Efficacy, safety and pharmacokinetics of dihydroartemisinin-piperaquine for perennial malaria chemoprevention in infants during routine health facility visits

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dc.contributor.advisorBarnes, Karen
dc.contributor.advisorTarning, Joel
dc.contributor.authorBanda, Clifford George
dc.date.accessioned2026-06-24T10:13:56Z
dc.date.available2026-06-24T10:13:56Z
dc.date.issued2026
dc.date.updated2026-06-24T09:44:27Z
dc.description.abstractMonthly dihydroartemisinin-piperaquine for perennial malaria chemoprevention (PMC) has been shown to offer superior malaria prevention compared to three-monthly dosing. However, aligning its administration with routine health facility visits has the potential to enhance adherence. Additionally, rapid physiological changes in infancy may influence drug exposure. We hypothesised that increasing age in infancy would result in a reduction in piperaquine's exposure due to age-related increases in apparent clearance (CL/F) and volume of distribution (Vd). Consequently, this could impact the protective efficacy of dihydroartemisinin-piperaquine for malaria prevention in infants. Methods: We assessed the efficacy and safety of dihydroartemisinin-piperaquine and piperaquine's exposure profile in Malawian infants receiving PMC aligned with routine health facility visits at 10 weeks, 14 weeks, 6 months, and 9 months of age, within a setting where the RTS,S/AS01 malaria vaccine became part of the standard of care. In a randomised, single- blind, placebo-controlled trial, infants were allocated to receive a three-day course of dihydroartemisinin-piperaquine (n = 110) or placebo (n = 110) starting at 10 weeks of age. Malaria incidence and adverse events were tracked until 12 months of age. In the dihydroartemisinin-piperaquine arm, piperaquine capillary blood samples were collected pre- dose and on days 3, 7, 14, and 28 following the 10-week and 6-month or 14-week and 9- month treatment courses. Nonlinear mixed-effects modelling was used to derive piperaquine's pharmacokinetic parameters. Geometric means (GM) and 90% confidence intervals (CI) were compared between 10 weeks and 14 weeks, 6 months or 9 months. Results: Malaria incidence was 1 versus 4 cases per 1,000 person-years (0.001 and 0.004 episodes per person-year) in the DP and placebo arms, respectively, corresponding to a non- significant 77% reduction with dihydroartemisinin-piperaquine (adjusted incidence rate ratio 0.23; 95% CI: 0.03 - 2.11; p = 0.196). All cases occurred within the first seven months, when nearly 50% of infants had received at least one malaria vaccine dose. Additionally, DP was associated with a 31% reduction in the prevalence of moderate–to–severe anaemia (18.3% and 12.5% in the DP and placebo arms, respectively; adjusted risk ratio 0.69, 95% CI 0.52– 0.93, p = 0.013). The frequency of adverse events was similar between groups (149 versus 134). At 9 months versus 10 weeks of age, piperaquine exposure was 58% lower (GM ratio 0.42; 90% CI 0.36-0.49) with corresponding CL/F and Vd that were 2.6 (GM ratio 2.61; 90% CI 2.52 – 2.70) and 3.2-fold (GM ratio 3.24; 90% CI 3.01–3.49) higher, respectively. Conclusion: Dihydroartemisinin-piperaquine administration during routine visits, in the context of ongoing malaria vaccination, was safe and showed a non-significant trend towards reduced malaria incidence in early infancy. However, age-related declines in piperaquine exposure indicate the need for dosage regimen optimisation of this promising antimalarial to ensure effective malaria chemoprevention in older infants.
dc.identifier.apacitationBanda, C. G. (2026). <i>Efficacy, safety and pharmacokinetics of dihydroartemisinin-piperaquine for perennial malaria chemoprevention in infants during routine health facility visits</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/43368en_ZA
dc.identifier.chicagocitationBanda, Clifford George. <i>"Efficacy, safety and pharmacokinetics of dihydroartemisinin-piperaquine for perennial malaria chemoprevention in infants during routine health facility visits."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2026. http://hdl.handle.net/11427/43368en_ZA
dc.identifier.citationBanda, C.G. 2026. Efficacy, safety and pharmacokinetics of dihydroartemisinin-piperaquine for perennial malaria chemoprevention in infants during routine health facility visits. . University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. http://hdl.handle.net/11427/43368en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Banda, Clifford George AB - Monthly dihydroartemisinin-piperaquine for perennial malaria chemoprevention (PMC) has been shown to offer superior malaria prevention compared to three-monthly dosing. However, aligning its administration with routine health facility visits has the potential to enhance adherence. Additionally, rapid physiological changes in infancy may influence drug exposure. We hypothesised that increasing age in infancy would result in a reduction in piperaquine's exposure due to age-related increases in apparent clearance (CL/F) and volume of distribution (Vd). Consequently, this could impact the protective efficacy of dihydroartemisinin-piperaquine for malaria prevention in infants. Methods: We assessed the efficacy and safety of dihydroartemisinin-piperaquine and piperaquine's exposure profile in Malawian infants receiving PMC aligned with routine health facility visits at 10 weeks, 14 weeks, 6 months, and 9 months of age, within a setting where the RTS,S/AS01 malaria vaccine became part of the standard of care. In a randomised, single- blind, placebo-controlled trial, infants were allocated to receive a three-day course of dihydroartemisinin-piperaquine (n = 110) or placebo (n = 110) starting at 10 weeks of age. Malaria incidence and adverse events were tracked until 12 months of age. In the dihydroartemisinin-piperaquine arm, piperaquine capillary blood samples were collected pre- dose and on days 3, 7, 14, and 28 following the 10-week and 6-month or 14-week and 9- month treatment courses. Nonlinear mixed-effects modelling was used to derive piperaquine's pharmacokinetic parameters. Geometric means (GM) and 90% confidence intervals (CI) were compared between 10 weeks and 14 weeks, 6 months or 9 months. Results: Malaria incidence was 1 versus 4 cases per 1,000 person-years (0.001 and 0.004 episodes per person-year) in the DP and placebo arms, respectively, corresponding to a non- significant 77% reduction with dihydroartemisinin-piperaquine (adjusted incidence rate ratio 0.23; 95% CI: 0.03 - 2.11; p = 0.196). All cases occurred within the first seven months, when nearly 50% of infants had received at least one malaria vaccine dose. Additionally, DP was associated with a 31% reduction in the prevalence of moderate–to–severe anaemia (18.3% and 12.5% in the DP and placebo arms, respectively; adjusted risk ratio 0.69, 95% CI 0.52– 0.93, p = 0.013). The frequency of adverse events was similar between groups (149 versus 134). At 9 months versus 10 weeks of age, piperaquine exposure was 58% lower (GM ratio 0.42; 90% CI 0.36-0.49) with corresponding CL/F and Vd that were 2.6 (GM ratio 2.61; 90% CI 2.52 – 2.70) and 3.2-fold (GM ratio 3.24; 90% CI 3.01–3.49) higher, respectively. Conclusion: Dihydroartemisinin-piperaquine administration during routine visits, in the context of ongoing malaria vaccination, was safe and showed a non-significant trend towards reduced malaria incidence in early infancy. However, age-related declines in piperaquine exposure indicate the need for dosage regimen optimisation of this promising antimalarial to ensure effective malaria chemoprevention in older infants. DA - 2026 DB - OpenUCT DP - University of Cape Town KW - volume of distribution KW - dihydroartemisinin-piperaquine LK - https://open.uct.ac.za PB - University of Cape Town PY - 2026 T1 - Efficacy, safety and pharmacokinetics of dihydroartemisinin-piperaquine for perennial malaria chemoprevention in infants during routine health facility visits TI - Efficacy, safety and pharmacokinetics of dihydroartemisinin-piperaquine for perennial malaria chemoprevention in infants during routine health facility visits UR - http://hdl.handle.net/11427/43368 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/43368
dc.identifier.vancouvercitationBanda CG. Efficacy, safety and pharmacokinetics of dihydroartemisinin-piperaquine for perennial malaria chemoprevention in infants during routine health facility visits. []. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2026 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/43368en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectvolume of distribution
dc.subjectdihydroartemisinin-piperaquine
dc.titleEfficacy, safety and pharmacokinetics of dihydroartemisinin-piperaquine for perennial malaria chemoprevention in infants during routine health facility visits
dc.typeThesis / Dissertation
dc.type.qualificationlevelDoctoral
dc.type.qualificationlevelPhD
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