or of a mosquito becoming infected.
RESULTS: In 2574 participants from 14 studies, PQ reduced PCR-determined gametocyte carriage on days 7 and 14, most apparently in patients presenting with gametocytemia on day 0 (odds ratio [OR], 0.22; 95% confidence interval [CI], .17-.28 and OR, 0.12; 95% CI, .08-.16, respectively). Rate of decline in gametocyte carriage was faster when PQ was combined with artemether-lumefantrine (AL) compared to dihydroartemisinin-piperaquine (DP) (P = .010 for day 7). Addition of 0.25 mg/kg PQ was associated with near complete prevention of transmission to mosquitoes.
CONCLUSIONS: Transmission blocking is achieved with 0.25 mg/kg PQ. Gametocyte persistence and infectivity are lower when PQ is combined with AL compared to DP.