Therapeutic efficacy of artemether–lumefantrine and artesunate–amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Mali, 2015–2016

Malaria Journal

Venkatachalam Udhayakumar¹  Dragan Ljolje¹  Eldin Talundzic¹  Douglas Nace¹  Naomi W. Lucchi¹  Eric S. Halsey²  Leah F. Moriarty²  Pharath Lim³  Halidou Sidibé⁴  Erin Eckert⁵  Dade Bouye Ben Haidara⁶  Donald J. Krogstad⁷  Jules Mihigo⁸  Celia J. Woodfill⁸  Ousmane A. Koita⁹  Lansana Sangaré⁹  Ababacar Maiga⁹  Mouctar Diallo⁹  Youssouf Diarra⁹  Hamadoun A. Sango⁹  Lassina Doumbia⁹  Oumar Koné⁹ 

[1] Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA;Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA;U.S. President’s Malaria Initiative, Atlanta, GA, USA;Medical Care Development International, Silver Spring, MD, USA;National Malaria Control Programme, Ministry of Health and Public Hygiene, Bamako, Mali;RTI International, Washington, DC, USA;Referral Health Centre of Sélingué, Ministry of Health and Public Hygiene, Bamako, Mali;Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA;U.S. President’s Malaria Initiative, USAID Office, Bamako, Mali;University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali;

关键词: Malaria;    Antimalarial resistance;    Efficacy;    Mali;    Artemether–lumefantrine;    Artesunate–amodiaquine;    Pfk13;    Pfcrt;    Pfmdr1;   

DOI  :  10.1186/s12936-021-03760-9

来源: Springer

【 摘 要 】

BackgroundThe current first-line treatments for uncomplicated malaria recommended by the National Malaria Control Programme in Mali are artemether–lumefantrine (AL) and artesunate–amodiaquine (ASAQ). From 2015 to 2016, an in vivo study was carried out to assess the clinical and parasitological responses to AL and ASAQ in Sélingué, Mali.MethodsChildren between 6 and 59 months of age with uncomplicated Plasmodium falciparum infection and 2000–200,000 asexual parasites/μL of blood were enrolled, randomly assigned to either AL or ASAQ, and followed up for 42 days. Uncorrected and PCR-corrected efficacy results at days 28 and 42. were calculated. Known markers of resistance in the Pfk13, Pfmdr1, and Pfcrt genes were assessed using Sanger sequencing.ResultsA total of 449 patients were enrolled: 225 in the AL group and 224 in the ASAQ group. Uncorrected efficacy at day 28 was 83.4% (95% CI 78.5–88.4%) in the AL arm and 93.1% (95% CI 89.7–96.5%) in the ASAQ arm. The per protocol PCR-corrected efficacy at day 28 was 91.0% (86.0–95.9%) in the AL arm and 97.1% (93.6–100%) in the ASAQ arm. ASAQ was significantly (p < 0.05) better than AL for each of the aforementioned efficacy outcomes. No mutations associated with artemisinin resistance were identified in the Pfk13 gene. Overall, for Pfmdr1, the N86 allele and the NFD haplotype were the most common. The NFD haplotype was significantly more prevalent in the post-treatment than in the pre-treatment isolates in the AL arm (p < 0.01) but not in the ASAQ arm. For Pfcrt, the CVIET haplotype was the most common.ConclusionsThe findings indicate that both AL and ASAQ remain effective for the treatment of uncomplicated malaria in Sélingué, Mali.

【 授权许可】

CC BY