Sex and gender in health research: updating policy to reflect evidence

Sex-Related Differences in Drugs with Anti-Inflammatory Properties

“…Sex is an important factor in epidemiology, pathophysiology, clinical manifestations, disease progression, and response to treatment [ 22 ]. We have not addressed the equally important aspect of sociocultural gender, which has recently been reviewed elsewhere [ 22 , 23 , 98 ]. The field of sex and gender research is slowly gaining speed, but fundamental evidence gaps still need to be addressed to better understand the way these characteristics function independently and together to influence health, disease, and health care [ 22 , 23 ].…”

Optimizing G6PD testing for Plasmodium vivax case management and beyond: why sex, counseling, and community engagement matter

“…Females in the lower range of intermediate G6PD activity are at risk of potentially clinically significant haemolysis from high dose 14-day primaquine (0.5mg/kg daily) and tafenoquine (300mg single dose) (Kozenis® and Krintafel®) 9,13,19,39,40 . In a systematic review comparing treatment with chloroquine versus chloroquine and primaquine, G6PD "normal" (classified using qualitative tests) females taking primaquine had significantly greater haemoglobin reductions than males 41 .…”

“…In a systematic review comparing treatment with chloroquine versus chloroquine and primaquine, G6PD "normal" (classified using qualitative tests) females taking primaquine had significantly greater haemoglobin reductions than males 41 . Recent studies exploring the efficacy of a high dose short course (7-day) primaquine regimen (1mg/kg) have shown consistently that females classified as normal by the fluorescent spot test are at risk for clinically significant primaquine-induced haemolysis 19,40 . One of the studies was carried out in an area with a high prevalence (15-18%) of G6PD deficiency; heterozygous females showed a significantly greater drop in haematocrit as compared to wild type homozygous females given the same treatments, and 2/16 females receiving dihydroartemisinin-piperaquine with the 7-day primaquine regimen needed a blood transfusion 18,40 .…”

“…One of the studies was carried out in an area with a high prevalence (15-18%) of G6PD deficiency; heterozygous females showed a significantly greater drop in haematocrit as compared to wild type homozygous females given the same treatments, and 2/16 females receiving dihydroartemisinin-piperaquine with the 7-day primaquine regimen needed a blood transfusion 18,40 . In the second study, 2 females from the site in Hanura, Indonesia had clinically significant haemolysis (a 31-40% haemoglobin reduction from pre-treatment) where 229 total participants were treated with the 7-day primaquine regimen 19 . Prevalence of G6PD deficiency in the area was unknown but previous reports in West Timor region gave a prevalence of 3.2% among males 42 .…”

“…As countries prepare to increase access to P. vivax radical cure with the curative regimens of primaquine 18,19 and tafenoquine (Kozenis® and Krintafel®) 11,12 , respectively, there are several opportunities that should be considered within broader national health systems for expanding the acceptability, utility, and concurrently, the cost-effectiveness of G6PD testing beyond malaria case management 15 . In this article, we discuss an important opportunity to reduce sex-related health disparities in an era of new tools and initiatives that improve the diagnosis of G6PD deficiency.…”