Piperaquine Population Pharmacokinetics and Cardiac Safety in Cambodia
Abstract
Despite the rising rates of resistance to dihydroartemisinin-piperaquine (DP), DP remains a first-line therapy for uncomplicated malaria in many parts of Cambodia. While DP is generally well tolerated as a 3-day DP (3DP) regimen, compressed 2-day DP (2DP) regimens were associated with treatment-limiting cardiac repolarization effects in a recent clinical trial. To better estimate the risks of piperaquine on QT interval prolongation, we pooled data from three randomized clinical trials conducted between 2010 and 2014 in northern Cambodia. A population pharmacokinetic model was developed to compare exposure-response relationships between the 2DP and 3DP regimens while accounting for differences in regimen and sample collection times between studies. A 2-compartment model with first-order absorption and elimination without covariates best fit the data. The linear slope-intercept model predicted a 0.05-ms QT prolongation per ng/ml of piperaquine (5 ms per 100 ng/ml) in this largely male population. Though the plasma half-life was similar in both regimens, peak and total piperaquine exposures were higher in those treated with the 2DP regimen. Furthermore, the correlation between the plasma piperaquine concentration and the QT interval prolongation was stronger in the population receiving the 2DP regimen. Neither the time since the previous meal nor the baseline serum magnesium or potassium levels had additive effects on QT interval prolongation. As electrocardiographic monitoring is often nonexistent in areas where malaria is endemic, 2DP regimens should be avoided and the 3DP regimen should be carefully considered in settings where viable alternative therapies exist. When DP is employed, the risk of cardiotoxicity can be mitigated by combining a 3-day regimen, enforcing a 3-h fast before and after administration, and avoiding the concomitant use of QT interval-prolonging medications. (This study used data from three clinical trials that are registered at ClinicalTrials.gov under identifiers NCT01280162, NCT01624337, and NCT01849640.)
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- May 01, 2017
- Source ID
- 10.1128/aac.02000-16
Entities
People
- Chanikarn Kodchakorn
- Chanthap Lon
- Charlotte Lanteri
- David Saunders
- Erin Milner
- Jessica Manning
- Louis Cantilena
- Mali Ittiverakul
- Mariusz Wojnarski
- Mark Haigney
- Mary So
- Michele D Spring
- Nillawan Buathong
- Pattaraporn Vanachayangkul
- Sabaithip Sriwichai
- Satharath Prom
- Soklyda Chann
- Sommethy Sok
- Sut-thang Pann
- Theng Youdaline
- Winita Ta-aksorn
- Worachet Kuntawunginn
Organizations
- Armed Forces Health Surveillance Center
- Armed Forces Research Institute of Medical Sciences
- National Malaria Center of Cambodia
- Royal Cambodian Armed Forces
- Uniformed Services University of the Health Sciences
- United States Army Medical Research and Development Command
- Walter Reed Army Institute of Research