Artemether-lumefantrine vs Chloroquine for Uncomplicated P. Vivax Malaria in Malaysia
Status:
Unknown status
Trial end date:
2017-12-01
Target enrollment:
Participant gender:
Summary
Both artemether-lumefantrine and chloroquine are currently used and recommended by Malaysian
Ministry of Health as blood stage treatments for non-severe P. vivax and P. knowlesi malaria.
Microscopic misdiagnosis between Plasmodium species remains a large issue in Sabah, Malaysia
and elsewhere. In order to facilitate potential policy change to a unified ACT guideline for
all malaria species in Sabah artemether-lumefantrine needs to be evaluated for P. vivax
malaria.
Preliminary data in a recently completed RCT evaluating artesunate-mefloquine vs chloroquine
for P. vivax showed up to 36% P. vivax recurrence with chloroquine monotherapy by day 28 post
treatment without primaquine. Based on these data blood stage chloroquine treatment failure
rates should also be evaluated in the context of standard concurrent (rather than delayed)
liver stage primaquine dosing, due to both its potential blood stage synergistic effect in
addition to known decreased recurrence rates. As artemether-lumefantrine is one of the
current first line Ministry of Health ACTs used in Sabah with a lower adverse event profile
compared to artesunate-mefloquine, this was recommended as the more appropriate ACT to
evaluate against chloroquine.