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Reviews of "Characterizing the Blood Stage Antimalarial Activity of Pyronaridine in Healthy Volunteers Experimentally Infected with Plasmodium Falciparum"

Reviewers: J Ding (MORU Tropical Health Network) | 📒📒📒◻️◻️ • T Wattanakul (MORU Tropical Health Network) | 📘📘📘📘📘 • Anonymous | 📒📒📒◻️◻️

Published onDec 14, 2023
Reviews of "Characterizing the Blood Stage Antimalarial Activity of Pyronaridine in Healthy Volunteers Experimentally Infected with Plasmodium Falciparum"
key-enterThis Pub is a Review of
Characterizing the blood stage antimalarial activity of pyronaridine in healthy volunteers experimentally infected with Plasmodium falciparum
Characterizing the blood stage antimalarial activity of pyronaridine in healthy volunteers experimentally infected with Plasmodium falciparum
Description

ABSTRACT Although pyronaridine has been used to successfully treat malaria for many years, its antimalarial activity in humans has not been completely characterized. This volunteer infection study aimed to determine the pharmacokinetic/pharmacodynamic (PK/PD) relationship of pyronaridine in healthy malaria naïve adults. Volunteers were inoculated with Plasmodium falciparum 3D7-infected erythrocytes on day 0 and different single oral doses of pyronaridine were administered on day 8. Parasitemia, and concentrations of pyronaridine in whole blood were measured and standard safety assessments performed. Curative artemether-lumefantrine therapy was administered if parasite regrowth occurred, or on day 47±2. Outcomes were parasite clearance kinetics, PK and PK/PD parameters from modelling. Ten participants were inoculated and administered 360 mg (n=4), 540 mg (n=4), or 720 mg (n=1) pyronaridine. One participant was withdrawn without receiving pyronaridine. Time to maximum pyronaridine concentration after dosing was 1-2 hours and the elimination half-life was 8-9 days. A parasite clearance half-life of approximately 5 hours was calculated for all dose levels. Parasite regrowth occurred after dosing with 360 mg (4/4 participants) and 540 mg (2/4 participants). Key efficacy parameters of pyronaridine including the minimum inhibitory concentration (MIC: 5.5 ng/mL) and minimum parasiticidal concentration that leads to 90% of maximum effect (MPC90: 8 ng/mL) were derived from the final PK/PD model. Adverse events considered related to pyronaridine were predominantly mild to moderate gastrointestinal symptoms. There were no serious adverse events. Data obtained in this study will support the use of pyronaridine in new antimalarial combination therapies by informing partner drug selection and dosing considerations.

To read the original manuscript, click the link above.

Summary of Reviews: This study assessed the pharmacokinetics/pharmacodynamics (PK/PD) of the antimalarial drug pyronaridine in human subjects challenged with Plasmodium falciparum, which provides parameters that could be used in helping guide drug dosing. Overall, reviewers were divided over the strength of this preprint, grading it from "potentially informative" to "strong". While some reviewers found that the results validated existing dosing recommendations or would be important in determining optimal dosing, others found that the results were ultimately inconsequential. Some reviewers determined that the methods were overall robust with well-described analyses and models. Several reviewers, however, noted an important limitation in the small sample size of the study, although these reviewers had varying opinions on the precise impact of this shortcoming. Because the reviewers had differing opinions of the robustness of the manuscript, we gave them an opportunity to discuss the reviews amongst themselves, as attached detailed in the supplement "Discussion Amongst Reviews". 

Reviewer 1 (Junjie D…) | 📒📒📒 ◻️◻️

Reviewer 2 (Thanaporn W…) | 📘📘📘📘📘

Reviewer 3 (Anonymous) | 📒📒📒 ◻️◻️

RR:C19 Strength of Evidence Scale Key

📕 ◻️◻️◻️◻️ = Misleading

📙📙 ◻️◻️◻️ = Not Informative

📒📒📒 ◻️◻️ = Potentially Informative

📗📗📗📗◻️ = Reliable

📘📘📘📘📘 = Strong

To read the reviews, click the links below. 

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