Uthman OA, et al. – Researchers determined the haemolysis risk with single dose or short course primaquine in glucose–6–phosphate dehydrogenase (G6PD) deficient people. In this study, falls in average haemoglobin are less marked with the 0.1 to 0.25 mg/kg PQ than with the 0.75 mg/kg dose, and severe haemolytic events are not common. However, data were limited and the evidence GRADE was low or very low certainty.

Methods

• Search was performed of major electronic databases (to August 2016) for single or short course 8-aminoquinolines (8-AQ) in
• (1) randomized comparisons against placebo in G6PD deficient people; and
• (2) observational comparisons in G6PD deficient compared to replete people.
• Eligibility, risk-of-bias, and extracted data were assessed by 2 authors independently.

Results

• Researchers included five randomized controlled trials and four controlled observational cohorts.
• High-dose (0.75 mg/kg) PQ in G6PD deficient individuals resulted in lower average haemoglobin levels at 7 days (mean difference [MD] -1.45 g/dl, 95% CI -2.17 to -0.74, 2 trials) and larger percentage fall from baseline to day 7 (MD -10.31%, 95% CI -17.69 to -2.92, 3 trials) compared to placebo.
• In G6PD deficient compared to replete people, lower average haemoglobin was observed at 7 days (MD -1.19 g/dl, 95% CI -1.94 to -0.44, 2 trials) and greater haemoglobin change from baseline to day 7 was evident (MD -9.10%, 95% CI -12.55 to -5.65, 5 trials).
• They identified one small trial that evaluated mid-range PQ dose (0.4–0.5 mg/kg) in G6PD deficient people, it indicated no difference in average haemoglobin at day 7 compared to placebo.
• In one cohort comparing G6PD deficient and replete people, a greater fall with G6PD deficiency was observed(MD -4.99%, 95% CI -9.96 to -0.02).
• For low-dose PQ (0.1–0.25 mg/kg) in G6PD deficient people, similar haemoglobin change was evident from baseline when compared to the placebo group (MD 1.72%, 95% CI -1.89 to 5.34, 2 trials).
• Comparing low dose PQ in G6PD deficient with replete people, lower average haemoglobin was observed in the G6PD deficient group at 7 days (-0.57 g (95% CI -0.97 to -0.17, 1 trial)); although change from baseline was similar (MD -1.45%, 95% CI -5.69 to 2.78, 3 trials).