HIGH RISK OF SEVERE ANAEMIA AFTER CHLOROPROGUANIL-DAPSONE+ARTESUNATE ANTIMALARIAL TREATMENT IN PATIENTS WITH G6PD(A-) DEFICIENCY
| Autor: | Aline Uwimana, David Modiano, Umberto D'Alessandro, Pamela Avellino, Corine Karema, Sue J. Lee, Germana Bancone, Caterina I. Fanello |
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| Jazyk: | angličtina |
| Rok vydání: | 2008 |
| Předmět: |
Male
lcsh:Medicine Artesunate Pharmacology Dapsone Gastroenterology chemistry.chemical_compound hemic and lymphatic diseases Medicine Malaria Falciparum lcsh:Science Child Multidisciplinary Hematology Haemolysis Oxidants Artemisinins Drug Combinations Pyrimethamine Pharmacology/Adverse Reactions Proguanil Child Preschool Drug Therapy Combination Female medicine.drug Research Article medicine.medical_specialty Anemia Amodiaquine Antimalarials Internal medicine parasitic diseases Sulfadoxine Humans Polymorphism Genetic business.industry lcsh:R Infant medicine.disease Chlorproguanil/dapsone/artesunate Glucosephosphate Dehydrogenase Deficiency chemistry lcsh:Q business Hematology/Hemoglobinopathies Glucose-6-phosphate dehydrogenase deficiency |
| Zdroj: | PLoS ONE PLoS ONE, Vol 3, Iss 12, p e4031 (2008) |
| ISSN: | 1932-6203 |
| Popis: | Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common inherited human enzyme defect. This deficiency provides some protection from clinical malaria, but it can also cause haemolysis after administration of drugs with oxidant properties. Methods The safety of chlorproguanil-dapsone+artesunate (CD+A) and amodiaquine+sulphadoxine-pyrimethamine (AQ+SP) for the treatment of uncomplicated P. falciparum malaria was evaluated according to G6PD deficiency in a secondary analysis of an open-label, randomized clinical trial [1]. 702 children, treated with CD+A or AQ+SP and followed for 28 days after treatment were genotyped for G6PD A- deficiency. Findings In the first 4 days following CD+A treatment, mean haematocrit declined on average 1.94% (95% CI 1.54 to 2.33) and 1.05% per day (95% CI 0.95 to 1.15) respectively in patients with G6PD deficiency and normal patients; a mean reduction of 1.3% per day was observed among patients who received AQ+SP regardless of G6PD status (95% CI 1.25 to 1.45). Patients with G6PD deficiency recipients of CD+A had significantly lower haematocrit than the other groups until day 7 (p = 0.04). In total, 10 patients had severe post-treatment haemolysis requiring blood transfusion. Patients with G6PD deficiency showed a higher risk of severe anaemia following treatment with CD+A (RR = 10.2; 95% CI 1.8 to 59.3) or AQ+SP (RR = 5.6; 95% CI 1.0 to 32.7). Conclusions CD+A showed a poor safety profile in individuals with G6PD deficiency most likely as a result of dapsone induced haemolysis. Screening for G6PD deficiency before drug administration of potentially pro-oxidants drugs, like dapsone-containing combinations, although seldom available, is necessary. Trial Registration ClinicalTrials.gov NCT00461578 |
| Databáze: | OpenAIRE |
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