Background
Methods
Inclusion criteria
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Mean difference in average haemoglobin values at day 7.
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Mean difference in percent haemoglobin value change between baseline and day 7.
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Relative risk of ≥5, ≥10 or ≥20% decline in haemoglobin concentration by day 7.
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Relative risk of moderate (≤8 g/dl) and severe (≤5 g/dl) anaemia at day 7.
Results
Study selection and study characteristics
Study name | Study design | 8-AQ duration | Dose | Adult dose (mg)a
| Total adult dose (mg) | Malaria | Country | Setting | Population | Age | PQ compared to placebo in G6PD deficient people | PQ in G6PD deficient compared to G6PD replete people |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Primaquine | ||||||||||||
Krudsood [24] | Randomized control trial | 7 days | 30 mg | 30 | 210 | Yes | Thailand | Patients | Primary care urban | 16–51 years | No | Yes |
Shekalaghe [22] | Randomized control trial | Once | 0.75 mg/kg | 45 | 45 | Yes | Tanzania | Residents | Rural | 3–15 years | Yes | Yes |
Shekalaghe [23] | Randomized control trial | Once | 0.75 mg/kg | 45 | 45 | No | Tanzania | Residents | Rural | 1–11 years | Yes | Yes |
Randomized control trial | Once | 0.1, 0.4 or 0.75 mg/kg | 6, 24, 45 | 6, 24, 45 | Yes | Uganda | Residents | Unknown | 1–10 years | Yes | Yes | |
Kheng [30] | Open parallel clinical trial | Once | 0.75 mg/kg | 45 | 45 | No | Cambodia | Healthcare centres | Adults and children | No | Yes | |
Bancone [29] | Cohort study | Once | 0.25 mg/kg | 15 | 15 | No | North-Western Myanmar–Thailand border | Residents | Rural | Adults and children | No | Yes |
Ley [31] | Cohort study | Once | 0.75 mg/kg | 45 | 45 | Yes | Bangladesh | Healthcare | Rural | Adults and children | No | Yes |
Mwaiswelo [28] | Randomized control trial | Once | 0.25 mg/kg | 15 | 15 | Yes | Tanzania | Dispensary | Town | Men and non-pregnant, non-lactating women aged ≥1 year | Yes | Yes |
Tafenoquine | ||||||||||||
Rueangweerayut [32] | Cohort study | Once | 100 mg (1.67 mg/kg), 200 mg (3.33 mg/kg), 300 mg (5.00 mg/kg) | 100, 200, 300 | 100, 200, 300 | No | Thailand | Laboratory | Research institute | 18–45 years | No | Yes |
Study (country) | Methods | Results | |
---|---|---|---|
Phenotype | Genotype | ||
Krudsood [24] (Thailand) | Not reported | G6PD normal: 134 patients G6PD deficient: 7 patients | Not tested |
Shekalaghe [22] (Tanzania) | PCR for G202A, A376G | G6PD normal: 77 patients G6PD deficient: 30 patients | G6PD wild type: 77 patients G6PD deficient heterozygous: 23 patients G6PD deficient hemizygous/homozygous: 7 patients |
Shekalaghe [23] (Tanzania) | PCR for G202A, A376G | G6PD normal: 493 patients G6PD deficient: 69 patients | G6PD wild type: 493 patients G6PD deficient heterozygous: 47 patients G6PD deficient hemizygous/homozygous: 22 patients |
Rueangweerayut [32] (Thailand) | PCR RFLP for Mahidol | G6PD normal (Mahidol negative with >80% G6PD activity): 6 patients G6PD deficient (G6PD enzyme activity 40–60% of normal): 6 patients | G6PD wild type: 6 patients G6PD deficient heterozygous: 6 patients |
(Uganda) | FST; PCR for G202A/A376G | G6PD normal: 373 patients G6PD deficient: 88 patients | G6PD wild type: 373 patients G6PD deficient heterozygous: 61 patients G6PD deficient hemizygous/homozygous: 27 patients |
Kheng [30] (Cambodia) | FST; enzyme quantification; PCR for Mahidol, Mediterranean, Coimbra, Chinese-5, and Canton | G6PD normal: 57 patients G6PD deficient: 18 patients | G6PD wild type: 57 patients G6PD deficient hemizygous male: 14 patients G6PD deficient homozygous female: 1 patient G6PD deficient heterozygous female: 3 patients |
Bancone [29] (Thai–Myanmar border) | FST; enzyme quantification; PCR RFLP for Mahidol. Chinese-4, Canton and Viangchan | G6PD normal: 1226 patients G6PD intermediate: 50 patients G6PD deficient: 124 patients | G6PD wild type: 1226 patients G6PD deficient hemizygous male: 39 patients G6PD deficient homozygous female: 5 patient G6PD deficient heterozygous female: 65 patients |
Ley [31] (Bangladesh) | FST; enzyme quantification | G6PD normal: 169 Mild G6PD deficiency: 5 patients Severe G6PD deficiency: 1 patient | Not tested |
Mwaiswelo [28] (Tanzania) | Rapid test; PCR for G202A, A376G | G6PD normal: 184 patients G6PD deficient: 33 patients | Males G6PD A wild type: 95 patients G6PD A− hemizygous: 15 patients |
Females G6PD AA and BA wild type: 83 patients G6PD A−A− homozygous: 5 patients G6PD AA− and BA−heterozygous: 22 patients |
Certainty of evidence
High dose (0.75 mg/kg) PQ
Mid-range dose (0.4–0.5 mg/kg)
Low dose (0.1–0.25 mg/kg)
Tafenoquine (Table 3)
TQ 100 mg | TQ 200 mg | TQ 300 mg | ||||
---|---|---|---|---|---|---|
G6PD normal | G6PD deficiency | G6PD normal | G6PD deficiency | G6PD normal | G6PD deficiency | |
Number of participants | 6 | 6 | 6 | 6 | 6 | 6 |
Average maximum decline in haemoglobin (g/dl) from baseline | −1.8 | −1.28 | −1.23 | −1.83 | −0.75 | −2.78 |
Average day of maximum decline | 10 | 10 | 10 | 10 | 10 | 9 |