Review of key knowledge gaps in glucose-6-phosphate dehydrogenase deficiency detection with regard to the safe clinical deployment of 8-aminoquinoline treatment regimens

A workshop report

Lorenz Von Seidlein, Sarah Auburn, F Espino, D Shanks, Q Cheng, James McCarthy, J Kevin Baird, Catherine Moyes, Rosalind Howes, Didier Menard, Bancone, A Winasti-Satuahraha, L Vestergaard, Justin Green, Gonzalo Domingo, Shunmay Yeung, Ric Price

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    Abstract

    The diagnosis and management of glucose-6-phosphate dehydrogenase (G6PD) deficiency is a crucial aspect in the current phases of malaria control and elimination, which will require the wider use of 8-aminoquinolines for both reducing Plasmodium falciparum transmission and achieving the radical cure of Plasmodium vivax. 8-aminoquinolines, such as primaquine, can induce severe haemolysis in G6PD-deficient individuals, potentially creating significant morbidity and undermining confidence in 8-aminoquinoline prescription. On the other hand, erring on the side of safety and excluding large numbers of people with unconfirmed G6PD deficiency from treatment with 8-aminoquinolines will diminish the impact of these drugs. Estimating the remaining G6PD enzyme activity is the most direct, accessible, and reliable assessment of the phenotype and remains the gold standard for the diagnosis of patients who could be harmed by the administration of primaquine. Genotyping seems an unambiguous technique, but its use is limited by cost and the large range of recognized G6PD genotypes. A number of enzyme activity assays diagnose G6PD deficiency, but they require a cold chain, specialized equipment, and laboratory skills. These assays are impractical for care delivery where most patients with malaria live. Improvements to the diagnosis of G6PD deficiency are required for the broader and safer use of 8-aminoquinolines to kill hypnozoites, while lower doses of primaquine may be safely used to kill gametocytes without testing. The discussions and conclusions of a workshop conducted in Incheon, Korea in May 2012 to review key knowledge gaps in G6PD deficiency are reported here. � 2013 von Seidlein et al.; licensee BioMed Central Ltd.
    Original languageEnglish
    Pages (from-to)112-1-112-12
    Number of pages12
    JournalMalaria Journal
    Volume12
    Issue number1
    DOIs
    Publication statusPublished - 2013

    Fingerprint

    Glucosephosphate Dehydrogenase Deficiency
    Primaquine
    Glucosephosphate Dehydrogenase
    Education
    Malaria
    Therapeutics
    Plasmodium vivax
    Refrigeration
    Enzyme Assays
    Plasmodium falciparum
    Korea
    Hemolysis
    Prescriptions
    Genotype
    8-aminoquinoline
    Morbidity
    Phenotype
    Safety
    Costs and Cost Analysis
    Equipment and Supplies

    Cite this

    Von Seidlein, Lorenz ; Auburn, Sarah ; Espino, F ; Shanks, D ; Cheng, Q ; McCarthy, James ; Baird, J Kevin ; Moyes, Catherine ; Howes, Rosalind ; Menard, Didier ; Bancone ; Winasti-Satuahraha, A ; Vestergaard, L ; Green, Justin ; Domingo, Gonzalo ; Yeung, Shunmay ; Price, Ric. / Review of key knowledge gaps in glucose-6-phosphate dehydrogenase deficiency detection with regard to the safe clinical deployment of 8-aminoquinoline treatment regimens : A workshop report. In: Malaria Journal. 2013 ; Vol. 12, No. 1. pp. 112-1-112-12.
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    abstract = "The diagnosis and management of glucose-6-phosphate dehydrogenase (G6PD) deficiency is a crucial aspect in the current phases of malaria control and elimination, which will require the wider use of 8-aminoquinolines for both reducing Plasmodium falciparum transmission and achieving the radical cure of Plasmodium vivax. 8-aminoquinolines, such as primaquine, can induce severe haemolysis in G6PD-deficient individuals, potentially creating significant morbidity and undermining confidence in 8-aminoquinoline prescription. On the other hand, erring on the side of safety and excluding large numbers of people with unconfirmed G6PD deficiency from treatment with 8-aminoquinolines will diminish the impact of these drugs. Estimating the remaining G6PD enzyme activity is the most direct, accessible, and reliable assessment of the phenotype and remains the gold standard for the diagnosis of patients who could be harmed by the administration of primaquine. Genotyping seems an unambiguous technique, but its use is limited by cost and the large range of recognized G6PD genotypes. A number of enzyme activity assays diagnose G6PD deficiency, but they require a cold chain, specialized equipment, and laboratory skills. These assays are impractical for care delivery where most patients with malaria live. Improvements to the diagnosis of G6PD deficiency are required for the broader and safer use of 8-aminoquinolines to kill hypnozoites, while lower doses of primaquine may be safely used to kill gametocytes without testing. The discussions and conclusions of a workshop conducted in Incheon, Korea in May 2012 to review key knowledge gaps in G6PD deficiency are reported here. � 2013 von Seidlein et al.; licensee BioMed Central Ltd.",
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    Von Seidlein, L, Auburn, S, Espino, F, Shanks, D, Cheng, Q, McCarthy, J, Baird, JK, Moyes, C, Howes, R, Menard, D, Bancone, Winasti-Satuahraha, A, Vestergaard, L, Green, J, Domingo, G, Yeung, S & Price, R 2013, 'Review of key knowledge gaps in glucose-6-phosphate dehydrogenase deficiency detection with regard to the safe clinical deployment of 8-aminoquinoline treatment regimens: A workshop report', Malaria Journal, vol. 12, no. 1, pp. 112-1-112-12. https://doi.org/10.1186/1475-2875-12-112

    Review of key knowledge gaps in glucose-6-phosphate dehydrogenase deficiency detection with regard to the safe clinical deployment of 8-aminoquinoline treatment regimens : A workshop report. / Von Seidlein, Lorenz; Auburn, Sarah; Espino, F; Shanks, D; Cheng, Q; McCarthy, James; Baird, J Kevin; Moyes, Catherine; Howes, Rosalind; Menard, Didier; Bancone; Winasti-Satuahraha, A; Vestergaard, L; Green, Justin; Domingo, Gonzalo; Yeung, Shunmay; Price, Ric.

    In: Malaria Journal, Vol. 12, No. 1, 2013, p. 112-1-112-12.

    Research output: Contribution to journalArticleResearchpeer-review

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    T1 - Review of key knowledge gaps in glucose-6-phosphate dehydrogenase deficiency detection with regard to the safe clinical deployment of 8-aminoquinoline treatment regimens

    T2 - A workshop report

    AU - Von Seidlein, Lorenz

    AU - Auburn, Sarah

    AU - Espino, F

    AU - Shanks, D

    AU - Cheng, Q

    AU - McCarthy, James

    AU - Baird, J Kevin

    AU - Moyes, Catherine

    AU - Howes, Rosalind

    AU - Menard, Didier

    AU - Bancone, null

    AU - Winasti-Satuahraha, A

    AU - Vestergaard, L

    AU - Green, Justin

    AU - Domingo, Gonzalo

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    N2 - The diagnosis and management of glucose-6-phosphate dehydrogenase (G6PD) deficiency is a crucial aspect in the current phases of malaria control and elimination, which will require the wider use of 8-aminoquinolines for both reducing Plasmodium falciparum transmission and achieving the radical cure of Plasmodium vivax. 8-aminoquinolines, such as primaquine, can induce severe haemolysis in G6PD-deficient individuals, potentially creating significant morbidity and undermining confidence in 8-aminoquinoline prescription. On the other hand, erring on the side of safety and excluding large numbers of people with unconfirmed G6PD deficiency from treatment with 8-aminoquinolines will diminish the impact of these drugs. Estimating the remaining G6PD enzyme activity is the most direct, accessible, and reliable assessment of the phenotype and remains the gold standard for the diagnosis of patients who could be harmed by the administration of primaquine. Genotyping seems an unambiguous technique, but its use is limited by cost and the large range of recognized G6PD genotypes. A number of enzyme activity assays diagnose G6PD deficiency, but they require a cold chain, specialized equipment, and laboratory skills. These assays are impractical for care delivery where most patients with malaria live. Improvements to the diagnosis of G6PD deficiency are required for the broader and safer use of 8-aminoquinolines to kill hypnozoites, while lower doses of primaquine may be safely used to kill gametocytes without testing. The discussions and conclusions of a workshop conducted in Incheon, Korea in May 2012 to review key knowledge gaps in G6PD deficiency are reported here. � 2013 von Seidlein et al.; licensee BioMed Central Ltd.

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