Evidence map›Paper›PMID 23718705›Full record

Trial reportMalaria journal2013

Triangular test design to evaluate tinidazole in the prevention of Plasmodium vivax relapse.

Louis Macareo, Khin Maung Lwin, Phaik Yeong Cheah, Prayoon Yuentrakul, R Scott Miller, Francois Nosten

Registry-linked trialOpen access · goldAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Malaria journal, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00811096 (Pilot Human Study of Tinidazole Efficacy For Radical Cure Of Plasmodium Vivax), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.6field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00811096 phase2completednot on this map

Pilot Human Study of Tinidazole Efficacy For Radical Cure Of Plasmodium Vivax

TypeinterventionalSponsorWalter Reed Army Institute of Research (WRAIR)Ran2008 to 2009Enrolled20ConditionsMalaria, VivaxArmsTinidazole, chloroquine
3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 12 citations in OpenAlex.

  1. Review
  2. Repurposing Drugs to Fight Hepatic Malaria Parasites.Molecules (Basel, Switzerland) · 2020
    Review
  3. Diagnosis and Treatment of Plasmodium vivax Malaria.The American journal of tropical medicine and hygiene · 2016
    Article
  4. Malaria medicines: a glass half full?Nature reviews. Drug discovery · 2015
    Review
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 3 countries.

Louis MacareoWalter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA. louis.macareo@us.army.mil
Khin Maung Lwin
Phaik Yeong Cheah
Prayoon Yuentrakul
R Scott Miller
Francois Nosten
Mahidol Oxford Tropical Medicine Research Unit · THMahidol University · THWalter Reed Army Institute of Research · US

Funding

Wellcome Trust 089275
6 · The paper itself

Abstract

backgroundThere are very few drugs that prevent the relapse of Plasmodium vivax malaria in man. Tinidazole is a 5-nitroimidazole approved in the USA for the treatment of indications including amoebiasis and giardiasis. In the non-human primate relapsing Plasmodium cynomolgi/macaque malaria model, tinidazole cured one of six macaques studied with an apparent mild delay to relapse in the other five of 14-28 days compared to 11-12 days in controls. One study has demonstrated activity against P. vivax in man. Presented here are the results of a pilot phase II, randomized, open-label study conducted along the Thai-Myanmar border designed to evaluate the efficacy of tinidazole to prevent relapse of P. vivax when administered with chloroquine.

methodsThis study utilized a modified triangular test sequential analysis which allows repeated statistical evaluation during the course of enrolment while maintaining a specified power and type 1 error and minimizing recruitment of subjects. Enrolment was to be halted when a pre-specified success/failure ratio was surpassed. The study was designed to have a 5% type 1 error and 90% power to show whether tinidazole would produce a relapse rate of less than 20% or greater than 45% through Day 63 of weekly follow-up after initiation of treatment and initial parasite clearance with 3 days of an oral weight based dosing of chloroquine and five days of 2 grams/day of tinidazole.

resultsAll subjects cleared their parasitaemia by Day 3. Six of the first seven subjects treated with tinidazole relapsed prior to Day 63 (average Day 48.3 (range 42-56)). This exceeded the upper boundary of the triangular test and enrolment to receive tinidazole was halted. A concurrent cohort of five subjects definitively treated with standard doses of primaquine and chloroquine (historically 100% effective) showed no episodes of recurrent P. vivax parasitaemia during the 63-day protocol specified follow-up period.

conclusionsTinidazole is ineffective in preventing relapse of P. vivax at the dose used. The macaque relapsing model appeared to correctly predict outcome in humans. Use of the modified triangular test allowed minimal enrolment and limited unnecessary exposure to the study drug and reduced costs. This adds weight to the ethical and economic advantages of this study design to evaluate similarly situated drugs.

trial registrationClinicalTrials.gov NCT00811096.

Indexed as

AdultAntimalarialsChemopreventionChloroquineDrug Therapy, CombinationFemaleHumansMalaria, VivaxMaleMyanmarParasite LoadParasitemiaSecondary PreventionThailandTinidazoleTreatment OutcomeAntimalarialsChloroquineTinidazole

Identifiers

PMID23718705
PMCPMC3671156
OpenAlexW2108650441

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.