In-Vivo Efficacy of Chloroquine to Clear Asymptomatic Infections in Mozambican Adults: A Randomized, Placebo-controlled Trial with Implications for Elimination Strategies.

Abstract

Recent reports regarding the re-emergence of parasite sensitivity to chloroquine call for a new consideration of this drug as an interesting complementary tool in malaria elimination efforts, given its good safety profile and long half-life. A randomized (2:1), single-blind, placebo-controlled trial was conducted in Manhiça, Mozambique, to assess the in-vivo efficacy of chloroquine to clear plasmodium falciparum (Pf) asymptomatic infections. Primary study endpoint was the rate of adequate and parasitological response (ACPR) to therapy on day 28 (PCR-corrected). Day 0 isolates were analyzed to assess the presence of the PfCRT-76T CQ resistance marker. A total of 52 and 27 male adults were included in the CQ and Placebo group respectively. PCR-corrected ACPR was significantly higher in the CQ arm 89.4% (95%CI 80-98%) compared to the placebo (p < 0.001). CQ cleared 49/50 infections within the first 72 h while placebo cleared 12/26 (LRT p < 0.001). The PfCRT-76T mutation was present only in one out of 108 (0.9%) samples at baseline, well below the 84% prevalence found in 1999 in the same area. This study presents preliminary evidence of a return of chloroquine sensitivity in Mozambican Pf isolates, and calls for its further evaluation in community-based malaria elimination efforts, in combination with other effective anti-malarials.

TRIAL REGISTRATION:

www.clinicalTrials.gov NCT02698748.

• Authors: Beatriz Galatas, Lidia Nhamussua, Baltazar Candrinho, Lurdes Mabote, Pau Cisteró, Himanshu Gupta, Regina Rabinovich, Clara Menéndez, Eusebio Macete, Francisco Saute, Alfredo Mayor, Pedro Alonso, Quique Bassat, Pedro Aide
• Journal: Scientific reports (Sci Rep) Vol. 7 Issue 1 Pg. 1356 (05 02 2017) ISSN: 2045-2322 [Electronic] England
• PMID: 28465550 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Chloroquine

Topics

• Adult
• Antimalarials (therapeutic use)
• Asymptomatic Infections
• Chloroquine (therapeutic use)
• Drug Resistance
• Humans
• Malaria, Falciparum (drug therapy)
• Male
• Mozambique
• Plasmodium falciparum (isolation & purification, pathogenicity)
• Single-Blind Method
• Treatment Outcome
• Young Adult