Haematological consequences of acute uncomplicated falciparum malaria : a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data

Mansoor, R.; Commons, R. J.; Douglas, N. M.; /Basco, Leonardo; /Cot, Michel; /Etard, Jean-François; et al.,; WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group

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dc.creator	Mansoor, R.
dc.creator	Commons, R. J.
dc.creator	Douglas, N. M.
dc.creator	/Basco, Leonardo
dc.creator	/Cot, Michel
dc.creator	/Etard, Jean-François
dc.creator	et al.,
dc.creator	WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group
dc.date	2022
dc.date.accessioned	2022-04-27T17:37:53Z
dc.date.available	2022-04-27T17:37:53Z
dc.identifier	https://www.documentation.ird.fr/hor/fdi:010084382
dc.identifier	oai:ird.fr:fdi:010084382
dc.identifier	Mansoor R., Commons R. J., Douglas N. M., Basco Leonardo, Cot Michel, Etard Jean-François, et al., WorldWide Antimalarial Resistance Network Falciparum Haematology Study Group. Haematological consequences of acute uncomplicated falciparum malaria : a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data. 2022, 20 (1), 85 [19 p.]
dc.identifier.uri	http://biblioteca-repositorio.clacso.edu.ar/handle/CLACSO/169142
dc.description	Background Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. Methods Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall >= 25% at day 3 and day 7. Results A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0-19.7 g/dL) in Africa, 11.6 g/dL (range 5.0-20.0 g/dL) in Asia and 12.3 g/dL (range 6.9-17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to >= 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39-3.05], p < 0.001). Conclusions In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery.
dc.language	EN
dc.subject	Plasmodium falciparum
dc.subject	Artemisinin-based therapy
dc.subject	Non-artemisinin-based therapy
dc.subject	Antimalarials
dc.subject	Haemoglobin
dc.subject	Severe anaemia
dc.subject	Pooled analysis of
dc.subject	individual patient data
dc.title	Haematological consequences of acute uncomplicated falciparum malaria : a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data
dc.type	text
dc.coverage	MONDE