Eficacia terapéutica de esquemas de Primaquina usados como alternativa al tratamiento estándar en la prevención de recaídas por Plasmodium vivax: Una revisión sistemática y meta-análisis

Abstract

Objective: To compare efficacy and safety of primaquine regimens currently used to prevent relapses by P. vivax. Methods: A systematic review was carried out to identify clinical trials evaluating efficacy and safety to prevent malaria recurrences by P. vivax of primaquine regimen 0.5 mg / kg / day for 7 or 14 days compared to standard regimen of 0.25 mg/kg/day for 14 days. Efficacy of primaquine according to cumulative incidence of recurrences after 28 days was determined. The overall relative risk with fixed-effects meta-analysis was estimated. Results: For the regimen 0.5 mg/kg/day/7 days were identified 7 studies, which showed an incidence of recurrence between 0% and 20% with follow-up 60-210 days; only 4 studies comparing with the standard regimen 0.25 mg/kg/day/14 days and no difference in recurrences between both regimens (RR= 0.977, 95% CI= 0.670 to 1.423) were found. 3 clinical trials using regimen 0.5 mg/kg/day/14 days with an incidence of recurrences between 1.8% and 18.0% during 330-365 days were identified; only one study comparing with the standard regimen (RR= 0.846, 95% CI= 0.484 to 1.477). High risk of bias and differences in handling of included studies were found. Conclusion: Available evidence is insufficient to determine whether currently PQ regimens used as alternative rather than standard treatment have better efficacy and safety in preventing relapse of P. vivax. Clinical trials are required to guide changes in treatment regimen of malaria vivax.

Primaquine at alternative dosing schedules for preventing relapse in people withPlasmodium vivaxmalaria

“…Our findings that 210 mg over 7 days may be as efficacious as 210 mg over 14 days are similar to the findings of other systematic reviews that examined both randomized and non‐randomized studies (Carmona‐Fonseca 2015; Zuluaga‐Idarraga 2015). Other reviews also commented on the difficulty of comparing results due to the varying treatment regimens and length of follow‐up used in clinical trials (John 2012; Carmona‐Fonseca 2015; Zuluaga‐Idarraga 2015).…”

Biological concepts in recurrentPlasmodium vivaxmalaria

“…Drug-associated considerations in recurrence It is well known that both blood schizontocides and the supposedly radically curative drug primaquine are not always effective for P. vivax malaria (e.g. Campo et al 2015;Carmona-Fonseca, 2015;Zuluaga-Idarraga et al 2015;Commons et al 2017). Recurrences can therefore be a consequence of failure to clear all parasites.…”