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Effect of adherence to primaquine on the risk of Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient data meta-analysis

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dc.contributor.author Mehdipour, Parinaz
dc.contributor.author Rajasekhar, Megha
dc.contributor.author Dini, Saber
dc.contributor.author Zaloumis, Sophie
dc.contributor.author Abreha, Tesfay
dc.contributor.author Adam, Ishag
dc.contributor.author Awab, Ghulam Rahim
dc.contributor.author Baird, J. Kevin
dc.contributor.author Brasil, Larissa W.
dc.contributor.author Chu, Cindy S.
dc.contributor.author Cui, Liwang
dc.contributor.author Daher, André
dc.contributor.author do Socorro M Gomes, Margarete
dc.contributor.author Gonzalez-Ceron, Lilia
dc.contributor.author Hwang, Jimee
dc.contributor.author Karunajeewa, Harin
dc.contributor.author Lacerda, Marcus V. G.
dc.contributor.author Ladeia-Andrade, Simone
dc.contributor.author Leslie, Toby
dc.contributor.author Ley, Benedikt
dc.contributor.author Lidia, Kartini
dc.contributor.author Llanos Cuentas, Elmer Alejandro
dc.contributor.author Longley, Rhea J.
dc.contributor.author Monteiro, Wuelton Marcelo
dc.contributor.author Pereira, Dhelio B.
dc.contributor.author Rijal, Komal Raj
dc.contributor.author Saravu, Kavitha
dc.contributor.author Sutanto, Inge
dc.contributor.author Taylor, Walter R. J.
dc.contributor.author Thanh, Pham Vinh
dc.contributor.author Thriemer, Kamala
dc.contributor.author Vieira, José Luiz F.
dc.contributor.author White, Nicholas J.
dc.contributor.author Zuluaga-Idarraga, Lina M.
dc.contributor.author Guerin, Philippe J.
dc.contributor.author Price, Ric N.
dc.contributor.author Simpson, Julie A.
dc.contributor.author Commons, Robert J.
dc.date.accessioned 2023-12-05T17:47:59Z
dc.date.available 2023-12-05T17:47:59Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/14625
dc.description.abstract Background: Imperfect adherence is a major barrier to effective primaquine radical cure of Plasmodium vivax. This study investigated the effect of reduced adherence on the risk of P. vivax recurrence. Methods: Efficacy studies of patients with uncomplicated P. vivax malaria, including a treatment arm with daily primaquine, published between January 1999 and March 2020 were identified. Individual patient data from eligible studies were pooled using standardized methodology. Adherence to primaquine was inferred from i) the percentage of supervised doses and ii) the total mg/kg dose received compared to the target total mg/kg dose per protocol. The effect of adherence to primaquine on the incidence of P. vivax recurrence between days 7 and 90 was investigated by Cox regression analysis. Results: Of 82 eligible studies, 32 were available including 6917 patients from 18 countries. For adherence assessed by percentage of supervised primaquine, 2790 patients (40.3%) had poor adherence (≤ 50%) and 4127 (59.7%) had complete adherence. The risk of recurrence by day 90 was 14.0% [95% confidence interval: 12.1–16.1] in patients with poor adherence compared to 5.8% [5.0–6.7] following full adherence; p = 0.014. After controlling for age, sex, baseline parasitaemia, and total primaquine dose per protocol, the rate of the first recurrence was higher following poor adherence compared to patients with full adherence (adjusted hazard ratio (AHR) = 2.3 [1.8–2.9]). When adherence was quantified by total mg/kg dose received among 3706 patients, 347 (9.4%) had poor adherence, 88 (2.4%) had moderate adherence, and 3271 (88.2%) had complete adherence to treatment. The risks of recurrence by day 90 were 8.2% [4.3–15.2] in patients with poor adherence and 4.9% [4.1–5.8] in patients with full adherence; p < 0.001. en_US
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartofseries Malaria Journal
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Malaria en_US
dc.subject Plasmodium vivax en_US
dc.subject Adherence en_US
dc.subject Primaquine en_US
dc.subject Rate of recurrence en_US
dc.subject Supervision en_US
dc.subject.mesh Malaria
dc.subject.mesh Plasmodium vivax
dc.subject.mesh Primaquina
dc.subject.mesh Recurrencia
dc.title Effect of adherence to primaquine on the risk of Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient data meta-analysis en_US
dc.type info:eu-repo/semantics/review
dc.identifier.doi https://doi.org/10.1186/s12936-023-04725-w
dc.relation.issn 1475-2875


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