ArticleLancet regional health. Americas2026
A systematic review and individual patient data meta-analysis to determine the effect of primaquine dose on efficacy, tolerability and safety in uncomplicated
Article in Lancet regional health. Americas, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Primaquine is widely used to prevent relapses of Methods: MEDLINE, Web of Science, Embase, Scopus and Cochrane Central were systematically searched for prospective clinical efficacy studies of patients with uncomplicated Findings: Of 40 eligible studies, 1734 patients from 13 studies were included. The cumulative incidence of recurrence 150 days after the last dose of primaquine was 68.2% (95% CI 59.5-76.6) in 119 patients not treated with primaquine, 30.8% (27.0-35.0) in 1000 patients treated with low total dose (2 to <5 mg/kg) primaquine, and 8.7% (5.6-13.2) in 286 patients treated with high total dose (≥5 mg/kg) primaquine. The rate of recurrence within 150 days was lower in patients treated with high compared to low total dose primaquine (adjusted hazard ratio (AHR) 0.36, 95% CI 0.21-0.62; p < 0.0001). Gastrointestinal disturbance was reported in 1.1% (1/94) of patients administered a low daily primaquine dose (<0.375 mg/kg/day) and 2.6% (4/152) administered an intermediate daily dose (0.375 to <0.75 mg/kg/day). None of 501 patients with ≥30% G6PD activity had an acute haemoglobin drop by >25% to <7 g/dL within 14 days of starting primaquine, although only 7 patients received high daily dose primaquine (≥0.75 mg/kg/day). Interpretation: Patients treated with high total dose primaquine had less than half the risk of Funding: Bill and Melinda Gates Foundation, Australian National Health and Medical Research Council and Royal Australasian College of Physicians.
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