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Advanced data synthesis to inform optimal antimalarial dosing

Plasmodium vivax requires treatment of both blood and liver stage parasites to prevent relapsing disease and interrupt malaria transmission. Primaquine and tafenoquine are the only drugs available to kill liver stage P. vivax malaria, however, they can cause severe haemolysis in individuals with glucose-6-phosphate dehydrogenase deficiency. Many countries and clinicians are unsure about the most efficacious and safe doses of primaquine and tafenoquine for this reason. We have used systematic reviews and individual patient data meta-analyses undertaken through collaboration with the WorldWide Antimalarial Resistance Network (WWARN) to improve our understanding of the risks and benefits of primaquine and tafenoquine and inform policymakers.

Selected publications

  1. Edler P,… Commons RJ, Automated reporting of primaquine dose efficacy, tolerability and safety for Plasmodium vivax malaria using a systematic review and individual patient data meta-analysis. Malar J. 2025 Nov 14;24(1):400. doi: 10.1186/s12936-025-05642-w.
  2. Fadilah I, Commons RJ, et al, Methaemoglobin as a surrogate marker of primaquine antihypnozoite activity in Plasmodium vivax malaria: A systematic review and individual patient data meta-analysis. PLoS Med. 2024 Sep 27;21(9):e1004411. doi: 10.1371/journal.pmed.1004411.
  3. Commons RJ, et al, Primaquine for uncomplicated Plasmodium vivax malaria in children younger than 15 years: a systematic review and individual patient data meta-analysis. Lancet Child Adolesc Health. 2024 Nov;8(11):798-808. doi: 10.1016/S2352-4642(24)00210-4.
  4. Commons RJ, et al, Effect of primaquine dose on the risk of recurrence in patients with uncomplicated Plasmodium vivax: a systematic review and individual patient data meta-analysis, Lancet Infectious Diseases. 2023 Sep 22:S1473-3099(23)00430-9. doi: 10.1016/S1473-3099(23)00430-9
  5. Rajasekhar M,… Commons RJ, Primaquine dose and the risk of haemolysis in patients with uncomplicated Plasmodium vivax malaria: a systematic review and individual patient data meta-analysis, Lancet Infectious Diseases. 2023 Sep 22:S1473-3099(23)00431-0. doi: 10.1016/S1473-3099(23)00431-0
  6. Watson JA, Commons RJ (co-first author),…. The clinical pharmacology of tafenoquine in the radical cure of Plasmodium vivax malaria: An individual patient data meta-analysis, eLife 2022, 11: e83433. doi: 10.7554/eLife.83433
  7. Commons RJ, Simpson JA, Thriemer K, et al., The risk of Plasmodium vivax parasitaemia after P. falciparum infection: a systematic review and meta-analysis, Lancet Infectious Diseases, 2019; 19(1): 91-101. doi: 10.1016/S1473-3099(18)30596-6
  8. Commons RJ, Simpson JA, Thriemer K, et al., The haematological consequences of Plasmodium vivax malaria after chloroquine treatment with and without primaquine: a WorldWide Antimalarial Resistance Network systematic review and individual patient data meta-analysis, BMC Medicine, 2019; 17(1): 151. doi: 10.1186/s12916-019-1386-6
  9. Commons RJ, Simpson JA, Thriemer K, et al., The effect of dihydroartemisinin-piperaquine and artemether-lumefantrine on the risk of Plasmodium vivax: an individual patient pooled analysis, PLOS Medicine, 2019; 16(10): e1002928. doi: 10.1371/journal.pmed.1002928
  10. Commons RJ, Simpson JA, Thriemer K, et al., The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis, Lancet Infectious Diseases, 2018; 18: 1025-1034. doi: 10.1016/S1473-3099(18)30348-7

Tools

Automated reporting of primaquine dose efficacy tolerability and safety for Plasmodium vivax malaria based on a database of individual patient data from antimalarial efficacy studies.

Automated vivax reports

Reference for above is: Edler P,… Commons RJ, Automated reporting of primaquine dose efficacy, tolerability and safety for Plasmodium vivax malaria using a systematic review and individual patient data meta-analysis. Malar J. 2025 Nov 14;24(1):400. doi: 10.1186/s12936-025-05642-w.