Efficacy and Safety of a Naphthoquine-Azithromycin Coformulation for Malaria Prophylaxis in Southeast Asia: A Phase 3, Double-blind, Randomized, Placebo-controlled Trial.
Henglin Yang, Jingyan Wang, Hui Liu, Yan Zhao, Seetha Lakshmi, Xingliang Li, Renhua Nie, Chunfu Li, Hengye Wang, Yaming Cao, Lynette Menezes, Liwang Cui
Author Information
Henglin Yang: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Pu'er, Yunnan, China.
Jingyan Wang: Institute of Microbiology and Epidemiology, Chinese Academy of Military Medical Sciences, Beijing, China.
Hui Liu: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Pu'er, Yunnan, China.
Yan Zhao: Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China.
Seetha Lakshmi: Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Xingliang Li: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Pu'er, Yunnan, China.
Renhua Nie: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Pu'er, Yunnan, China.
Chunfu Li: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Pu'er, Yunnan, China.
Hengye Wang: Yunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Pu'er, Yunnan, China.
Yaming Cao: Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China.
Lynette Menezes: Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Liwang Cui: Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA. ORCID
BACKGROUND: A prophylactic antimalarial drug that is both effective for protection and improves compliance is in high demand. METHODS: We conducted a randomized, placebo-controlled, double-blinded phase 3 trial to evaluate the 1:1 fixed-dose combination of naphthoquine-azithromycin (NQAZ) for safety and protection against Plasmodium infections in villages along the China-Myanmar border. A total of 631 residents, 5-65 years of age, were randomized into the drug group (n = 319) and the placebo group (n = 312) to receive NZAQ and placebo, respectively, as a single-dose monthly treatment. Follow-ups were conducted weekly to monitor for adverse events and malaria infections. RESULTS: Of the 531 subjects completing the trial, there were 46 and 3 blood smear-positive Plasmodium infections in the placebo and treatment groups, respectively. For the intent-to-treat analysis, the single-dose monthly NQAZ treatment had 93.62% protective efficacy (95% confidence interval [CI]: 91.72%-95.52%). For the per-protocol analysis, NQAZ treatment provided a 93.04% protective efficacy (95% CI: 90.98%-95.1%). Three smear-positive cases in the NQAZ group were all due to acute falciparum malaria. In comparison, NQAZ treatment provided 100% protection against the relapsing malaria Plasmodium vivax and Plasmodium ovale. The treatment group had 5.6% of participants experiencing transient elevation of liver aminotransferases compared with 2.2% in the placebo group (P > .05). CONCLUSIONS: Monthly prophylaxis with NQAZ tablets was well tolerated and highly effective for preventing Plasmodium infections. It may prove useful for eliminating P. vivax in areas with a high prevalence of glucose-6-phosphate dehydrogenase deficiency in the population. CLINICAL TRIALS REGISTRATION: ChiCTR1800020140.
