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A newer antimalaria medication with a simplified dosing regimen may be useful in US patients as prophylaxis or as an antirelapse treatment, according to a review in the Morbidity and Mortality Weekly Report.
The US Food and Drug Administration approved tafenoquine in 2018 as prophylaxis for individuals traveling to malaria-endemic areas and for antirelapse therapy for people infected with the Plasmodium vivax malaria parasite. Previously, only primaquine was available for antirelapse therapy.
Most antimalarial drugs target the blood stage of the parasite. As such, malaria treatments must be given for months after infection to kill some species such as P vivax and Plasmodium ovale that can lie dormant in the liver for months and then emerge, causing a relapse, the authors explained. In 2016, these 2 species caused about 19% of the roughly 1800 imported malaria cases with an identified species of parasite in the United States. Antirelapse therapy is required for P vivax and P ovale infections and for travelers with intense or prolonged exposure to them.
The CDC’s evidence review found that tafenoquine was comparable with the current standard of care mefloquine for prophylaxis. The agency’s report also provides clinicians with guidance on tafenoquine use. In addition to the FDA’s approved indications, the CDC noted that tafenoquine can be used off-label to prevent P ovale relapse. Because P ovale is too rare to allow for adequately powered trials, CDC experts extrapolated data from P vivax trials. The report noted that patients must be tested for G6PD (glucose-6-phosphate dehydrogenase) deficiency prior to taking tafenoquine because it can cause hemolytic anemia among patients with this genetic mutation.
“The approval of tafenoquine marks a notable advancement for the prevention of malaria and treatment of P vivax and P ovale,” the authors wrote. Weekly dosing for prophylactic therapy and a single dose for antirelapse therapy may improve adherence, they added.
Kuehn B. New Malaria Option. JAMA. 2020;323(2):112. doi:10.1001/jama.2019.20669
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