Evidence map›Paper›PMID 25213732›Full record

SynthesisThe Lancet. Infectious diseases2014

Global extent of chloroquine-resistant Plasmodium vivax: a systematic review and meta-analysis.

Ric N Price, Lorenz von Seidlein, Neena Valecha, Francois Nosten, J Kevin Baird, Nicholas J White

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Infectious diseases, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 237 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
237citing papers in PubMed, 10 pooled it
34.4field-weighted citation impact, top 1% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

237 citing papers in PubMed, 10 syntheses or guidelines pooled it, 396 citations in OpenAlex.

  1. A systematic review of CQ-resistantPathogens and global health · 2024
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  5. Tafenoquine for preventing relapse in people with Plasmodium vivax malaria.The Cochrane database of systematic reviews · 2020
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  10. The Vivax Surveyor: Online mapping database for Plasmodium vivax clinical trials.International journal for parasitology. Drugs and drug resistance · 2017
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177 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 5 countries.

Ric N PriceWorldwide Anti-malarial Resistance Network, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. Electronic address: rprice@menzies.edu.au.
Lorenz von SeidleinGlobal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
Neena ValechaNational Institute of Malaria Research, Dwarka, New Delhi, India.
Francois NostenCentre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Shoklo Malaria Research Unit, Mae Sot, Tak, Thailand; Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
J Kevin BairdCentre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.
Nicholas J WhiteCentre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Charles Darwin University · AUUniversity of Oxford · GBEijkman Institute for Molecular Biology · IDNational Institute of Malaria Research · IN

Funding

Wellcome Trust 091625Wellcome Trust 093956
6 · The paper itself

Abstract

backgroundChloroquine is the first-line treatment for Plasmodium vivax malaria in most endemic countries, but resistance is increasing. Monitoring of antimalarial efficacy is essential, but in P. vivax infections the assessment of treatment efficacy is confounded by relapse from the dormant liver stages. We systematically reviewed P. vivax malaria treatment efficacy studies to establish the global extent of chloroquine resistance.

methodsWe searched Medline, Web of Science, Embase, and the Cochrane Database of Systematic Reviews to identify studies published in English between Jan 1, 1960, and April 30, 2014, which investigated antimalarial treatment efficacy in P. vivax malaria. We excluded studies that did not include supervised schizonticidal treatment without primaquine. We determined rates of chloroquine resistance according to P. vivax malaria recurrence rates by day 28 whole-blood chloroquine concentrations at the time of recurrence and study enrolment criteria.

findingsWe identified 129 eligible clinical trials involving 21,694 patients at 179 study sites and 26 case reports describing 54 patients. Chloroquine resistance was present in 58 (53%) of 113 assessable study sites, spread across most countries that are endemic for P. vivax. Clearance of parasitaemia assessed by microscopy in 95% of patients by day 2, or all patients by day 3, was 100% predictive of chloroquine sensitivity.

interpretationHeterogeneity of study design and analysis has confounded global surveillance of chloroquine-resistant P. vivax, which is now present across most countries endemic for P. vivax. Improved methods for monitoring of drug resistance are needed to inform antimalarial policy in these regions.

fundingWellcome Trust (UK).

Indexed as

Drug ResistanceAntimalarialsChloroquineDrug Therapy, CombinationGlobal HealthHumansMalaria, VivaxPlasmodium vivaxRecurrenceTreatment OutcomeAntimalarialsChloroquine

Identifiers

PMID25213732
PMCPMC4178238
OpenAlexW2096415021

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.