#VisualAbstract: Single-Dose Tafenoquine to Prevent Relapse of Plasmodium vivax Malaria

1. After initial chloroquine treatment, P. vivax malaria infected patients treated with tafenoquine had significantly lower rates of P. vivax infection at 6 months compared to patients given placebo.

2. Mean hemoglobin levels were mildly reduced in the tafenoquine group but returned to baseline after treatment.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: P. vivax, one of the causative pathogens of malaria, can infect a substantial portion of the world population and be difficult to completely treat due to different life stages of the parasite. Generally, chloroquine is used to treat asexual parasites and a subsequent 14-day treatment with a primaquine clears hypnozoites. Due to adherence difficulties, a shorter course of treatment for hypnozoites is sought. This study evaluated clearance of P. vivax infection in patients treated with chloroquine followed by a single dose of the long acting drug tafenoquine, placebo, or a 14-day regimen of primaquine. After 6 months, patients treated with tafenoquine had a significantly lower relapse for infection rate than those treated with placebo, and had a comparable relapse rate as those in the primaquine group. Hemoglobin levels were mildly lower for a brief period after tafenoquine treatment but returned to baseline in all patients.

This study supports use of a single dose treatment for clearance of hypnozoites in P. vivax malaria infected patients. Though the study is limited in the number of patients included and subsequent hazard ratios for various outcomes were often large, results were conclusive across all subgroups assessed that tafenoquine is substantially more effective than placebo after chloroquine treatment.

Click to read the study in NEJM

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