Vivax Malaria Clinical Trial
Official title:
A Randomised Open Label Study Comparing the Efficacy of Chloroquine/Primaquine, Chloroquine and Artesunate in the Treatment of Vivax Malaria Along the Thai-Burmese Border
This is a randomised open label trial with follow up for 1 year. 660 adults and children above 6 months diagnosed with acute Plasmodium vivax will be randomised into 3 groups, either chloroquine, artesunate, or chloroquine/primaquine therapy. Participants will be screened on the day of inclusion then followed weekly for 8 visits and every 4 weeks until week 52. The primary objective of the study is to compare the efficacy of the WHO and Thai Ministry of Public Health recommended radical curative regimen of chloroquine and primaquine with the currently used monotherapy regimens of chloroquine and artesunate along the Thai-Burmese border.
Considerably less attention has been paid to Plasmodium vivax epidemiology than Plasmodium
falciparum. In areas of relatively low unstable transmission, which comprise the majority of
P.vivax affected areas, vivax malaria is predominantly a disease of children (Luxemburger et
al 1999). Chloroquine has long been the standard treatment for vivax malaria. Primaquine is
recommended for radical cure of vivax malaria, but is difficult to administer due to dosing
duration and side effects.
This study aims to characterize the epidemiologic history comparing the efficacy of 3
antimalarial regimens (chloroquine, artesunate, and chloroquine/primaquine) for plasmodium
vivax in western Thailand. Chloroquine is currently the standard of treatment for Plasmodium
vivax. Due to the long half-life or chloroquine, the first relapse of vivax malaria may be
delayed. In contrast, artesunate has a very short half-life, thus, having no impact on first
relapse. It is not known whether chloroquine reduces the overall number of relapses, or only
delays the first relapse. There are many important questions about the biology of vivax
malaria of relevance to treatment that remain unanswered. For example is the number of
relapses per infection (i.e. per successful inoculation) predetermined or adaptive? If it is
predetermined then suppression of the first relapse (as with chloroquine, mefloquine or
piperaquine) will reduce the total number of relapses and this is a clear benefit. If it is
adaptive then these drugs will simply delay the relapses and there is less clear benefit.
These various uncertainties illustrate the importance of detailed comparative longitudinal
evaluations. In order to characterize the biology of vivax malaria, it will be necessary to
compare regimens with and without primaquine. Because of the challenges that face primaquine
prescription (side effects, toxicity in G6PD deficient patients and duration of treatment),
it is not commonly deployed along the Thai Burma border. In effect, we will be comparing
usual practice (non primaquine regimens) with the recommended WHO and Thai MOPH practice
(use of primaquine for 14 days). The information we will gather is crucial to the
understanding of chloroquine and its effect on the vivax parasite. This will lead to future
studies and invariably change the way we treat vivax malaria.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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