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A Randomized Comparison of Chloroquine versus Dihydroartemisinin–Piperaquine for the Treatment of Plasmodium vivax Infection in Vietnam

A total of 128 Vietnamese patients with symptomatic Plasmodium vivax mono-infections were enrolled in a prospective, open-label, randomized trial to receive either chloroquine or dihydroartemisinin–piperaquine (DHA-PPQ). The proportions of patients with adequate clinical and parasitological response...

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Detalles Bibliográficos
Autores principales: Thuan, Phung Duc, Ca, Nguyen Thuy Nha, Van Toi, Pham, Nhien, Nguyen Thanh Thuy, Thanh, Ngo Viet, Anh, Nguyen Duc, Phu, Nguyen Hoan, Thai, Cao Quang, Hong Thai, Le, Hoa, Nhu Thi, Thanh Dong, Le, Loi, Mai Anh, Son, Do Hung, Khanh, Tran Tinh Ngoc, Dolecek, Christiane, Nhan, Ho Thi, Wolbers, Marcel, Thwaites, Guy, Farrar, Jeremy, White, Nicholas J., Hien, Tran Tinh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The American Society of Tropical Medicine and Hygiene 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824232/
https://www.ncbi.nlm.nih.gov/pubmed/26856909
http://dx.doi.org/10.4269/ajtmh.15-0740
Descripción
Sumario:A total of 128 Vietnamese patients with symptomatic Plasmodium vivax mono-infections were enrolled in a prospective, open-label, randomized trial to receive either chloroquine or dihydroartemisinin–piperaquine (DHA-PPQ). The proportions of patients with adequate clinical and parasitological responses were 47% in the chloroquine arm (31 of 65 patients) and 66% in the DHA-PPQ arm (42 of 63 patients) in the Kaplan–Meier intention-to-treat analysis (absolute difference 19%, 95% confidence interval = 0–37%), thus establishing non-inferiority of DHA-PPQ. Fever clearance time (median 24 versus 12 hours, P = 0.02), parasite clearance time (median 36 versus 18 hours, P < 0.001), and parasite clearance half-life (mean 3.98 versus 1.80 hours, P < 0.001) were all significantly shorter in the DHA-PPQ arm. All cases of recurrent parasitemia in the chloroquine arm occurred from day 33 onward, with corresponding whole blood chloroquine concentration lower than 100 ng/mL in all patients. Chloroquine thus remains efficacious for the treatment of P. vivax malaria in southern Vietnam, but DHA-PPQ provides more rapid symptomatic and parasitological recovery.