ACTA Medical Health Sciences

Hypolipidemic effect of lime (Citrus aurantifolia) fruit ethanol extract on total cholesterol levels in rats

2025-03-01T08:47:13-08:00

High cholesterol levels are a significant risk factor for cardiovascular disease. Statins are commonly used to reduce total cholesterol levels; however, long-term use can lead to adverse effects such as myalgia, an increased risk of type 2 diabetes, and liver damage. As a result, there is a growing need for research into natural medicines for cholesterol management. Lime
(Citrus aurantifolia) is rich in flavonoids, which have been shown to reduce cholesterol by inhibiting the HMG-CoA reductase enzyme, a mechanism similar to that of statins. This study aimed to evaluate the effect of lime fruit ethanol extract on total cholesterol levels in male Wistar strain rats induced with a high-fat diet and PTU. This study was conducted as a laboratory experiment using a post-test control group design. Male Wistar rats were divided into six groups: a normal control group, a negative control group (high-fat diet + PTU), a positive control group (simvastatin), and three test groups (lime fruit ethanol extract 0.875, 1.75, and 3.5 g/kg BW). The high-fat diet and PTU were induced for 14 days, and total cholesterol levels were determined using the enzymatic colorimetric method (CHOD/PAP) at the end. The administration of lime fruit ethanol extract at a dose of 0.875 g/kgBW significantly reduced total cholesterol compared to the negative control group (p=0.013), with no significant difference from the normal group (p=0.965). However, higher doses of 1.75 and 3.5 g/kg BW caused mortality in the test groups. These findings suggest that lime fruit ethanol extract effectively reduces total cholesterol levels at a dose of 0.875 g/kg BW. Further research is needed to determine the optimal dose and toxicity profile of lime fruit ethanol extract for
hyperlipidemia therapy.

DOI : 10.35990/amhs.v3n3.p118-129

REFERENCES

Siregar FA, Makmur T. Metabolisme lipid dalam tubuh. J Inov Kesehat Masy. 2020;1:60–6.
Sovia E, Roslaeni R, Prakasa B, Putri AA, Ulhaq AD, Djajasasmita D, et al. Antihyperlipidemic effect of bitter melon extract (Momordica charantia L.) in Wistar rats. Indones J Clin Pharm. 2022;11:209–16.
Oktavelia W, Kusuma SAF. Therapy for dyslipidemia: plant inhibitors of HMG-CoA reductase. Indones J Biol Pharm. 2022;2:159–70.
Al-Zahrani J, Shubair MM, Al-Ghamdi S, Alrasheed AA, Alduraywish AA, Alreshidi FS, et al. The prevalence of hypercholesterolemia and associated risk factors in Al-Kharj population, Saudi Arabia: a cross-sectional survey. BMC Cardiovasc Disord. 2021;21:1–8.
Puspaseruni K. Tatalaksana dislipidemia terkait penyakit kardiovaskular aterosklerosis (ASCVD): fokus pada penurunan LDL-c. CDK. 2021;48:395–401.
Lestari WA, Utari DM. Dominant factors of hypercholesterolemia among pre-elderly in working area of Rangkapanjaya public health center in Depok. BKM J Community Med Public Health. 2017;33:267–72.
Noubiap JJN, Nansseu JRN, Bigna JJR, Jingi AM, Kengne AP. Prevalence and incidence of dyslipidaemia among adults in Africa: a systematic review and meta-analysis protocol. BMJ Open. 2015;4:1–5.
Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. Heart disease and stroke statistics - 2023 update: a report from the American Heart Association. Circulation. 2023;147:93–621.
Aman AM, Soewondo P, Arsana PM, Zufry H, Rosandi R, Walewangko OC, et al. Panduan pengelolaan dislipidemia di Indonesia. PB PERKENI; 2021.
Adam JMF. Dislipidemia. In: Buku Ajar Ilmu Penyakit Dalam. Vol VI. Jakarta: Interna Publishing; 2014. p. 2549–58.
Prastiwi SS, Ferdiansyah F. Kandungan dan aktivitas farmakologi jeruk nipis (Citrus aurantifolia s.). Farmaka. 2017;15:1–8.
Minami GS, Lumbantoruan EC, Puteri, Nuraini R, Harianto JC, Fahrurroji A. The potential of sweet orange (Citrus sinensis) in cardiovascular health: a literature review. J Kedokteran dan Kesehatan Indonesia. 2023;:82–94.
Purnamasari AW, Isnawati M. Pengaruh pemberian jus pare (Momordica charantia L.) dan jus jeruk nipis (Citrus aurantifolia) terhadap kadar kolesterol total tikus Sprague Dawley hiperkolesterolemia. J Nutr College. 2014;3:894–902.
Lin LY, Chuang CH, Chen HC, Yang KM. Lime (Citrus aurantifolia (Christm.) Swingle) essential oils: volatile compounds, antioxidant capacity, and hypolipidemic effect. Foods. 2019;8.
Cyndi B, Andriane Y, MNur I. Pengaruh pemberian ekstrak etanol daun jeruk nipis (Citrus aurantifolia Swingle) terhadap penurunan kadar kolesterol total darah pada mencit model hiperkolesterolemia. Pros Pendidikan Dokter. 2016;2:911–7.
Ardiani R. Efek antikolesterol ekstrak etanol daun Afrika (Vernonia amygdalina Del.) pada tikus. 2017;2:153–8.
Sasmita, Djabir YY, Yustisia I. Efek pemberian dangke terhadap kadar kolesterol dan trigliserida darah tikus pemodelan hiperkolesterolemia dan hipertrigliseridemia. Maj Farmasi Farmakol. 2023;27:43–6.
Penelitian A, Arfan M, Simatupang B, Sutysna H. Pengaruh minyak zaitun dan olahraga terhadap kadar trigliserida tikus Wistar diet tinggi lemak. 2020;1.
Christianty FM, Holidah D, Fajrin FA, Salsabina MCA, Roni A. Profil lipid dan gambaran histopatologi aorta tikus hiperlipidemia dengan pemberian ekstrak kopi hijau. J Ilmu Kefarmasian Indones. 2020;18:21–7.
Sovia E, Kristiana R, Nurdina S, Rachman H. Cinnamon (Cinnamomum burmanii) extract hepatoprotection activity against isoniazid-induced rat serum aspartate transaminase (AST) levels. Acta Med Health Sci. 2024;:109–15.
Untari MK, Pramukantoro E. Aktivitas antihiperkolesterolemia ekstrak etanol daun Stevia rebaudiana Bertoni pada tikus putih jantan. J Syifa Sci Clin Res. 2020;2:11–20.
Sinaga EM, Ambarwati NF, Aritonang B, Ritonga AH. Making antiseptic solid soap ethanol extract lemon peel (Citrus limon (L.) Burm. f.). J Multidisiplin Madani (MUDIMA). 2022;2:877–88.
Awad K, Serban MC, Penson P, Mikhailidis DP, Toth PP, Jones SR, et al. Effects of morning vs evening statin administration on lipid profile: a systematic review and meta-analysis. J Clin Lipidol. 2017;11:972–85.
McPherson RA, Pincus MR. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 24th ed. 2021.
Yurista SR, Ferdian RA, Sargowo D. Principles of the 3Rs and ARRIVE guidelines in animal research. J Kardiol Indones. 2016;37:156–63.
Andari F, Rahayuni A. Pengaruh pemberian serbuk biji labu kuning (Cucurbita moschata) terhadap penurunan kolesterol total tikus Wistar hiperkolesterolemia. J Nutr College. 2014;3:506–16.
Nuralifah, Wahyuni, Parawansah, Shintia UD. Uji aktivitas antihiperlipidemia ekstrak etanol daun Notika (Arcboldiodendron calosericeum Kobuski) terhadap kadar kolesterol total tikus jantan galur Wistar. J Syifa Sci Clin Res. 2020;2:1–10.
Mutia S, Fauziah, Thomy Z. Pengaruh pemberian ekstrak etanol daun andong (Cordyline fruticosa (L.) A. Chev) terhadap kadar kolesterol total dan trigliserida darah tikus putih (Rattus norvegicus) hiperkolesterolemia. J Bioleuser. 2018;2:29–35.
Aprilia CA, Ninditasari G, Walujo BRD. Hypolipidemic effect and antioxidant activity of tamarind leaves extract in hypercholesterol-fed rats. Indones J Cardiol. 2017;38:72–80.
Rindiany C, Widjastuti T. Pengaruh pemberian mikrokapsul ekstrak buah mengkudu (Morinda citrifolia L.) sebagai feed additive terhadap kadar kolesterol dan trigliserida darah ayam Sentul. J Nutr Ternak Trop dan Ilmu Pakan. 2022;4:129–37.
Ezeigwe OC, Ani ON, Okafor MC. Toxicological studies of Citrus aurantifolia fruit juice in Wistar rats. Asian J Biochem Genet Mol Biol. 2022;:38–47.
Shchérazade OSF, Pétronille AZ, Joseph FKY, Georges A. Study of the analgesic effect of the aqueous extract of the leaves of Citrus aurantifolia (Rutaceae) in mice. GSC Biol Pharm Sci. 2021;14:207–14.

Phytochemical screening and antidyslipidemic effect of lime fruit (Citrus aurantifolia) ethanol extract on high-density lipoprotein levels of high-fat diet-induced rats

2025-03-01T09:05:47-08:00

Dyslipidemia is a significant health problem in Indonesia and a major cause of coronary heart disease (CHD). According to the 2018 Riset Kesehatan Dasar Nasional (RISKESDAS), 24.3% of Indonesians aged ≥15 years had low high-density lipoprotein (HDL) levels, while 13.8% had high HDL levels. Treatment with traditional medicine is a popular approach in Indonesia. Lime (Citrus aurantifolia) contains flavonoids that can inhibit the activity of the hydroxymethylglutaryl-coenzyme A reductase (HMG-CoA reductase) enzyme. This study aimed to identify the chemical compounds found in lime peel and fruit, as well as to determine the effective dose of ethanol extract from lime fruit in increasing HDL levels. This research is a true experimental study conducted in the laboratory using an in vivo approach. The research used a randomized post-test only control group design involving both control and treatment groups. Based on the results of phytochemical screening, the lime fruit ethanol extract contains flavonoids, alkaloids, tannins, polyphenols, saponins, and quinones. Using the Saphiro-Wilk normality test, the data obtained are normally distributed with a p-value of 0.809 (p > 0.05). Statistical analysis was continued with the one-way ANOVA parametric test, and a p-value of 0.146 (p > 0.05) was obtained. An increase in the average HDL levels was also observed in the treatment group given a dose of 0.875 g/KgBW of lime fruit ethanol extract, but there was no significant difference in the average HDL levels between the groups.

DOI : 10.35990/amhs.v3n3.p130-140

REFERENCES

Agung LR. Pengaruh Daun Salam (Syzygium polyanthum) terhadap Kadar Trigliserida dan Kolesterol Total Darah pada Penderita Dislipidemia. J Ilm Kesehat Sandi Husada. 2021;10(2):408–12.
Siregar SRM, Boy E. Faktor Risiko pada Pasien Dislipidemia. J Implementa Husada. 2022;3(4):230.
Pengelolaan Dislipidemia di Indonesia 2021. PB Perkeni; 2021. p. 1–2.
Gayatri AMT, Aulia AP, Riza M. Pengaruh Pemberian Ekstrak Biji Almond terhadap Kadar HDL. Studi Eksperimental pada Tikus Putih yang Diinduksi Kuning Telur. J Ilm Sultan Agung. 2023:889–97. https://jurnal.unissula.ac.id/index.php/JIMU/article/view/31396/84465
Rafsanjani MS, Asriati A, Kholidha AN, Alifariki LO. Hubungan Kadar High Density Lipoprotein (HDL) dengan Kejadian Hipertensi. J Profesi Med J Kedokt dan Kesehat. 2019;13(2):74–81.
Badan Penelitian dan Pengembangan Kesehatan RI. Laporan Riskesdas 2018 Nasional. Lembaga Penerbit Balitbangkes; 2018. p. 156.
Badan Penelitian dan Pengembangan Kesehatan RI. Laporan Riskesdas 2013 Nasional. Lembaga Penerbit Balitbangkes; 2013;127(3309):1275–9.
Sinaga YO, Tiho M, Mewo YM. Gambaran Kadar Kolesterol High Density Lipoprotein Darah pada Mahasiswa Angkatan 2011 Fakultas Kedokteran Universitas Sam Ratulangi dengan Indeks Massa Tubuh ≥23,0 kg/m². J e-Biomedik. 2013;1(3):1096–100.
Saragih AD. Terapi Dislipidemia untuk Mencegah Risiko Penyakit Jantung Koroner. Indones J Nurs Heal Sci. 2020;1(1):15–24.
Panduan Tata Laksana Dislipidemia 2022. PB Perki; 2022. p. 128.
Latif WD, Aswad M, Bahar MA. Perbandingan Efektivitas Klinik Simvastatin dan Atorvastatin terhadap Profil Lipid Darah: Studi Kasus di Rumah Sakit Universitas Hasanuddin. J Sains Farm Klin. 2022;9(1):34–41. doi:10.25077/jsfk.9.1.34-41.2022
Cyndi B, Andriane Y, Nur I. Pengaruh Pemberian Ekstrak Etanol Daun Jeruk Nipis (Citrus aurantifolia Swingle) terhadap Penurunan Kadar Kolesterol Total Darah pada Mencit Model Hiperkolesterolemia. Pros Pendidik Dr. 2016;2(2):911–8.
Novriyanti R, Putri NEK, Rijai L. Skrining Fitokimia dan Uji Aktivitas Antioksidan Ekstrak Etanol Kulit Jeruk Nipis (Citrus aurantifolia) Menggunakan Metode DPPH. Proceeding Mulawarman Pharm Conf. 2022;15:165–70.
Mahmudi Y, Afrian S. Efektivitas Konsentrasi Ekstrak Kulit Jeruk Nipis (Citrus aurantifolia) dalam Menghambat Pertumbuhan Colletotrichum gloesporioides. J Agrotek Trop. 2021;10(2):85–93.
Carvalho BMR, Nascimento LC, Nascimento JC, et al. Citrus Extract as a Perspective for the Control of Dyslipidemia: A Systematic Review With Meta-Analysis From Animal Models to Human Studies. Front Pharmacol. 2022;13(February):1–21.
Pangestuti D. Pengaruh Pemberian Air Perasan Jeruk Nipis (Citrus aurantifolia Swingle) terhadap Kadar Kolesterol pada Mencit Hiperkolesterolemia. J Ris Hesti Medan. 2019;4(1):42–7.
Mende R, Simbala H, Mansauda KLR. Uji Efektivitas Sari Buah dan Ekstrak Etanol Kulit Jeruk Nipis (Citrus aurantifolia) terhadap Hiperkolesterolemia pada Tikus Putih Jantan Galur Wistar (Rattus norvegicus). Pharmacon. 2021;10(1):676.
Kemit N, Widarta IWR, Nocianitri KA. Pengaruh Jenis Pelarut dan Waktu Maserasi terhadap Kandungan Senyawa Flavonoid dan Aktivitas Antioksidan Ekstrak Daun Alpukat (Persea americana Mill). J Ilmu Teknol Pangan. 2016;5(2):130–41.
Alaydrus S, Amara Pagal RP. Uji Efektivitas Ekstrak Etanol Biji Alpukat (Persea americana Mill.) terhadap Penurunan Kadar Kolesterol Total Tikus Putih Jantan Model Hiperkolesterolemia Diabetes. J Sains Kes. 2020;2(4):2407–6082.
Untari MK, Pramukantoro GE. Aktivitas Antihiperkolesterolemia Ekstrak Etanol Daun Stevia Rebaudiana Bertoni pada Tikus Putih Jantan. J Syifa Sci Clin Res. 2020;2(1):11–20.
Allain CC, Poon LS, Chan CSG, Richmond W, Fu PC. Enzymatic determination of total serum cholesterol. Clin Chem. 1974;20(4):470–5.
Shchérazade OSF, Pétronille AZ, Joseph FKY, Georges A. Study of the Analgesic Effect of the Aqueous Extract of the Leaves of Citrus aurantifolia (Rutaceae) in Mice. GSC Biol Pharm Sci. 2021;14(3):207–14.
Bawekes SM, Yudistira A, Rumondor EM. Uji Kualitatif Kandungan Senyawa Kimia Perasan Jeruk Nipis (Citrus aurantifolia Swingle). Pharmacon. 2023;12(3):373–7.
Mazara F, Mahata LE, Kadri H, Putri BO. Efek Ekstrak Daun Kemangi (Ocimum basilicum L.) terhadap Kadar HDL Tikus Model Aterosklerosis. Jurnal XYZ. 2024;17(2).
Chriscensia E, Wibowo EC, Enriko G, Wijaya OC. Phytochemical Screening, Therapeutic Benefits, and Adverse Effects of Citrus aurantifolia – A Review. J XYZ. 2020;2(2).
Nisa IK, Amananti W, Febriyanti R. Skrining Fitokimia pada Kulit Jeruk Nipis di Wilayah Tegal dan Pemalang. 2021.
Lin L-Y, Chuang C-H, Chen H-C. Lime (Citrus aurantifolia (Christm.) Swingle) Essential Oils: Volatile Compounds, Antioxidant Capacity, and Hypolipidemic Effect. Foods. 2019;8(398):1–11.
Mustiqawati E, Yolandari S. Identifikasi Senyawa Saponin Ekstrak Daun Jeruk Nipis (Citrus aurantifolia S.) dengan Kromatografi Lapis Tipis. J Promot Prefentif. 2022;5(2):66–73.
Afrina, Chismirina S, Magistra RY. Konsentrasi Hambat dan Bunuh Minimum Ekstrak Daun Jeruk Nipis (Citrus aurantifolia) terhadap Aggregatibacter actinomycetemcomitans secara In Vitro. Cakradonya Dent J. 2016;8(1):68–76.
Ezeabara CA, Okeke C, Aziagba BO. Flavonoid Content of Citrus Species Grown in Awka, Anambra State, Southeastern Nigeria. Int J Agric Biosci. 2013;8(2):89–98.
Mulyadi IC, Ratnawati H, Rosnaeni. Efek Ekstrak Etanol Daun Salam (Syzygium polyanthum (Wight) Walp) dibandingkan Simvastatin terhadap Kadar HDL Serum Tikus Wistar Jantan yang Diinduksi Pakan Tinggi Lemak. 2015:6.
Depari SAF, Rambe DJA, Meilando R, et al. Uji Efektivitas Ekstrak Etanol Kulit Jeruk Sunkist (Citrus sinensis (L.) Osbeck) terhadap Kadar Kolesterol. J XYZ.

Assessment of GeneXpert MTB/RIF performance for tuberculosis at doctor chasbullah abdulmajid hospital, bekasi city

2025-03-01T09:24:44-08:00

Tuberculosis (TB) remains a critical global health threat, with effective detection methods continuing to pose challenges. Since 2012, the Indonesian National TB Control Program has utilized the GeneXpert examination with the Xpert MTB/RIF (Mycobacterium Tuberculosis/Rifampicin) cartridge, enabling rapid identification of Mycobacterium tuberculosis (MTB) and simultaneous detection of rifampicin resistance. This descriptive study assesses the performance of the GeneXpert MTB/RIF assay in patients at Doctor Chasbullah Abdulmajid Hospital. Results were classified into successful tests (MTB detected, MTB not detected, MTB detected with rifampicin resistance, and MTB detected with rifampicin indeterminate) and failed tests (invalid, error, and no result). Data were sourced from the National Tuberculosis Information System (SITB), comprising 2,408 patients who met the inclusion criteria. The findings indicate that most suspected TB patients were between 19 and 44 years old (36.62%), with a higher prevalence in males (58.39%) than in females (41.6%). The majority were new TB cases (88.88%). The GeneXpert MTB/RIF assay exhibited an impressive 99.8% success rate, alongside a failure rate of 0.12%. Among successful tests,
30.06% detected MTB, with 26.61% being rifampicin-sensitive and 3.44% resistant. Notably, 69.80% of tests resulted in undetectable MTB. Error results may arise from various factors, including undetectable MTB DNA and system malfunctions. While a significant number of negative results were observed, these findings merit further investigation, particularly in suspected pediatric TB cases.

DOI : 10.35990/amhs.v3n3.p141-150

REFERENCES

Indonesia Ministry of Health. Health Community Movement. Tuberculosis Examination GeneXpert Molecular Rapid Test Instructions Manual. 2023.
Indonesia Ministry of Health. Report on Tuberculosis Control Program in 2022. 2023.
World Health Organization. WHO Operational Handbook on Tuberculosis: Module 3 – Rapid diagnostics for Tuberculosis Detection. 3rd ed. 2024.
World Health Organization. Global Tuberculosis Report 2023. Geneva: WHO; 2023.
Indonesia Ministry of Health. 2023 Tuberculosis Program Monitoring and Evaluation Meeting. 2023.
Sahiratmadja E, Mega GS, Andriyoko B, Parwati I. Performance of Xpert® MTB/RIF in detecting multidrug-resistant tuberculosis in West Java, Indonesia. Majalah Kedokteran Bandung. 2020;52(2):99–106.
Newtonraj A, Venables E, Selvaraj K, Kundu D, Purty A, Manikandan M, et al. Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India. J Family Med Prim Care. 2019;8(4):1379.
Kohli M, Schiller I, Dendukuri N, Yao M, Dheda K, Denkinger CM, et al. Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev. 2021;2021(1).
Gidado M, Nwokoye N, Ogbudebe C, Nsa B, Nwadike P, Ajiboye P, et al. Assessment of GeneXpert MTB/RIF performance by type and level of healthcare facilities in Nigeria. Niger Med J. 2019;60(1):33.
Rolo M, González-Blanco B, Reyes CA, Rosillo N, López-Roa P. Epidemiology and factors associated with extrapulmonary tuberculosis in a low-prevalence area. J Clin Tuberc Other Mycobact Dis. 2023;32:100377.
Rivani E, Sabrina T, Patricia V. Comparison of GeneXpert MTB/RIF diagnostic test to detect rifampicin resistance of Mycobacterium tuberculosis in pulmonary TB patients at RSUP Dr. Moh. Hoesin Palembang. JKK. 2019;6(1).
Lamberto M, Mboeik W, Wicaksono Pitoyo C, Karjadi TH, Karuniawati A, Dewiasty E. Performance of Xpert MTB/RIF using gastric lavage samples in diagnosing pulmonary tuberculosis in HIV patients suspected of pulmonary tuberculosis. J Penyakit Dalam Indonesia. 2018;5.
Dewi AIS, Andrika P, Artana IB, Kunci K. Characteristics of tuberculosis patients in the Respiratory Department of Sanglah Hospital, Denpasar. Available from: https://ojs.unud.ac.id/index.php/eum
Kesek J, Cerelia S, Polii E. Characteristics and demographics of pulmonary tuberculosis patients of productive age at Prof. Dr. R. D. Kandou General Hospital Manado for the period 2014–2015. 2019 [cited 2024 Sep 10]; Available from: https://ejournal.unsrat.ac.id/index.php/msj
Caraux-Paz P, Diamantis S, de Wazières B, Gallien S. Tuberculosis in the elderly. J Clin Med. 2021;10(24):5888.
Putri PA, Setyoningrum RA, Handayani S, Rosyid AN. Correlation between demographic factors and tuberculosis prevention: A literature review. Int J Res Publ. 2022;115(1).
Indonesia Ministry of Health. Changes in Diagnosis and Treatment of Tuberculosis Protocols in Indonesia. 2021 Apr.
Rarome BB, Aisah N, Setyoningrum RA, Mertaniasih NM. GeneXpert MTB/RIF and Mycobacterium tuberculosis sputum culture in establishing the diagnosis of pulmonary tuberculosis and rifampicin resistance in suspected childhood pulmonary tuberculosis in Soetomo Hospital. Int J Tuberc Infect Dis. [Internet]. Available from: https://e-journal.unair.ac.id/IJTID/
Arbués MD, Rossetti MLR. Evaluation of the GeneXpert MTB/RIF to diagnose tuberculosis in a public health laboratory. Rev Saude Publica. 2024;58(1):3.
Huang W, Lee MKT, Sin ATK, Nazari RS, Chua SY, Sng LH. Evaluation of Xpert MTB/RIF Ultra assay for detection of Mycobacterium tuberculosis and rifampicin resistance. Pathology. 2023;55(5):688–97.
Alemu A, Amare M, Ameni G, Kebede A, Beyene D, Yenew B, et al. Monitoring quality indicators for the Xpert MTB/RIF molecular assay in Ethiopia. PLoS One. 2019;14(11).

Efficacy and safety of short vs. Standard long regimens for multidrug- resistant tuberculosis: a network meta-analysis

2025-03-02T01:55:56-08:00

Drug-resistant tuberculosis (DR-TB) remains a critical health concern, particularly in high- burden regions like Indonesia. Shorter treatment regimens have been proposed to improve outcomes for multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB). This systematic review and Bayesian network meta-analysis aimed to evaluate the efficacy and safety of these shorter regimens. Using PRISMA-NMA guidelines, we systematically searched multiple databases, including PubMed, Cochrane, Scopus, WOAJ, and WOS, for studies published between 2014 to 2024. We included 23 eligible studies comprising a total of 6,343 MDR/RR- TB patients. Results showed that treatment with a 9-12 month regimen, specifically Kanamycin (Km)/Capreomycin (Cm), Moxifloxacin (Mfx)/Levofloxacin (Lfx), Prothionamide (Pto), Clofazimine (Cfz), Pyrazinamide (Z), Ethambutol (E), High-dose Isoniazid (Hh) demonstrated almost twice the probability of favorable outcomes defined as cure or treatment completion, compared to the standard regimens [RR 1.66 (95%CrI 1.34;2.04), P=0.0094]. Additionally, the 6-month regimen Bedaquiline (Bdq), Pretomanid (Pa), Linezolid (Lzd), Moxifloxacin (Mfx) also showed significantly higher favorable outcomes [RR 1.59 (95%CrI 1.29;2.03), P<0.001]. For safety outcomes, regimens containing bedaquiline, such as the 6-month Bdq, Pa, Lzd, Mfx regimen, had a 38% reduction in the risk of adverse events compared to the standard [RR 0.623 (95%CrI 0.280;1.29), P < 0.0001]. This was followed by the 6-month Bdq, Pa, Lzd and the Bdq, Pa, Lzd, Cfz regimen, which also showed lower risks of adverse events. In conclusion, shorter MDR/RR-TB regimens, especially those containing bedaquiline, appear to enhance cure rates while reducing adverse effects, supporting current WHO guidelines for 6-month treatment options

DOI : 10.35990/amhs.v3n3.p151-162

REFERENCES

World Health Organization. Tuberculosis. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis (accessed 10 October 2024).
Perhimpunan Dokter Paru Indonesia (PDPI). Buku Pedoman TBC 2021. 2021. Available from: https://bukupdpi.klikpdpi.com/wp-content/uploads/2022/08/BUKU-GUIDELINE-TB-2021.pdf (accessed 10 October 2024).
World Health Organization. Tuberculosis: Multidrug-resistant Tuberculosis (MDR-TB). 2018. Available from: https://www.who.int/news-room/questions-and-answers/item/tuberculosis-multidrug-resistant-tuberculosis-(mdr-tb) (accessed 10 October 2024).
Kementerian Kesehatan Republik Indonesia. Laporan Program Penanggulangan Tuberkulosis Tahun 2022. 2023. Available from: https://www.tbindonesia.or.id/wp-content/uploads/2023/09/Laporan-Tahunan-Program-TBC-2022.pdf (accessed 10 October 2024).
Jang JG, Chung JH. Diagnosis and treatment of multidrug-resistant tuberculosis. Yeungnam Univ J Med. 2020;37(4):277–85.
Soedarsono S, Mertaniasih NM, Kusmiati T, Permatasari A, Ilahi WK, Anggraeni AT. Characteristics of previous tuberculosis treatment history in patients with treatment failure and the impact on acquired drug-resistant tuberculosis. Antibiotics. 2023;12(3):598.
Yew WW, Koh WJ. Emerging strategies for the treatment of pulmonary tuberculosis: promise and limitations? Korean J Intern Med. 2015;31(1):15–29.
Trevisi L, Hernán MA, Mitnick CD, Khan U, Seung KJ, Rich ML, et al. Effectiveness of bedaquiline use beyond six months in patients with multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2023;207(11):1525–32.
Putra ON, Yulistiani Y, Soedarsono S, Subay S. Early efficacy of individual regimens containing bedaquiline in patients with drug resistant tuberculosis. Asian Pac J Trop Med. 2023;16(4):169–75.
Gill CM, Dolan L, Piggott LM, McLaughlin AM. New developments in tuberculosis diagnosis and treatment. Breathe. 2022;18(1):210149.
Padmapriyadarsini C, Vohra V, Bhatnagar A, Solanki R, Sridhar R, Anande L, et al. Bedaquiline, delamanid, linezolid, and clofazimine for treatment of pre-extensively drug-resistant tuberculosis. Clin Infect Dis. 2022;76(3):e938–46.
Mok J, Lee M, Kim DK, Kim JS, Jhun BW, Jo KW, et al. 9 months of delamanid, linezolid, levofloxacin, and pyrazinamide versus conventional therapy for fluoroquinolone-sensitive multidrug-resistant tuberculosis (MDR-END): a multicentre, randomised, open-label phase 2/3 non-inferiority trial in South Korea. Lancet. 2022;400(10362):1522–30.
Nyang’wa BT, Berry C, Kazounis E, Motta I, Parpieva N, Tigay Z, et al. A 24-week, all-oral regimen for rifampin-resistant tuberculosis. N Engl J Med. 2022;387(25):2331–43.
Esmail A, Oelofse S, Lombard C, Perumal R, Mbuthini L, Goolam Mahomed A, et al. An all-oral 6-month regimen for multidrug-resistant tuberculosis: a multicenter, randomized controlled clinical trial (the NExT Study). Am J Respir Crit Care Med. 2022;205(10):1214–27.
Nunn AJ, Phillips PPJ, Meredith SK, Chiang CY, Conradie F, Dalai D, et al. A trial of a shorter regimen for rifampin-resistant tuberculosis. N Engl J Med. 2019;380(13):1201–13.
Tang S, Yao L, Hao X, Liu Y, Zeng L, Liu G, et al. Clofazimine for the treatment of multidrug-resistant tuberculosis: prospective, multicenter, randomized controlled study in China. Clin Infect Dis. 2015;60(9):1361–7.
Duan H, Chen X, Li Z, Pang Y, Jing W, Liu P, et al. Clofazimine improves clinical outcomes in multidrug-resistant tuberculosis: a randomized controlled trial. Clin Microbiol Infect. 2019;25(2):190–5.
Garcia-Prats AJ, Frias M, van der Laan L, De Leon A, Gler MT, Schaaf HS, et al. Delamanid added to an optimized background regimen in children with multidrug-resistant tuberculosis: results of a Phase I/II clinical trial. Antimicrob Agents Chemother. 2022;66(5):e0214421.
von Groote-Bidlingmaier F, Patientia R, Sanchez E, Balanag V, Ticona E, Segura P, et al. Efficacy and safety of delamanid in combination with an optimised background regimen for treatment of multidrug-resistant tuberculosis: a multicentre, randomised, double-blind, placebo-controlled, parallel group phase 3 trial. Lancet Respir Med. 2019;7(3):249–59.
Yao G, Zhu M, Nie Q, Chen N, Tu S, Zhou Y, et al. Improved outcomes following addition of bedaquiline and clofazimine to a treatment regimen for multidrug-resistant tuberculosis. J Int Med Res. 2023;51(1):3000605221148416.
Diacon AH, Pym A, Grobusch MP, de los Rios JM, Gotuzzo E, Vasilyeva I, et al. Multidrug-resistant tuberculosis and culture conversion with bedaquiline. N Engl J Med. 2014;371(8):723–32.
Song Y, Shu W, Pei Y, Du J, Wu G, Wang H, et al. Nine months of bedaquiline, linezolid, levofloxacin, clofazimine, and cycloserine chemotherapy for rifampicin/multidrug-resistant tuberculosis: a multicenter, randomized, open-label non-inferiority trial in China. BMC Med. 2024;22(1):465.
Dooley KE, Rosenkranz SL, Conradie F, Moran L, Hafner R, von Groote-Bidlingmaier F, et al. QT effects of bedaquiline, delamanid, or both in patients with rifampicin-resistant tuberculosis: a phase 2, open-label, randomised, controlled trial. Lancet Infect Dis. 2021;21(7):975–83.
Nyang’wa BT, Berry C, Kazounis E, Motta I, Parpieva N, Tigay Z, et al. Short oral regimens for pulmonary rifampicin-resistant tuberculosis (TB-PRACTECAL): an open-label, randomised, controlled, phase 2B-3, multi-arm, multicentre, non-inferiority trial. Lancet Respir Med. 2024;12(2):117–28.
Du Y, Qiu C, Chen X, Wang J, Jing W, Pan H, et al. Treatment outcome of a shorter regimen containing clofazimine for multidrug-resistant tuberculosis: a randomized control trial in China. Clin Infect Dis. 2020;71(4):1047–54.
Hassane-Harouna S, Cherif GF, Ortuno-Gutierrez N, Cisse D, Camara LM, Diallo BD, et al. Better programmatic outcome with the shorter regimen for the treatment of multidrug-resistant tuberculosis (MDR-TB) in Guinea: a retrospective cohort study. PLoS ONE. 2020;15(8):e0237355.
Mleoh L, Mziray SR, Tsere D, Koppelaar I, Mulder C, Lyakurwa D. Shorter regimens improved treatment outcomes of multidrug-resistant tuberculosis patients in Tanzania in 2018 cohort. Trop Med Int Health. 2023;28(5):357–66.
Mok J, Lee M, Kim DK, Kim JS, Jhun BW, Jo KW, et al. 9 months of delamanid, linezolid, levofloxacin, and pyrazinamide versus conventional therapy for fluoroquinolone-sensitive multidrug-resistant tuberculosis (MDR-END): a multicentre, randomised, open-label phase 2/3 non-inferiority trial in South Korea. Lancet. 2018;400(10362):1522–30.
Ronnachit D, Cros DP, Khamraev A, Lister D, Ronnachit A, Berry C, et al. Comparing shorter with conventional MDR-TB treatment in Uzbekistan: 2-month culture-conversion rates and treatment outcomes. F1000Research. 2017;6:913.
Myemba DT, Bwire GM, Sambayi G, Maganda BA, Njiro BJ, Ndumwa HP, et al. Clinical characteristics and treatment outcomes of patients with MDR tuberculosis in Dar Es Salaam region, Tanzania. JAC Antimicrob Resist. 2020;2(4):dlaa108.
Wahid A, Ghafoor A, Khan AW, Al-Worafi YM, Latif A, Shahwani NA, et al. Comparative effectiveness of individualized longer and standardized shorter regimens in the treatment of multidrug resistant tuberculosis in a high burden country. Front Pharmacol. 2022;13:973713.
Zhdanova E, Goncharova O, Davtyan H, Alaverdyan S, Sargsyan A, Harries AD, et al. 9-12 months short treatment for patients with MDR-TB increases treatment success in Kyrgyzstan. J Infect Dev Ctries. 2021;15(9.1):66S–74S.

The relationship between family support factors and substance abuse relapse: an updated literature review

2025-03-02T02:14:14-08:00

Current global data indicate that 296 million individuals engage in drug abuse, representing an increase of 12 million compared to previous figures. In Indonesia, the prevalence was 1.73%, with 173 individuals having used drugs in the past year. This study aimed to examine the supportive factors and challenges faced by substance abusers in overcoming dependence, achieving abstinence, and preventing relapse, focusing on resilience, self-esteem, and family functioning. This study employed a literature review methodology. Literature sources were identified using search engines through electronic media, including Google Scholar, PubMed, and ScienceDirect, covering publications from 2014 to 2024. The selected articles were assessed and evaluated based on predefined inclusion criteria, resulting in a final selection of 20 articles relevant to the topic. The findings indicate that the risk of relapse can be minimized with strong social support, especially from family members, which increases self-efficacy and resilience, thereby strengthening commitment to treatment. Therefore, intervention strategies that focus on improving family dynamics, strengthening self-esteem, and enhancing resilience are essential to facilitate sustainable recovery for individuals with substance use disorders. Family support has a positive impact on reducing the likelihood of relapsing in substance abusers. This article also compared similar findings from previous studies and presented the latest expert opinions supporting the importance of family communication in drug prevention. Adequate family support, in the form of communication and emotional support, can increase the resilience of substance users, thereby minimizing the risk of relapse in substance abuse.

DOI : 10.35990/amhs.v3n3.p163-177

REFERENCES

National Survey on Drug Abuse. 2023.
Fatseas M, Kervran C, Auriacombe M. Troubles du sommeil et addictions: Impact sur la qualité de vie et le risque de rechute. Presse Medicale. 2016;45:1164–9.
Lopes-Rosa R, Kessler FP, Pianca TG, Guimarães L, Ferronato P, Pagnussat E, et al. Predictors of early relapse among adolescent crack users. J Addict Dis. 2017;36(2):136–43.
Andersson HW, Wenaas M, Nordfjærn T. Relapse after inpatient substance use treatment: A prospective cohort study among users of illicit substances. Addict Behav. 2019;90:222–8.
Kabisa E, Biracyaza E, Habagusenga J d’Amour, Umubyeyi A. Determinants and prevalence of relapse among patients with substance use disorders: Case of Icyizere Psychotherapeutic Centre. Subst Abuse Treat Prev Policy. 2021;16(1).
Perwita Sari A, Umbul Wahyuni C, Wibowo A. Social support and substance abuse relapse. Health Notions. 2018;2(1). Available from: http://heanoti.com/index.php/hn/article/view/hn20112
Nikmanesh Z, Baluchi MH, Motlagh AAP. The role of self-efficacy beliefs and social support on prediction of addiction relapse. Int J High Risk Behav Addict. 2017;6(1).
Stevens E, Jason LA, Ram D, Light J. Investigating social support and network relationships in substance use disorder recovery. Subst Abus. 2015;36(4):396–9.
Atadokht A, Hajloo N, Karimi M, Narimani M. The role of family expressed emotion and perceived social support in predicting addiction relapse. Int J High Risk Behav Addict. 2015;4(1).
Torrecillas FL. Predictive capacity of self-efficacy in drug dependence and substance abuse treatment. J Psychol Clin Psychiatry. 2015;2(3).
American Addiction Center. Addiction relapse: Risk factors, coping & treatment options. 2024.
Wang YJ, Tang SS, Chen GD, Xia JH, Wang LN, Zhang H Le. Effect of family intervention on relapse rate of Chinese patients with alcohol dependence. Front Public Health. 2024;12.
Venkateswaran S, Thirumalai R. A follow-up study on coping strategies and its association with relapse among alcohol-dependent patients. Indian J Psychol Med. 2024;46(3):245–52.
Jan F, Iqbal N, Wasif S, Hassan B, Mushtaq R. Family functioning and relapse among drug addicts: Mediating role of psychological capital. Pak J Psychol Res. 2023;38(4):579–91.
Mardani M, Alipour F, Rafiey H, Fallahi-Khoshknab M, Arshi M. Challenges in addiction-affected families: A systematic review of qualitative studies. BMC Psychiatry. 2023;23(1).
Mohd Ghazalli FS, Ramly AF. Readiness of families to support a community-based drug rehabilitation program: A case study in Terengganu. Int J Acad Res Bus Soc Sci. 2023;13(12).
Liu L, Meng W, Liu B. The mediating role of social support in the relationship between parenting styles and adolescent drug abuse identification. Front Psychol. 2022;12.
Singh R, Goyal E, Chaudhury S, Puria A, Kumar S, Kumar A. Psychiatric morbidity in family members of alcohol dependence patients. Ind Psychiatry J. 2022;31(2):306–12.
Hong P, Li S, Yu Y, Deng Q. How to enhance the motivation for drug detoxification: Consciousness guidance and behaviour restriction of family intergenerational ethics. Int J Environ Res Public Health. 2022;19(1).
Rathinam B, Ezhumalai S. Resilience among abstinent individuals with substance use disorder.
Zeng X, Lu M, Chen M. The relationship between family intimacy and relapse tendency among people who use drugs: A moderated mediation model. Subst Abuse Treat Prev Policy. 2021;16(1).
Nawi AM, Ismail R, Ibrahim F, Hassan MR, Manaf MRA, Amit N, et al. Risk and protective factors of drug abuse among adolescents: A systematic review. BMC Public Health. 2021;21(1).
Lee SB, Chung S, Seo JS, Jung WM, Park IH. Socioeconomic resources and quality of life in alcohol use disorder patients: The mediating effects of social support and depression. Subst Abuse Treat Prev Policy. 2020;15(1).
Sarmawati, Ghozali MH. Literature review: Hubungan antara dukungan keluarga dengan kepatuhan pengguna narkoba menjalani therapeutic community. Vol. 2.
Kang SK, Kim HJ, Shin S. A qualitative case study on recovery and personal growth in Korean drug addicts. J Soc Serv Res. 2018;44(3):279–90.
Park GH, Choi YJ. Family stress and coping from hospitalization of clients with severe alcohol use disorder in Korea. J Addict Nurs. 2017;28(1):4–10.
Asmoro DS, Melaniani S. Pengaruh lingkungan keluarga terhadap penyalahgunaan NAPZA pada remaja. Kesehatan Masyarakat Universitas Airlangga.
Nasution J, Marliyah Z. The impact of drug abuse on social and family economics in the perspective of Sharia economics (Case Study at Baitu Syifa Drug Rehabilitation Institution in Medan). EKOMBIS Review. 2024;12(1):12. Available from: https://jurnal.unived.ac.id/index.php/er
Xia Y, Gong Y, Wang H, Li S, Mao F. Family function impacts relapse tendency in substance use disorder: Mediated through self-esteem and resilience. Front Psychiatry. 2022;13.
Zeng X, Tan C. The relationship between family functioning of individuals with drug addiction and relapse tendency: A moderated mediation model. Int J Environ Res Public Health. 2021;18(2):1–12.
Afaf SN. Factors associated with relapse for patients with substance use disorder: An integrative review. NeuroQuantology. 2022;20(7):2974–82. Available from: www.neuroquantology.com
Senormanci G, Esmen E, Turan C, Senormanci O. Evaluation of resilience, quality of life, and depression in family members of alcohol or substance dependent patients. Dusunen Adam. 2019;32(4):320–7.
Tarantino N, Lamis DA, Ballard ED, Masuda A, Dvorak RD. Parent-child conflict and drug use in college women: A moderated mediation model of self-control and mindfulness. J Couns Psychol. 2015;62(2):303–13.
Xie Q, Bi T, Du Y, Kou H, Yang B. Childhood maltreatment is associated with aggression among male juvenile delinquents in China: The mediating effects of callous-unemotional traits and self-control. Front Psychol. 2020;11.
Tomori C, Go VF, Tuan LN, Huong NM, Binh NT, Zelaya CE, et al. “In their perception we are addicts”: Social vulnerabilities and sources of support for men released from drug treatment centers in Vietnam. Int J Drug Policy. 2014;25(5):897–904.
Ramsewak S, Putteeraj M, Somanah J. Exploring substance use disorders and relapse in Mauritian male addicts. Heliyon. 2020;6(8).
Taplin C, Saddichha S, Li K, Krausz MR. Family history of alcohol and drug abuse, childhood trauma, and age of first drug injection. Subst Use Misuse. 2014;49(10):1311–6.
Rogers CJ, Forster M, Sussman S, Steinberg J, Barrington-Trimis JL, Grigsby TJ, et al. The impact of childhood trauma on problematic alcohol and drug use trajectories and the moderating role of social support. Int J Environ Res Public Health. 2023;20(4).
Incerti L, Henderson-Wilson C, Dunn M. Challenges in the family: Problematic substance use and sibling relationships. Int J Qual Stud Health Well-being. 2014.
Lindeman SK, Selseng LB, Lorås L, Løberg AH. Living with sibling's drug use: Bereaved siblings’ family stories. Int J Qual Stud Health Well-being. 2023;18(1).
Studi P, Komunikasi I, Dakwah F, Komunikasi D, Ampel S, Yani Sja, et al. Komunikasi interpersonal rehabilitasi pecandu narkoba di Malang. J Ilmu Komunikasi. 2020;10(1). Available from: http://jurnalfdk.uinsby.ac.id/index.php/jik
Massey SH, Newmark RL, Wakschlag LS. Explicating the role of empathic processes in substance use disorders: A conceptual framework and research agenda. Drug Alcohol Rev. 2018;37:316–32.
Shehata MH, Ebrahim SN. Effectiveness of strengthening resilience training program on patients with substance abuse. IOSR J Nurs Health Sci. 8(3):63–72.
Calpe-López C, Martínez-Caballero MA, García-Pardo MP, Aguilar MA. Resilience to the effects of social stress on vulnerability to developing drug addiction. World J Psychiatry. 2022;12(1):24–58.
Blain-Arcaro C, Vaillancourt T. Longitudinal associations between depression and aggression in children and adolescents. J Abnorm Child Psychol. 2017;45(5):959–70.
Dallas JC, Jullamate P, Vatanasin D, Moungkum S, Nadarajan S, Krungkraipetch N. Resilience and influencing factors among youths undergoing substance abuse treatment in Thailand: A cross-sectional study. SAGE Open Nurs. 2023;9.

Efficacy safety of chemoprophylactic plasmodium falciparum and sporozoite vaccines for malaria prevention: a systematic review and meta- analysis

2025-03-02T02:30:47-08:00

PfSPZ-CVac, an innovative vaccine, aims to combat malaria by using live, weakened Plasmodium falciparum sporozoites in combination with chloroquine. This approach employs the whole parasite, triggering a strong immune response and potentially providing long-term protection. The objective of this study is to assess the efficacy and safety of the PfSPZ- Chemoprophylaxis Vaccine (PfSPZ-CVac) for malaria prevention. A systematic review following PRISMA guidelines was conducted, focusing on randomized controlled trials (RCTs) that assessed the efficacy and safety of the vaccine. Seven eligible studies were selected from eight electronic databases. The quality was assessed using the Cochrane Risk of Bias tool, and data analysis was performed using Review Manager 5.4. PfSPZ-CVac combines live sporozoites with chloroquine, which prevents the parasite from entering the liver and enhance the body’s immune response, particularly T-cell activation, to provide long- lasting protection against malaria. The meta-analysis revealed a significant reduction in parasitemia (P<0.00001, I²=35%, MD=0.38). Local solicited adverse events did not show a significant increase (MD=0.73, P=0.45, I²=0%). Similarly, systemic solicited adverse events and unsolicited adverse events demonstrated minimal risks (MD=0.89, P=0.56, I²=23%; MD=0.65, P=0.20, I²=0%). Although PfSPZ-CVac exhibits high efficacy, its administration is complex, and it carries a slight of rare adverse reactions. PfSPZ-CVac demonstrates potential for providing strong, long-term protection against malaria , with a positive safety profile, making it a promising candidate for widespread use in high-transmission regions.

DOI : 10.35990/amhs.v3n3.p178-189

REFERENCES

World Health Organization. World malaria report 2022 [Internet]. Geneva: WHO; 2022 [cited 2023 Mar 5]. Available from: https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2022.
World Health Organization. Malaria [Internet]. WHO; 2023 [cited 2023 Mar 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/malaria.
Berman J. Chemotherapy against malaria. Br Med Bull. 2000;54(2):459–70. https://doi.org/10.1258/0007142001903250.
Cowman AF, Healer J, Marapana D, Marsh K. Malaria: Biology and disease. Cell. 2016;167(3):610–24. https://doi.org/10.1016/j.cell.2016.07.055.
RTS,S Clinical Trials Partnership. Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: Final results of a phase 3, individually randomised, controlled trial. Lancet. 2015;386(9988):31–45. https://doi.org/10.1016/S0140-6736(15)60721-8.
Ghana Health Service. Ghana becomes first country to approve malaria vaccine [Internet]. Accra: GHS; 2023 [cited 2023 Apr 1]. Available from: https://www.ghanahealthservice.org.
Laurens MB. RTS,S/AS01 vaccine (Mosquirix™): An overview. Hum Vaccin Immunother. 2020;16(3):480–9. https://doi.org/10.1080/21645515.2019.1669415.
World Health Organization. WHO recommends groundbreaking malaria vaccine for children at risk [Internet]. WHO; 2021 [cited 2023 Mar 6]. Available from: https://www.who.int/news/item/06-10-2021-who-recommends-groundbreaking-malaria-vaccine-for-children-at-risk.
Programme for Immunization. WHO recommends the R21/Matrix-M malaria vaccine [Internet]. WHO; 2023 [cited 2023 Apr 1]. Available from: https://www.who.int/news/item/02-10-2023-who-recommends-r21-matrix-m-malaria-vaccine.
Datoo MS, Natama HM, Somé A, Traoré O, Rouamba T, Bellamy D, et al. Efficacy of a low-dose candidate malaria vaccine, R21 in adjuvant Matrix-M, with seasonal administration to children in Burkina Faso: A randomised controlled trial. Lancet. 2021;397(10287):1809–18. https://doi.org/10.1016/S0140-6736(21)00943-0.
gov. Study to evaluate efficacy, immunogenicity and safety of the R21/Matrix-M vaccine (MAL-ED) [Internet]. 2023 [cited 2023 Apr 2]. Available from: https://clinicaltrials.gov/ct2/show/NCT04868604.
Mahamar A, Issiaka D, Barry A, Kone DT, Traore F, Sissoko M, et al. Safety and immunogenicity of the R21/Matrix-M malaria vaccine administered seasonally in children in Mali: A randomised, controlled, phase 1/2 trial. Lancet Infect Dis. 2022;22(4):590–8. https://doi.org/10.1016/S1473-3099(21)00559-1.
University of Oxford. R21/Matrix-M vaccine shows high-level efficacy of 77% over 12 months of follow-up [Internet]. Oxford; 2022 [cited 2023 Apr 2]. Available from: https://www.ox.ac.uk/news/2022-09-07.
R21/Matrix-M malaria vaccine receives WHO recommendation [Internet]. UNICEF; 2023 [cited 2023 Apr 2]. Available from: https://www.unicef.org.
World Health Organization. R21/Matrix-M malaria vaccine: WHO recommendation [Internet]. WHO; 2023 [cited 2023 Apr 3]. Available from: https://www.who.int/publications/i/item/9789240072056.
Malaria vaccine implementation programme (MVIP) [Internet]. PATH; 2022 [cited 2023 Apr 3]. Available from: https://www.path.org/resources/malaria-vaccine-implementation-programme-mvip.
Agnandji ST, Lell B, Fernandes JF, Abossolo BP, Methogo BG, Kabwende AL, et al. A phase 3 trial of RTS,S/AS01 malaria vaccine in African infants. N Engl J Med. 2011;365(20):1863–75. https://doi.org/10.1056/NEJMoa1102287.
Otieno L, Akhwale W, Nzila A, Hunt R, Ochola S, Tetteh KKA, et al. Protective efficacy of RTS,S/AS01 malaria vaccine in children 5 to 17 months of age in Kenya and Tanzania: A phase 3, randomized, controlled trial. Lancet Infect Dis. 2016;16(11):1339–48. https://doi.org/10.1016/S1473-3099(16)30227-3.
Olotu A, Fegan G, Wambua J, Nyangweso G, Leach A, Lievens M, et al. Seven-year efficacy of RTS,S/AS01 malaria vaccine among young African children. N Engl J Med. 2016;374(26):2519–29. https://doi.org/10.1056/NEJMoa1515257.
White MT, Verity R, Griffin JT, Asante KP, Owusu-Agyei S, Greenwood B, et al. Immunogenicity of the RTS,S/AS01 malaria vaccine and implications for duration of vaccine efficacy: Secondary analysis of data from a phase 3 randomised controlled trial. Lancet Infect Dis. 2015;15(12):1450–8. https://doi.org/10.1016/S1473-3099(15)00239-X.
Penny MA, Verity R, Bever CA, Galactionova K, Flasche S, White MT, et al. Public health impact and cost-effectiveness of the RTS,S/AS01 malaria vaccine: A systematic comparison of predictions from four mathematical models. Lancet. 2016;387(10016):367–75. https://doi.org/10.1016/S0140-6736(15)00725-4.
Ehreth J. The global value of vaccination. Vaccine. 2003;21(7–8):596–600. https://doi.org/10.1016/S0264-410X(02)00623-0.
Vaccine investment strategy [Internet]. Gavi, the Vaccine Alliance; 2023 [cited 2023 Apr 3]. Available from: https://www.gavi.org.
Advancing the malaria vaccine pipeline [Internet]. PATH; 2022 [cited 2023 Apr 3]. Available from: https://www.path.org/articles/advancing-malaria-vaccine-pipeline.
United Nations. Goal 3: Ensure healthy lives and promote well-being for all at all ages [Internet]. UN; 2022 [cited 2023 Apr 3]. Available from: https://sdgs.un.org/goals/goal3.
The Global Fund. Malaria and the global fund [Internet]. 2023 [cited 2023 Apr 3]. Available from: https://www.theglobalfund.org/en/malaria.
European Medicines Agency. First malaria vaccine receives positive scientific opinion from EMA [Internet]. EMA; 2015 [cited 2023 Apr 4]. Available from: https://www.ema.europa.eu/en/news.
UNICEF Supply Division. Vaccine procurement and delivery [Internet]. UNICEF; 2022 [cited 2023 Apr 4]. Available from: https://www.unicef.org/supply.
Bill & Melinda Gates Foundation. Malaria strategy overview [Internet]. Gates Foundation; 2023 [cited 2023 Apr 4]. Available from: https://www.gatesfoundation.org.
Malaria: Developing better prevention and treatment [Internet]. Wellcome Trust; 2023 [cited 2023 Apr 4]. Available from: https://wellcome.org/what-we-do/our-work/malaria.
What is the malaria vaccine pipeline? [Internet]. PATH; 2023 [cited 2023 Apr 4]. Available from: https://www.path.org/articles.
RTS,S Clinical Trials Partnership. Long-term safety and efficacy of RTS,S/AS01 malaria vaccine in African infants and children: An open-label 4-year extension study of a phase 3 randomized controlled trial. Lancet Infect Dis. 2021;21(10):1404–16. https://doi.org/10.1016/S1473-3099(20)30779-8.
Datoo MS, Natama HM, Somé A, Traoré O, Rouamba T, Bellamy D, et al. Efficacy of the R21/Matrix-M malaria vaccine with seasonal administration in children in Burkina Faso: A double-blind, randomized, controlled trial. Lancet Infect Dis. 2023;23(1):1–10. https://doi.org/10.1016/S1473-3099(22)00541-X.
WHO Strategic Advisory Group of Experts on Immunization. WHO SAGE roadmap for prioritizing uses of malaria vaccines [Internet]. WHO; 2022 [cited 2023 Apr 4]. Available from: https://www.who.int/publications.
Deeks JJ, Higgins JPT, Altman DG, editors. Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane; 2021. Available from: training.cochrane.org/handbook.
Mordmüller B, Surat G, Lagler H, et al. Sterile protection against human malaria by chemoattenuated PfSPZ vaccine. Nature. 2017;542:445–60. https://doi.org/10.1038/nature21060.
Camponovo F, Campo JJ, Le TQ, Oberai A, Hung C, Pablo JV, et al. Proteome-wide analysis of a malaria vaccine study reveals personalized humoral immune profiles in Tanzanian adults. eLife. 2020;9:e53080. https://doi.org/10.7554/eLife.53080.
Skelly CL, Cassagnol M, Munakomi S. Adverse effects of vaccines. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Apr 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538239/.
Ibanez J, Fendel R, Lorenz FR, et al. Efficacy, T cell activation and antibody responses in accelerated Plasmodium falciparum sporozoite chemoprophylaxis vaccine regimens. NPJ Vaccines. 2022;7:59. https://doi.org/10.1038/s41541-022-00473-1.
Healy SA, Murphy SC, Hume JCC, Shelton L, Kuntz S, Voorhis WCV, et al. Chemoprophylaxis vaccination: Phase I study to explore stage-specific immunity to Plasmodium falciparum in US adults. Clin Infect Dis. 2020;71(6):1481–90. https://doi.org/10.1093/cid/ciz1010.
Mwakingwe-Omari A, Healy SA, Lane J, et al. Two chemoattenuated PfSPZ malaria vaccines induce sterile hepatic immunity. Nature. 2021;595:289–94. https://doi.org/10.1038/s41586-021-03684-z.
Sulyok Z, Fendel R, Eder B, et al. Heterologous protection against malaria by a simple chemoattenuated PfSPZ vaccine regimen in a randomized trial. Nat Commun. 2021;12:2518. https://doi.org/10.1038/s41467-021-22740-w.
Jongo SA, Urbano V, Church LWP, Olotu A, Manock SR, Schindler T, Mtoro A, et al. Immunogenicity and protective efficacy of radiation-attenuated and chemo-attenuated PfSPZ vaccines in Equatoguinean adults. Am J Trop Med Hyg. 2021;104(1):283–93. https://doi.org/10.4269/ajtmh.20-0435.