Pub Date : 2025-01-16DOI: 10.1016/s1473-3099(25)00003-9
Macià D, Campo JJ, Jairoce C, et al. The effect of Plasmodium falciparum exposure and maternal anti-circumsporozoite protein antibodies on responses to RTS,S/AS01Evaccination in infants and children: an ancillary observational immunological study to a phase 3, randomised clinical trial. Lancet Infect Dis 2024; published online Oct 23. https://doi.org/10.1016/S1473-3099(24)00527-9—In the table of this Article, the † footnote has been removed from the Kintampo row of the Infant section. In figure 2, the correlation values in panel C have been coloured blue and purple to indicate the age group to which they are referring and the legend has been updated to state that, in panel B, “Green dots indicate significant results at a false discovery rate below 5%.” In panel A of figure 4, the text has been updated to refer to “High pre-vaccination Plasmodium falciparum IgG levels”. And in the Results section, the first sentence of the second paragraph has been corrected to “IgG levels to 981 (98%) out of 1000 P falciparum antigens showed a significant increase following a malaria episode”. These corrections have been made to the online version as of Jan 16, 2025, and will be made to the printed version.
{"title":"Correction to Lancet Infect Dis 2024; published online Oct 23. https://doi.org/10.1016/S1473-3099(24)00527-9","authors":"","doi":"10.1016/s1473-3099(25)00003-9","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00003-9","url":null,"abstract":"<em>Macià D, Campo JJ, Jairoce C, et al. The effect of</em> Plasmodium falciparum <em>exposure and maternal anti-circumsporozoite protein antibodies on responses to RTS,S/AS01</em><sub>E</sub> <em>vaccination in infants and children: an ancillary observational immunological study to a phase 3, randomised clinical trial.</em> Lancet Infect Dis <em>2024; published online Oct 23. https://doi.org/10.1016/S1473-3099(24)00527-9</em>—In the table of this Article, the † footnote has been removed from the Kintampo row of the Infant section. In figure 2, the correlation values in panel C have been coloured blue and purple to indicate the age group to which they are referring and the legend has been updated to state that, in panel B, “Green dots indicate significant results at a false discovery rate below 5%.” In panel A of figure 4, the text has been updated to refer to “High pre-vaccination <em>Plasmodium falciparum</em> IgG levels”. And in the Results section, the first sentence of the second paragraph has been corrected to “IgG levels to 981 (98%) out of 1000 <em>P falciparum</em> antigens showed a significant increase following a malaria episode”. These corrections have been made to the online version as of Jan 16, 2025, and will be made to the printed version.","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"55 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-15DOI: 10.1016/s1473-3099(24)00746-1
Anthony Nuwa, Kevin Baker, Richard Kajubi, Chukwudi A Nnaji, Katherine Theiss-Nyland, Musa Odongo, Tonny Kyagulanyi, Jane Nabakooza, David Salandini, Victor Asua, Maureen Nakirunda, Christian Rassi, Damian Rutazaana, Richard Achuma, Patrick Sagaki, John Baptist Bwanika, Godfrey Magumba, Adoke Yeka, Sam Nsobya, Moses R Kamya, Jimmy Opigo
<h3>Background</h3>Seasonal malaria chemoprevention (SMC) with sulfadoxine–pyrimethamine combined with amodiaquine (SPAQ) effectively protects eligible children from malaria in areas of high and seasonal transmission. However, concerns about parasite resistance to sulfadoxine–pyrimethamine in East and Southern Africa necessitate evaluating alternative drug regimens. This study assessed the effectiveness of SPAQ and dihydroartemisinin–piperaquine for SMC in Uganda.<h3>Methods</h3>This three-arm, open-label, non-inferiority and superiority, cluster-randomised, controlled trial was conducted in Karamoja subregion, Uganda, among children aged 3–59 months and 6–59 months for SPAQ and dihydroartemisinin–piperaquine, respectively. Of 427 villages, 380 were randomly assigned (1:1) to the SPAQ group and dihydroartemisinin–piperaquine group, and 47 were assigned to the control group (no SMC). The superiority component compared the SPAQ and dihydroartemisinin–piperaquine groups with the control group, whereas the non-inferiority component compared the dihydroartemisinin–piperaquine group with the SPAQ group. The primary endpoint was confirmed malaria incidence using rapid diagnostic tests or microscopy. Survival analyses were done on an intention-to-treat basis (in all randomised participants), with adjustments made for covariate imbalances at baseline. Additionally, molecular markers associated with resistance to sulfadoxine–pyrimethamine and amodiaquine were analysed on 750 malaria-positive blood samples from children younger than 5 years before and after five SMC cycles. This trial was registered with <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, <span><span>NCT05323721</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, and has been completed.<h3>Findings</h3>During June 18–30, 2022, 3881 children were enrolled; 1755 in SPAQ, 1736 in dihydroartemisinin–piperaquine, and 390 in control villages. Of these children, 3629 were analysed. Incidence rates were 0·90 cases per 100 person-months in the SPAQ group, 0·80 cases per 100 person-months in the dihydroartemisinin–piperaquine group, and 18·26 cases per 100 person-months in the control group. SPAQ and dihydroartemisinin–piperaquine reduced malaria risk by 94% (hazard ratio [HR] 0·06 [95% CI 0·04–0·08]; p<0·001) and 96% (0·04 [0·03–0·06]; p<0·001), respectively. Based on the prespecified non-inferiority margin of 1·4, there was non-inferiority between the protective effectiveness of dihydroartemisinin–piperaquine and that of SPAQ (HR 0·90 [95% CI 0·58–1·39]). Prevalence of mutations linked to moderate (<em>Plasmodium falciparum</em> dihydrofolate red
{"title":"Effectiveness of sulfadoxine–pyrimethamine plus amodiaquine and dihydroartemisinin–piperaquine for seasonal malaria chemoprevention in Uganda: a three-arm, open-label, non-inferiority and superiority, cluster-randomised, controlled trial","authors":"Anthony Nuwa, Kevin Baker, Richard Kajubi, Chukwudi A Nnaji, Katherine Theiss-Nyland, Musa Odongo, Tonny Kyagulanyi, Jane Nabakooza, David Salandini, Victor Asua, Maureen Nakirunda, Christian Rassi, Damian Rutazaana, Richard Achuma, Patrick Sagaki, John Baptist Bwanika, Godfrey Magumba, Adoke Yeka, Sam Nsobya, Moses R Kamya, Jimmy Opigo","doi":"10.1016/s1473-3099(24)00746-1","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00746-1","url":null,"abstract":"<h3>Background</h3>Seasonal malaria chemoprevention (SMC) with sulfadoxine–pyrimethamine combined with amodiaquine (SPAQ) effectively protects eligible children from malaria in areas of high and seasonal transmission. However, concerns about parasite resistance to sulfadoxine–pyrimethamine in East and Southern Africa necessitate evaluating alternative drug regimens. This study assessed the effectiveness of SPAQ and dihydroartemisinin–piperaquine for SMC in Uganda.<h3>Methods</h3>This three-arm, open-label, non-inferiority and superiority, cluster-randomised, controlled trial was conducted in Karamoja subregion, Uganda, among children aged 3–59 months and 6–59 months for SPAQ and dihydroartemisinin–piperaquine, respectively. Of 427 villages, 380 were randomly assigned (1:1) to the SPAQ group and dihydroartemisinin–piperaquine group, and 47 were assigned to the control group (no SMC). The superiority component compared the SPAQ and dihydroartemisinin–piperaquine groups with the control group, whereas the non-inferiority component compared the dihydroartemisinin–piperaquine group with the SPAQ group. The primary endpoint was confirmed malaria incidence using rapid diagnostic tests or microscopy. Survival analyses were done on an intention-to-treat basis (in all randomised participants), with adjustments made for covariate imbalances at baseline. Additionally, molecular markers associated with resistance to sulfadoxine–pyrimethamine and amodiaquine were analysed on 750 malaria-positive blood samples from children younger than 5 years before and after five SMC cycles. This trial was registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT05323721</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and has been completed.<h3>Findings</h3>During June 18–30, 2022, 3881 children were enrolled; 1755 in SPAQ, 1736 in dihydroartemisinin–piperaquine, and 390 in control villages. Of these children, 3629 were analysed. Incidence rates were 0·90 cases per 100 person-months in the SPAQ group, 0·80 cases per 100 person-months in the dihydroartemisinin–piperaquine group, and 18·26 cases per 100 person-months in the control group. SPAQ and dihydroartemisinin–piperaquine reduced malaria risk by 94% (hazard ratio [HR] 0·06 [95% CI 0·04–0·08]; p<0·001) and 96% (0·04 [0·03–0·06]; p<0·001), respectively. Based on the prespecified non-inferiority margin of 1·4, there was non-inferiority between the protective effectiveness of dihydroartemisinin–piperaquine and that of SPAQ (HR 0·90 [95% CI 0·58–1·39]). Prevalence of mutations linked to moderate (<em>Plasmodium falciparum</em> dihydrofolate red","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"9 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/s1473-3099(25)00005-2
Pragya D Yadav, Deepak Y Patil
No Abstract
{"title":"Interim analysis of SARS-CoV-2 vaccine NVX-CoV2601 as a heterologous booster dose","authors":"Pragya D Yadav, Deepak Y Patil","doi":"10.1016/s1473-3099(25)00005-2","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00005-2","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/s1473-3099(24)00670-4
Katia Alves, Karen Kotloff, R Scott McClelland, Alex Kouassi, Joyce S Plested, Raj Kalkeri, MingZhu Zhu, Shane Cloney-Clark, Zhaohui Cai, Katherine Smith, Muneer Kaba, Joy Nelson, E Adrianne Hammershaimb, Raburn M Mallory, Fernando Noriega
<h3>Background</h3>Authorities globally recommended a monovalent omicron XBB.1.5-based COVID-19 vaccine for the 2023–24 season. The Novavax COVID-19 vaccine, NVX-CoV2601, contains XBB.1.5 recombinant spike protein, based on an authorised prototype vaccine (NVX-CoV2373) technology. We aimed to determine whether a single dose of NVX-CoV2601 versus NVX-CoV2373 (from a previous study [2019nCoV-311 part 2]) produced superior neutralising antibody (nAb) responses, and non-inferior seroresponse rates to XBB.1.5, after three or more previous mRNA-based COVID-19 vaccinations.<h3>Methods</h3>In part 1 of this single-arm, phase 2/3 study (2019nCoV-313), participants aged 18 years or older who had been previously vaccinated with three or more doses of mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) were enrolled across 30 US centres (research groups and universities) located across 20 states. Participants received one intramuscular injection of NVX-CoV2601 (5 μg XBB.1.5 spike plus 50 μg Matrix-M adjuvant). Coprimary endpoints were superiority of baseline-adjusted nAb geometric mean XBB.1.5 titres (adjusted GMTs), with superiority declared when the lower bound of the 95% CI for the GMT ratio (GMTR) was greater than 1, and non-inferiority of seroresponse rates, with non-inferiority declared when the lower bound of the 95% CI for the seroresponse rate difference was greater than –10%, on day 28; comparisons were made for NVX-CoV2601 administered in this study versus NVX-CoV2373 administered in part 2 (group G) of the 2019nCoV-311 study. Coprimary endpoints were assessed in the per-protocol immunogenicity set (ie, all participants who received study vaccine, underwent 28 days of follow-up, had day 0 and day 28 samples available, and had no major protocol deviations). Safety was a secondary endpoint and included assessments of solicited treatment-emergent adverse events up to 7 days and unsolicited treatment-emergent adverse events up to 28 days after vaccination in the safety analysis set (ie, all participants who received study vaccine). Here we report the prespecified interim analysis of immunogenicity and safety up to day 28. This study is registered with <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, <span><span>NCT05975060</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, and is now complete.<h3>Findings</h3>Between Sept 7 and Sept 8, 2023, 380 individuals were screened, of whom 332 were enrolled and received study vaccine. At the 28-day interim analysis database lock (Jan 17, 2023), the per-protocol analysis sets included 309 (93%) of 332 NVX-CoV2601 recipients and 227 (90%) of 252 NVX-CoV2373 recipie
{"title":"Immunogenicity and safety of a monovalent omicron XBB.1.5 SARS-CoV-2 recombinant spike protein vaccine as a heterologous booster dose in US adults: interim analysis of a single-arm phase 2/3 study","authors":"Katia Alves, Karen Kotloff, R Scott McClelland, Alex Kouassi, Joyce S Plested, Raj Kalkeri, MingZhu Zhu, Shane Cloney-Clark, Zhaohui Cai, Katherine Smith, Muneer Kaba, Joy Nelson, E Adrianne Hammershaimb, Raburn M Mallory, Fernando Noriega","doi":"10.1016/s1473-3099(24)00670-4","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00670-4","url":null,"abstract":"<h3>Background</h3>Authorities globally recommended a monovalent omicron XBB.1.5-based COVID-19 vaccine for the 2023–24 season. The Novavax COVID-19 vaccine, NVX-CoV2601, contains XBB.1.5 recombinant spike protein, based on an authorised prototype vaccine (NVX-CoV2373) technology. We aimed to determine whether a single dose of NVX-CoV2601 versus NVX-CoV2373 (from a previous study [2019nCoV-311 part 2]) produced superior neutralising antibody (nAb) responses, and non-inferior seroresponse rates to XBB.1.5, after three or more previous mRNA-based COVID-19 vaccinations.<h3>Methods</h3>In part 1 of this single-arm, phase 2/3 study (2019nCoV-313), participants aged 18 years or older who had been previously vaccinated with three or more doses of mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) were enrolled across 30 US centres (research groups and universities) located across 20 states. Participants received one intramuscular injection of NVX-CoV2601 (5 μg XBB.1.5 spike plus 50 μg Matrix-M adjuvant). Coprimary endpoints were superiority of baseline-adjusted nAb geometric mean XBB.1.5 titres (adjusted GMTs), with superiority declared when the lower bound of the 95% CI for the GMT ratio (GMTR) was greater than 1, and non-inferiority of seroresponse rates, with non-inferiority declared when the lower bound of the 95% CI for the seroresponse rate difference was greater than –10%, on day 28; comparisons were made for NVX-CoV2601 administered in this study versus NVX-CoV2373 administered in part 2 (group G) of the 2019nCoV-311 study. Coprimary endpoints were assessed in the per-protocol immunogenicity set (ie, all participants who received study vaccine, underwent 28 days of follow-up, had day 0 and day 28 samples available, and had no major protocol deviations). Safety was a secondary endpoint and included assessments of solicited treatment-emergent adverse events up to 7 days and unsolicited treatment-emergent adverse events up to 28 days after vaccination in the safety analysis set (ie, all participants who received study vaccine). Here we report the prespecified interim analysis of immunogenicity and safety up to day 28. This study is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT05975060</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and is now complete.<h3>Findings</h3>Between Sept 7 and Sept 8, 2023, 380 individuals were screened, of whom 332 were enrolled and received study vaccine. At the 28-day interim analysis database lock (Jan 17, 2023), the per-protocol analysis sets included 309 (93%) of 332 NVX-CoV2601 recipients and 227 (90%) of 252 NVX-CoV2373 recipie","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"59 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-13DOI: 10.1016/s1473-3099(24)00689-3
Constanze Ciavarella, Chris Drakeley, Ric N Price, Ivo Mueller, Michael White
Background
Plasmodium vivax forms dormant liver stages (hypnozoites) that can reactivate weeks to months after primary infection. Radical cure requires a combination of antimalarial drugs to kill both the blood-stage and liver-stage parasites. Hypnozoiticidal efficacy of the liver-stage drugs primaquine and tafenoquine cannot be estimated directly because hypnozoites are undetectable. We aimed to estimate hypnozoiticidal efficacy from clinical trial data, and quantify the community-level impact of implementing case management with radical cure.
Methods
We calibrated a novel P vivax Recurrence Model to publicly available data from prospective clinical trials to estimate the hypnozoiticidal efficacy of different supervised primaquine (3·5 mg/kg or 7 mg/kg over 7 or 14 days) and tafenoquine (5 mg/kg or 7·5 mg/kg single dose) regimens in patients with normal glucose-6-phosphate dehydrogenase (G6PD) activity. We used an existing P vivax Individual-Based Model to quantify the 5-year impact of case management with unsupervised primaquine or tafenoquine regimens across various transmission settings.
Findings
We estimated median hypnozoiticidal efficacies of 99·1% (95% credible interval 96·0–100) for primaquine 7 mg/kg over 14 days; 96·3% (90·8–99·7) for primaquine 7 mg/kg over 7 days; 72·3% (68·1–76·3) for primaquine 3·5 mg/kg over 7 or 14 days; 62·4% (49·1–76·3) for tafenoquine 5 mg/kg single dose; and 87·5% (62·1–99·3) for tafenoquine 7·5 mg/kg single dose. 5 years of community-level tafenoquine case management was estimated to reduce P vivax transmission by 74–79% where pre-intervention prevalence as measured by PCR was low (<2%) and by 17–20% where prevalence as measured by PCR was high (around 35%). Similar 5-year reductions were estimated with primaquine case management only when adherence to the primaquine regimen was above 50%.
Interpretation
Substantial reductions in prevalence as measured by PCR were predicted with primaquine and tafenoquine regimens if these could be implemented with high coverage and adherence. The benefits of preventing P vivax relapses need to be balanced against the risks of inducing severe haemolysis in patients with G6PD deficiency.
Funding
Bill & Melinda Gates Foundation and Horizon Europe.
{"title":"Quantifying Plasmodium vivax radical cure efficacy: a modelling study integrating clinical trial data and transmission dynamics","authors":"Constanze Ciavarella, Chris Drakeley, Ric N Price, Ivo Mueller, Michael White","doi":"10.1016/s1473-3099(24)00689-3","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00689-3","url":null,"abstract":"<h3>Background</h3><em>Plasmodium vivax</em> forms dormant liver stages (hypnozoites) that can reactivate weeks to months after primary infection. Radical cure requires a combination of antimalarial drugs to kill both the blood-stage and liver-stage parasites. Hypnozoiticidal efficacy of the liver-stage drugs primaquine and tafenoquine cannot be estimated directly because hypnozoites are undetectable. We aimed to estimate hypnozoiticidal efficacy from clinical trial data, and quantify the community-level impact of implementing case management with radical cure.<h3>Methods</h3>We calibrated a novel <em>P vivax</em> Recurrence Model to publicly available data from prospective clinical trials to estimate the hypnozoiticidal efficacy of different supervised primaquine (3·5 mg/kg or 7 mg/kg over 7 or 14 days) and tafenoquine (5 mg/kg or 7·5 mg/kg single dose) regimens in patients with normal glucose-6-phosphate dehydrogenase (G6PD) activity. We used an existing <em>P vivax</em> Individual-Based Model to quantify the 5-year impact of case management with unsupervised primaquine or tafenoquine regimens across various transmission settings.<h3>Findings</h3>We estimated median hypnozoiticidal efficacies of 99·1% (95% credible interval 96·0–100) for primaquine 7 mg/kg over 14 days; 96·3% (90·8–99·7) for primaquine 7 mg/kg over 7 days; 72·3% (68·1–76·3) for primaquine 3·5 mg/kg over 7 or 14 days; 62·4% (49·1–76·3) for tafenoquine 5 mg/kg single dose; and 87·5% (62·1–99·3) for tafenoquine 7·5 mg/kg single dose. 5 years of community-level tafenoquine case management was estimated to reduce <em>P vivax</em> transmission by 74–79% where pre-intervention prevalence as measured by PCR was low (<2%) and by 17–20% where prevalence as measured by PCR was high (around 35%). Similar 5-year reductions were estimated with primaquine case management only when adherence to the primaquine regimen was above 50%.<h3>Interpretation</h3>Substantial reductions in prevalence as measured by PCR were predicted with primaquine and tafenoquine regimens if these could be implemented with high coverage and adherence. The benefits of preventing <em>P vivax</em> relapses need to be balanced against the risks of inducing severe haemolysis in patients with G6PD deficiency.<h3>Funding</h3>Bill & Melinda Gates Foundation and Horizon Europe.","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"75 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-13DOI: 10.1016/s1473-3099(24)00771-0
Marcus Lacerda, Márcio Cortez
No Abstract
无摘要
{"title":"Efficacy of 8-aminoquinolines for Plasmodium vivax malaria radical cure: only one part of the problem","authors":"Marcus Lacerda, Márcio Cortez","doi":"10.1016/s1473-3099(24)00771-0","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00771-0","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"29 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.1016/s1473-3099(24)00669-8
Alejandro Krolewiecki, Stella Kepha, Pedro E Fleitas, Lisette van Lieshout, Woyneshet Gelaye, Augusto Messa, Javier Gandasegui, Jaime Algorta, Valdemiro Novela, Áuria de Jesus, Martin Rono, Dawit Degarege, Dereje Bedane, Jusper Mwahanje, Inácio Mandomando, Charles Mwandawiro, Wendemagegn Enbiale, José Muñoz
<h3>Background</h3>Treatments for soil-transmitted helminthiases face challenges, especially in addressing <em>Trichuris trichiura</em>. Combination regimens, particularly of ivermectin and albendazole, are promising. We aimed to assess the safety, efficacy, and palatability of a combination tablet for the treatment of <em>T trichiura</em>, hookworm, and <em>Strongyloides stercoralis</em> infections among school-aged children in Ethiopia, Kenya, and Mozambique.<h3>Methods</h3>We conducted an adaptive phase 2/3, randomised, parallel-group, active-controlled, superiority trial in 15 schools in Ethiopia, Kenya, and Mozambique. Eligible participants for both phases were aged 5–18 years, weighed at least 15 kg, and were infected with <em>T trichiura</em>, hookworms, or <em>S stercoralis</em>. Participants were randomly assigned via a computer-generated sequence to either a single dose of a fixed-dose combination (FDC×1) of albendazole (400 mg) plus ivermectin (9 mg or 18 mg), three consecutive daily doses of an FDC (FDC×3) of albendazole (400 mg) plus ivermectin (9 mg or 18 mg), or a single dose of albendazole alone (400 mg) via block randomisation, stratified by soil-transmitted helminth species. Participants and those administering the treatments were not masked to treatment assignment, but those assessing the outcomes were masked. The primary outcome of phase 2 (conducted in Kenya only) was safety during the first 3 h after the intervention and for 7 days, and the primary outcome of phase 3 was efficacy (ie, the proportion of individuals cured at day 21 out of the total number infected at baseline) for <em>T trichiura</em>; both primary outcomes were analysed in the intention-to-treat population. This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, <span><span>NCT05124691</span><svg aria-label="Opens in new window" focusable="false" height="20" viewbox="0 0 8 8"><path d="M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z"></path></svg></span>, and is terminated.<h3>Findings</h3>Between Jan 20, 2022, and March 24, 2023, 1001 participants were recruited (465 [46%] were female and 536 [54%] were male). 636 (64%) were infected with <em>T trichiura</em>, 360 (36%) with hookworm, and 104 (10%) with <em>S stercoralis</em>; 94 (9%) of 1001 participants had co-infections and were included in the analysis of each infecting species. A total of 243 participants were allocated to the albendazole group, 381 to the FDC×1 group, and 377 to the FDC×3 group. In both phase 2 and 3, gastrointestinal symptoms were the most common mild-to-moderate adverse events in the FDC groups, but resolved within 48 h without intervention. At least one treatment-related adverse event occurred in 34 (14%) of 243 participants in t
{"title":"Albendazole–ivermectin co-formulation for the treatment of Trichuris trichiura and other soil-transmitted helminths: a randomised phase 2/3 trial","authors":"Alejandro Krolewiecki, Stella Kepha, Pedro E Fleitas, Lisette van Lieshout, Woyneshet Gelaye, Augusto Messa, Javier Gandasegui, Jaime Algorta, Valdemiro Novela, Áuria de Jesus, Martin Rono, Dawit Degarege, Dereje Bedane, Jusper Mwahanje, Inácio Mandomando, Charles Mwandawiro, Wendemagegn Enbiale, José Muñoz","doi":"10.1016/s1473-3099(24)00669-8","DOIUrl":"https://doi.org/10.1016/s1473-3099(24)00669-8","url":null,"abstract":"<h3>Background</h3>Treatments for soil-transmitted helminthiases face challenges, especially in addressing <em>Trichuris trichiura</em>. Combination regimens, particularly of ivermectin and albendazole, are promising. We aimed to assess the safety, efficacy, and palatability of a combination tablet for the treatment of <em>T trichiura</em>, hookworm, and <em>Strongyloides stercoralis</em> infections among school-aged children in Ethiopia, Kenya, and Mozambique.<h3>Methods</h3>We conducted an adaptive phase 2/3, randomised, parallel-group, active-controlled, superiority trial in 15 schools in Ethiopia, Kenya, and Mozambique. Eligible participants for both phases were aged 5–18 years, weighed at least 15 kg, and were infected with <em>T trichiura</em>, hookworms, or <em>S stercoralis</em>. Participants were randomly assigned via a computer-generated sequence to either a single dose of a fixed-dose combination (FDC×1) of albendazole (400 mg) plus ivermectin (9 mg or 18 mg), three consecutive daily doses of an FDC (FDC×3) of albendazole (400 mg) plus ivermectin (9 mg or 18 mg), or a single dose of albendazole alone (400 mg) via block randomisation, stratified by soil-transmitted helminth species. Participants and those administering the treatments were not masked to treatment assignment, but those assessing the outcomes were masked. The primary outcome of phase 2 (conducted in Kenya only) was safety during the first 3 h after the intervention and for 7 days, and the primary outcome of phase 3 was efficacy (ie, the proportion of individuals cured at day 21 out of the total number infected at baseline) for <em>T trichiura</em>; both primary outcomes were analysed in the intention-to-treat population. This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, <span><span>NCT05124691</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>, and is terminated.<h3>Findings</h3>Between Jan 20, 2022, and March 24, 2023, 1001 participants were recruited (465 [46%] were female and 536 [54%] were male). 636 (64%) were infected with <em>T trichiura</em>, 360 (36%) with hookworm, and 104 (10%) with <em>S stercoralis</em>; 94 (9%) of 1001 participants had co-infections and were included in the analysis of each infecting species. A total of 243 participants were allocated to the albendazole group, 381 to the FDC×1 group, and 377 to the FDC×3 group. In both phase 2 and 3, gastrointestinal symptoms were the most common mild-to-moderate adverse events in the FDC groups, but resolved within 48 h without intervention. At least one treatment-related adverse event occurred in 34 (14%) of 243 participants in t","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"29 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}