Quantifying Plasmodium vivax radical cure efficacy: a modelling study integrating clinical trial data and transmission dynamics
Résumé
We calibrated a novel P vivax Recurrence Model to publicly available data from prospective clinical trials to estimate the hypnozoiticidal efficacy of different supervised primaquine (3•5 mg/kg or 7 mg/kg over 7 or 14 days) and tafenoquine (5 mg/kg or 7•5 mg/kg single dose) regimens in patients with normal glucose-6-phosphate dehydrogenase (G6PD) activity. We used an existing P vivax Individual-Based Model to quantify the 5-year impact of case management with unsupervised primaquine or tafenoquine regimens across various transmission settings.
Findings We estimated median hypnozoiticidal efficacies of 99•1% (95% credible interval 96•0-100) for primaquine 7 mg/kg over 14 days; 96•3% (90•8-99•7) for primaquine 7 mg/kg over 7 days; 72•3% (68•1-76•3) for primaquine 3•5 mg/kg over 7 or 14 days; 62•4% (49•1-76•3) for tafenoquine 5 mg/kg single dose; and 87•5% (62•1-99•3) for tafenoquine 7•5 mg/kg single dose. 5 years of community-level tafenoquine case management was estimated to reduce P vivax transmission by 74-79% where pre-intervention prevalence as measured by PCR was low (<2%) and by 17-20% where prevalence as measured by PCR was high (around 35%). Similar 5-year reductions were estimated with primaquine case management only when adherence to the primaquine regimen was above 50%.
Interpretation Substantial reductions in prevalence as measured by PCR were predicted with primaquine and tafenoquine regimens if these could be implemented with high coverage and adherence. The benefits of preventing P vivax relapses need to be balanced against the risks of inducing severe haemolysis in patients with G6PD deficiency.
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https://pasteur.hal.science/pasteur-04893546
Soumis le : vendredi 17 janvier 2025-11:55:26
Dernière modification le : vendredi 17 janvier 2025-15:51:47
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- HAL Id : pasteur-04893546 , version 1
- DOI : 10.1016/s1473-3099(24)00689-3
- PUBMED : 39818221