Dihydroartemisinin-piperaquine: if it works for control, can we use it for elimination?

February 1, 2017 at 2:04 pm

Lancet Infectious Diseases February 2017 V.17 N.2 P.121–122

COMMENT

Quique Bassat

Historically, antimalarial drugs have been used at a population level in malaria-endemic areas with the objective of decreasing the burden, impact, and transmissibility of malaria. Continuous chemoprophylaxis, once experimented but never seriously considered a feasible wide-scale implementable strategy, has been superseded by the concept of intermittent treatment targeting different population groups, presenting many advantages, including non-interference with the acquisition of natural immunity against malaria. A fundamental premise for the use of any drug as part of population wide distribution efforts, besides its efficacy, is that the drug is sufficiently safe so as to not to risk endangering the healthy individuals that will be exposed to it. The artemisinin-derived combination dihydroartemisinin-piperaquine (DP), registered under the European Medicines Agency in 2011, would appear as an ideal candidate for the treatment of malaria, not only because of its high-demonstrated efficacy, but on account of its excellent tolerability and good safety profile, well reported in the literature. From a preventive point of view, the long half-life of the partner drug piperaquine conveys protection of 22 days for adult patients and around 20 days for paediatric patients, indicating a better post-treatment prophylactic effect than other combination therapies. In the Lancet Infectious Diseases, Julie Gutman and colleagues analyse the safety, tolerability, and efficacy of repeated doses of DP, for the treatment and prevention of malaria, with a particular focus on its use as intermittent preventive treatment (IPT). Their meta-analysis, looking at over 4000 patients exposed to repeated courses of DP, substantiates the high efficacy of this drug in terms of controlling malaria and all-cause hospital admission, and the good tolerability of repeated treatment schemes, with no evidence of arrhythmias secondary to the potential QT prolongation effect of cumulative doses of piperaquine after repeated doses. Although numbers are clearly insufficient to rule out this rare, life-threatening complication, and the small number of carefully ECG monitored patients calls for caution and further cardio safety studies, this analysis adds up to the growing body of evidence supporting the potential of this drug for IPT strategies. as an alternative to the currently recommended drugs. In areas where transmission remains high, it may be prudent to restrict ACTs for the treatment of cases, and not overexpose this drug family for prophylactic purposes…

FULL TEXT

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30459-5/fulltext?elsca1=etoc

PDF

http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(16)30459-5.pdf

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Entry filed under: Antiparasitarios, Biología Molecular, Epidemiología, FIEBRE en el POST-VIAJE, Infecciones parasitarias, Medicina del viajero, Metodos diagnosticos, Sepsis, Update, Zoonosis.

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