ArticleThe American journal of tropical medicine and hygiene2023
Severe Hemolysis during Primaquine Radical Cure of Plasmodium vivax Malaria: Two Systematic Reviews and Individual Patient Data Descriptive Analyses.
Article in The American journal of tropical medicine and hygiene, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 25 citations in OpenAlex.
- Effectiveness and safety of 7-day high-dose primaquine and single-dose tafenoquine versus 14-day low-dose primaquine in patients with Plasmodium vivax malaria (EFFORT): a multicentre, open-label, randomised, controlled, superiority trial.The Lancet. Infectious diseases · 2026Trial
- Safety and Efficacy of 3 Alternative Regimens Against Relapsing Plasmodium vivax Malaria in Glucose 6-Phosphate Dehydrogenase-Deficient Patients in the Brazilian Amazon (ALTPRIM).Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Trial
- Trial
- Malaria Prevention: Progress to Date.Drugs · 2026Review
- Integrating parallelCommunications health · 2026Article
- The inducible gametocyte producer (iGP1) strain is well-suited to produce both immature and mature gametocytes for subsequent drug sensitivity profiling.Frontiers in cellular and infection microbiology · 2026Article
- Perceptions of shorter radical cure Plasmodium vivax treatment regimens and their implementation: a qualitative study among stakeholders in Cambodia.Malaria journal · 2025Article
- High daily dose Short COurse PrimaquinE after G6PD testing for the radical cure of Plasmodium vivax malaria in Indonesia and Papua New Guinea: the SCOPE implementation study protocol.BMC infectious diseases · 2025Article
- Quantifying Plasmodium vivax radical cure efficacy: a modelling study integrating clinical trial data and transmission dynamics.The Lancet. Infectious diseases · 2025Article
- Co-design of a routine clinical review to improve the safety of high dose radical cure treatment for Plasmodium vivax malaria: findings from Cambodia and Ethiopia.Malaria journal · 2025Article
- Unexpected Primaquine-Induced Hemolysis in a G6PD-Normal Patient: A Case Report From Nepal.Clinical case reports · 2025Article
- Ternary structure of Plasmodium vivaxN-myristoyltransferase with myristoyl-CoA and inhibitor IMP-0001173.Acta crystallographica. Section F, Structural biology communications · 2024Article
- Addressing health equity for breastfeeding women: primaquine for Plasmodium vivax radical cure.Malaria journal · 2024Review
- Linked-evidence modelling of qualitative G6PD testing to inform low- and intermediate-dose primaquine treatment for radical cure of Plasmodium vivax.PLoS neglected tropical diseases · 2024Article
- Evidence uptake is only part of the process: Stakeholders' insights on WHO treatment guideline recommendation processes for radical cure of P. vivax malaria.PLOS global public health · 2024Article
- Radical Cure ofEthiopian journal of health sciences · 2024Article
- Putative Contribution of 8-Aminoquinolines to Preventing Recrudescence of Malaria.Tropical medicine and infectious disease · 2023Article
Corrections and comments
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Authors and funding
10 authors at 8 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Primaquine (PQ) kills Plasmodium vivax hypnozoites but can cause severe hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. We conducted two systematic reviews. The first used data from clinical trials to determine the variety of definitions and frequency of hematological serious adverse events (SAEs) related to PQ treatment of vivax malaria. The second used data from prospective studies and case reports to describe the clinical presentation, management, and outcome of severe PQ-associated hemolysis necessitating hospitalization. In the first review, SAEs were reported in 70 of 249 clinical trials. There were 34 hematological SAEs among 9,824 patients with P. vivax malaria treated with PQ, nine of which necessitated hospitalization or blood transfusion. Criteria used to define SAEs were diverse. In the second review, 21 of 8,487 articles screened reported 163 patients hospitalized after PQ radical cure; 79.9% of whom (123 of 154) were prescribed PQ at ≥ 0.5 mg/kg/day. Overall, 101 patients were categorized as having probable or possible severe PQ-associated hemolysis, 96.8% of whom were G6PD deficient (< 30% activity). The first symptoms of hemolysis were reported primarily on day 2 or 3 (45.5%), and all patients were hospitalized within 7 days of PQ commencement. A total of 57.9% of patients (77 of 133) had blood transfusion. Seven patients (6.9%) with probable or possible hemolysis died. Even when G6PD testing is available, enhanced monitoring for hemolysis is warranted after PQ treatment. Clinical review within the first 5 days of treatment may facilitate early detection and management of hemolysis. More robust definitions of severe PQ-associated hemolysis are required.
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