Characterization of an in vivo concentration-effect relationship for piperaquine in malaria chemoprevention
Title | Characterization of an in vivo concentration-effect relationship for piperaquine in malaria chemoprevention |
Publication Type | Journal Article |
Year of Publication | 2014 |
Authors | Bergstrand, M, Nosten, F, Lwin, KM, Karlsson, MO, White, NJ, Tarning, J |
Journal | Sci Transl Med |
Volume | 6 |
Issue | 260 |
Pagination | 260ra147 |
Date Published | Oct 29 |
ISBN Number | 1946-6242 (Electronic)1946-6234 (Linking) |
Abstract | A randomized, placebo-controlled trial conducted on the northwest border of Thailand compared malaria chemoprevention with monthly or bimonthly standard 3-day treatment regimens of dihydroartemisinin-piperaquine. Healthy adult male subjects (N = 1000) were followed weekly during 9 months of treatment. Using nonlinear mixed-effects modeling, the concentration-effect relationship for the malaria-preventive effect of piperaquine was best characterized with a sigmoidal Emax relationship, where plasma concentrations of 6.7 ng/ml [relative standard error (RSE), 23%] and 20 ng/ml were found to reduce the hazard of acquiring a malaria infection by 50% [that is, median inhibitory concentration (IC50)] and 95% (IC95), respectively. Simulations of monthly dosing, based on the final model and published pharmacokinetic data, suggested that the incidence of malaria infections over 1 year could be reduced by 70% with a recently suggested dosing regimen compared to the current manufacturer's recommendations for small children (8 to 12 kg). This model provides a rational framework for piperaquine dose optimization in different patient groups. |
URL | http://stm.sciencemag.org/content/6/260/260ra147.short |
Short Title | Science translational medicine |