Details:

Alternative Title:
Lancet Infect Dis
Publisher's site:
http://dx.doi.org/10.1016/S1473-3099(16)30378-4
Personal Author:
Gutman, Julie ; Kovacs, Stephanie ; Dorsey, Grant ; Stergachis, Andy ; ter Kuile, Feiko O
Gutman, Julie ; Kovacs, Stephanie ; Dorsey, Grant ; Stergachis, Andy ; ter Kuile, Feiko O Less -
Description:
Background

Intermittent preventive treatment (IPT) for malaria is used in infants, children, adults, and pregnant women. Dihydroartemisinin-piperaquine (DP) is an effective, well tolerated artemisinin-based combination therapy. The long half-life of piperaquine makes it attractive for IPT. We conducted a systematic review and meta-analysis to establish the efficacy and safety of repeated treatment with DP.

Methods

Following PRISMA guidelines, we searched multiple databases on Sept 1, 2016, with the terms: “human” AND “dihydroartemisinin-piperaquine” OR “DHA-PPQ”. Studies were eligible if they were randomised controlled trials (RCTs) or prospective cohort studies involving repeat exposures to standard 3-day courses of DP for either seasonal malaria chemoprevention, mass drug administration, or treatment of clinical malaria, conducted at any time and in any geographic location. Random-effects meta-analysis was used to generate pooled incidence rate ratios and relative risks, or risk differences.

Findings

11 studies were included: two repeat treatment studies (one in children younger than 5 years and one in pregnant women), and nine IPT trials (five in children younger than 5 years, one in schoolchildren, one in adults, two in pregnant women). Comparator interventions included placebo, artemether-lumefantrine, sulfadoxine-pyrimethamine (SP), SP+amodiaquine, SP+piperaquine, SP+chloroquine, and co-trimoxazole. Of 14 628 participants, 3935 received multiple DP courses (2–18). Monthly IPT-DP was associated with an 84% reduction in the incidence of malaria parasitaemia measured by microscopy compared with placebo. Monthly IPT-DP was associated with fewer serious adverse events than placebo, daily co-trimoxazole, or monthly SP. Among 56 IPT-DP recipients (26 children, 30 pregnant women) with cardiac parameters, all QTc intervals were within normal limits, with no significant increase in QTc prolongation with increasing courses of DP.

Interpretation

Monthly DP appears well tolerated and effective for IPT. Additional data are needed in pregnancy and to further explore the cardiac safety with monthly dosing.

Funding

Bill & Melinda Gates Foundation and NIH.


Subject:
[+]
Articles

Source:
Lancet Infect Dis. 2017; 17(2):184-193.
Pubmed ID:
27865890
Pubmed Central ID:
PMC5266794
Document Type:
Journal Article
Funding:
TL1 TR000422/TR/NCATS NIH HHS/United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:a7ff1be4c4dca090bb174ba2566c46819dd44a6abe5a95d5a3d99c3a2208316d
File Type:

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