Of 14 628 participants, 3935 received multiple DP courses (2–18). Monthly IPT-DP was associated with an 84% reduction in the incidence of malaria parasitaemia compared with placebo and with fewer serious adverse events than placebo, daily co-trimoxazole, or monthly sulfadoxine-pyrimethamine. In addition, of 56 IPT-DP recipients (26 children, 30 pregnant women) with cardiac parameters, all QTc intervals were within normal limits, with no significant increase in QTc prolongation with increasing courses of DP.
A commentary notes that although numbers are clearly insufficient to rule out risk of arrhythmias secondary to the potential QT prolongation, and the small number of carefully ECG monitored patients calls for caution and further cardio safety studies, this analysis adds up to the growing body of evidence supporting the potential of this drug for intermittent preventive treatment strategies as an alternative to the currently recommended drugs. In areas where transmission remains high, it may be prudent to restrict ACTs for the treatment of cases, and not overexpose this drug family for prophylactic purposes.
Currently in UK, DP is not licensed for more than two courses of treatment within a 12 month period; and a second course is not advised within 2 months after the first course due to the long elimination half-life of piperaquine.