PMID- 33834208
OWN - NLM
STAT- MEDLINE
DCOM- 20210809
LR  - 20220531
IS  - 1708-8305 (Electronic)
IS  - 1195-1982 (Linking)
VI  - 28
IP  - 5
DP  - 2021 Jul 7
TI  - Efficacy of a 3-day pretravel schedule of tafenoquine for malaria 
      chemoprophylaxis: a network meta-analysis.
LID - taab057 [pii]
LID - 10.1093/jtm/taab057 [doi]
AB  - BACKGROUND: Chemoprophylaxis with weekly doses of tafenoquine (200 mg/day for 
      3 days before departure [loading dose], 200 mg/week during travel and 1-week 
      post-travel [maintenance doses]) is effective in preventing malaria. 
      Effectiveness of malaria chemoprophylaxis drugs in travellers is often 
      compromised by poor compliance. Shorter schedules that can be completed before 
      travel, allowing 'drug-free holidays', could increase compliance and thus reduce 
      travel-related malaria. In this meta-analysis, we examined if a loading dose of 
      tafenoquine alone is effective in preventing malaria in short-term travellers. 
      METHODS: Four databases were searched in November 2020 for randomized controlled 
      trials (RCTs) that assessed efficacy and/or safety of tafenoquine for 
      chemoprophylaxis. Network meta-analysis using the generalized pair-wise modelling 
      framework was utilized to estimate the odds ratio (OR) of malaria infection in 
      long-term (>28 days) and short-term (</=28 days) travellers, as well as adverse 
      events (AEs) associated with receiving loading dose of tafenoquine alone, loading 
      dose of tafenoquine followed by maintenance doses, loading dose of mefloquine 
      followed by maintenance doses, or placebo. RESULTS: Nine RCTs (1714 participants) 
      were included. In long-term travellers, compared to mefloquine, tafenoquine with 
      maintenance doses (OR = 1.05; 95% confidence interval [CI]: 0.44-2.46) was 
      equally effective in preventing malaria, while there was an increased risk of 
      infection with the loading dose of tafenoquine alone (OR = 2.89; 95% CI: 
      0.78-10.68) and placebo (OR = 62.91; 95% CI: 8.53-463.88). In short-term 
      travellers, loading dose of tafenoquine alone (OR = 0.98; 95% CI: 0.04-22.42) and 
      tafenoquine with maintenance doses (OR = 1.00; 95% CI: 0.06-16.10) were as 
      effective as mefloquine. The risk of AEs with tafenoquine with maintenance doses 
      (OR = 1.03; 95% CI: 0.67-1.60) was similar to mefloquine, while loading dose of 
      tafenoquine alone (OR = 0.58; 95% CI: 0.20-1.66) was associated with lower risk 
      of AEs, although the difference was not statistically significant. CONCLUSIONS: 
      For short-term travellers, loading dose of tafenoquine alone was equally 
      effective, had possibly lower rate of AEs, and likely better compliance than 
      standard tafenoquine or mefloquine chemoprophylaxis schedules with maintenance 
      doses. Studies are needed to confirm if short-term travellers remain free of 
      infection after long-term follow-up. REGISTRATION: The meta-analysis was 
      registered in PROSPERO (CRD42021223756). HIGHLIGHT: Tafenoquine is the latest 
      approved drug for malaria chemoprophylaxis. A loading dose of tafenoquine 
      (200 mg/day for 3 days before departure) is as effective in preventing malaria in 
      short-term (</=28 days) travellers as chemoprophylaxis schedules of tafenoquine or 
      mefloquine with maintenance doses, allowing travellers to have a 'drug-free 
      holiday'.
CI  - (c) International Society of Travel Medicine 2021. Published by Oxford University 
      Press. All rights reserved. For Permissions, please e-mail: 
      journals.permissions@oup.com.
FAU - Islam, Nazmul
AU  - Islam N
AD  - Department of Public Health, College of Health Sciences, QU Health, Qatar 
      University, Doha, PO BOX 2713, Qatar.
FAU - Wright, Sophie
AU  - Wright S
AD  - ANU Medical School, Australian National University, Canberra, ACT 2601, 
      Australia.
FAU - Lau, Colleen L
AU  - Lau CL
AD  - School of Public Health, Faculty of Medicine, The University of Queensland, 
      Herston, QLD 4006, Australia.
AD  - Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD 4000, 
      Australia.
FAU - Doi, Suhail A R
AU  - Doi SAR
AD  - Department of Population Medicine, College of Medicine, QU Health, Qatar 
      University, Doha, PO BOX 2713, Qatar.
FAU - Mills, Deborah J
AU  - Mills DJ
AD  - Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD 4000, 
      Australia.
AD  - Research School of Population Health, Australian National University, Canberra, 
      ACT 2601, Australia.
FAU - Clark, Justin
AU  - Clark J
AD  - Institute for Evidence-Based Healthcare, Bond University, Robina, QLD 4226, 
      Australia.
FAU - Clements, Archie C A
AU  - Clements ACA
AD  - Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia.
FAU - Furuya-Kanamori, Luis
AU  - Furuya-Kanamori L
AD  - Research School of Population Health, Australian National University, Canberra, 
      ACT 2601, Australia.
AD  - UQ Centre for Clinical Research, Faculty of Medicine, The University of 
      Queensland, Herston, QLD 4029, Australia.
LA  - eng
GR  - APP1158469/National Health and Medical Research Council/
PT  - Journal Article
PT  - Meta-Analysis
PL  - England
TA  - J Travel Med
JT  - Journal of travel medicine
JID - 9434456
RN  - 0 (Aminoquinolines)
RN  - 0 (Antimalarials)
RN  - 262P8GS9L9 (tafenoquine)
RN  - TML814419R (Mefloquine)
SB  - IM
CIN - J Travel Med. 2021 Jul 7;28(5):. PMID: 34050367
MH  - Aminoquinolines/adverse effects/therapeutic use
MH  - *Antimalarials/adverse effects/therapeutic use
MH  - Humans
MH  - *Malaria/drug therapy/prevention & control
MH  - Mefloquine/adverse effects/therapeutic use
MH  - Network Meta-Analysis
MH  - Travel
OTO - NOTNLM
OT  - Loading dose
OT  - meta-analysis
OT  - network
OT  - systematic review
OT  - travel
OT  - traveller
EDAT- 2021/04/10 06:00
MHDA- 2021/08/10 06:00
CRDT- 2021/04/09 06:34
PHST- 2021/02/11 00:00 [received]
PHST- 2021/03/30 00:00 [revised]
PHST- 2021/04/01 00:00 [accepted]
PHST- 2021/04/10 06:00 [pubmed]
PHST- 2021/08/10 06:00 [medline]
PHST- 2021/04/09 06:34 [entrez]
AID - 6217513 [pii]
AID - 10.1093/jtm/taab057 [doi]
PST - ppublish
SO  - J Travel Med. 2021 Jul 7;28(5):taab057. doi: 10.1093/jtm/taab057.