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

Malaria Journal

Douglas Nace¹  Venkatachalam Udhayakumar¹  Leah F. Moriarty¹  Naomi W. Lucchi¹  Eric S. Halsey¹  Eldin Talundzic¹  Dragan Ljolje¹  Pharath Lim²  Halidou Sidibé³  Erin Eckert⁴  Dade Bouye Ben Haidara⁵  Donald J. Krogstad⁶  Jules Mihigo⁷  Celia J. Woodfill⁷  Lassina Doumbia⁸  Ousmane A. Koita⁸  Lansana Sangaré⁸  Mouctar Diallo⁸  Youssouf Diarra⁸  Oumar Koné⁸  Hamadoun A. Sango⁸  Ababacar Maiga⁸ 

[1] Malaria Branch, Centers for Disease Control and Prevention;Medical Care Development International;National Malaria Control Programme, Ministry of Health and Public Hygiene;RTI International;Referral Health Centre of Sélingué, Ministry of Health and Public Hygiene;Tulane School of Public Health and Tropical Medicine;U.S. President’s Malaria Initiative, USAID Office;University of Sciences, Techniques and Technologies of Bamako;

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

DOI  :  10.1186/s12936-021-03760-9

来源: DOAJ

【 摘 要 】

Abstract Background The 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. Methods Children 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. Results A 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. Conclusions The findings indicate that both AL and ASAQ remain effective for the treatment of uncomplicated malaria in Sélingué, Mali.

【 授权许可】

Unknown