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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Bibliographic Details
Published in:The American journal of tropical medicine and hygiene 2016-04, Vol.94 (4), p.879-885
Main Authors: 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, Thai, Le Hong, Hoa, Nhu Thi, Dong, Le Thanh, 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
Format: Article
Language:English
Subjects:
Antimalarials - administration & dosage
Antimalarials - therapeutic use
Artemisinins - administration & dosage
Artemisinins - therapeutic use
Chloroquine - therapeutic use
Drug Therapy, Combination
Female
Humans
Malaria, Vivax - drug therapy
Male
Plasmodium vivax
Plasmodium vivax - drug effects
Quinolines - administration & dosage
Quinolines - therapeutic use
Treatment Outcome
Vietnam
Young Adult
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Summary: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.
ISSN:0002-9637
1476-1645
DOI:10.4269/ajtmh.15-0740