Effect of primaquine dose on the risk of recurrence in patients with uncomplicated Plasmodium vivax: a systematic review and individual patient data meta-analysis

Safety and efficacy of primaquine in patients withPlasmodium vivaxmalaria from South Asia: a systematic review and individual patient data meta-analysis

“…This contrasts with other regions of the world, with a recent individual patient data metaanalysis of 6879 patients from all vivax-endemic countries suggesting a benefit of 7 mg/kg total dose primaquine regimens. 10 WHO currently recommends low total dose primaquine regimens for South Asia and these recommendations are supported by the current metaanalysis. 7 46 47 Primaquine radical cure regimens are generally administered over 14 days, however, the WHO recently revised treatment guidelines to include a 7-day 3.5 mg/kg total dose primaquine regimen.…”

Optimizing test and treat options for Vivax malaria: an options assessment toolkit (OAT) for Asia Pacific National Malaria Control Programs

“…Defining acceptable tolerability of non-lifethreatening events such as gastro-intestinal disturbance is even more difficult. More recent data however further support the use of higher primaquine doses in settings where G6PD testing can be provided (14,(31)(32)(33).…”

“…Within this study, experts suggested that 85% efficacy, or in other words a 15% risk of recurrence at 6 months to be an adequate threshold for efficacy of radical cure drug regimen. To put this in context, in a recent individual patient data meta-analysis the risk of recurrence with low dose primaquine at 6 months was 19.3%, with 22% and 17% in low and high relapse areas, respectively (31). Similarly, the risk of recurrent P. vivax malaria at 6 months for tafenoquine ranges from 28% to 38% (16,35).…”

Primaquine dose and the risk of haemolysis in patients with uncomplicated Plasmodium vivax malaria: a systematic review and individual patient data meta-analysis

“…The risk of severe haemolysis in patients with activity between 30% and less than 70% treated with 1 mg/kg per day primaquine remains unclear. These reassuring safety findings, in combination with evidence of the benefit of increased total mg/kg primaquine doses, 36 pave the way for the widespread implementation of more efficacious primaquine regimens to reduce morbidity associated with vivax malaria.…”

“…Higher total primaquine doses are more effective than lower doses, 35 , 36 and are generally standard practice in countries where G6PD testing is routinely available. 37 In areas where G6PD testing is not available, most malaria-endemic countries adopt a primaquine regimen at a lower dose (ie, 3·5 mg/kg total dose) administered during 7 days or 14 days.…”