Efficacy and safety of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated Plasmodium falciparum malaria in Kenyan children aged less than five years: results of an open-label, randomized, single-centre study

Malaria Journal

Research

Douglas J Perkins¹  Edgar K Omondi²  Kevin O Onyango²  Nelly Koskei²  Elizabeth Juma³  Bernhards R Ogutu⁴  Lucas Otieno⁴  Godfrey A Otieno⁴  Charles Obonyo⁵  John M Ongecha⁵  Willis Akhwale⁶  Raymond Omollo⁷  Fredrick Eyase⁸  Jacob D Johnson⁸ 

[1] Center for Global Health, University of New Mexico, New Mexico, USA;Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya;Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya;Division of Malaria Control, Ministry of Public Health and Sanitation, Nairobi, Kenya;Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya;Walter Reed Project/Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya;Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya;Department of Disease Control and Prevention, Ministry of Public Health and Sanitation, Nairobi, Kenya;Drugs for Neglected Disease Initiative, Kenya Medical Research Institute, Nairobi, Kenya;Walter Reed Project/Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya;

关键词: Artemether-lumefantrine;    Dihydroartemisinin-piperaquine;    Plasmodium falciparum;   

DOI  :  10.1186/1475-2875-13-33

 received in 2013-08-13, accepted in 2014-01-07,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundThis open-label, randomized study evaluated efficacy and safety of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) in treatment of uncomplicated falciparum malaria in children below five years of age, to build evidence on use of AL as first-line treatment and DP as second-line treatment in Kenya.MethodsA total of 454 children aged six to 59 months with uncomplicated falciparum malaria were randomized (1:1) to receive AL dispersible or DP paediatric tablets and followed up for 42 days. Primary efficacy variable was corrected adequate clinical and parasitological response (ACPR) rate on day 28. Secondary variables included corrected (day 14, 28 and 42), uncorrected (day 3, 14, 28 and 42) cure rates, parasitological failure at days 3, 14 and 42. Acceptability and tolerability of both drugs were assessed by caregiver questionnaire.ResultsOn day 28, corrected ACPR rates for AL dispersible and DP paediatric were 97.8% (95% CI: 94.9-99.3) and 99.1% (95% CI: 96.8-99.9), respectively, in intention-to-treat population, with no significant treatment differences noted between AL dispersible and DP paediatric arms. Additionally, no significant differences were observed for PCR corrected cure rates on days 14 and ACPR on day 42 for AL dispersible (100%; 96.8%) and DP paediatric (100%; 98.7%). Similarly, for PCR uncorrected cure rates, no significant differences were seen on days 3, 14, 28, and 42 for AL dispersible (99.1%; 98.7%; 81.1%; 67.8%) and DP paediatric (100%; 100%; 87.7%; 70.5%). Parasite clearance was rapid, with approximately 90% clearance achieved in 40 hours in both treatment arms. Incidence of adverse events was related to underlying disease; malaria being reported in both treatment arms. One serious adverse event was noted in AL dispersible (0.42%) arm, not related to study drug. Adherence to treatment regimen was higher for children treated with AL dispersible (93.6%) compared to DP paediatric (85.6%). Acceptability of AL dispersible regimen was assessed as being significantly better than DP paediatric.ConclusionsAL and DP were both efficacious and well tolerated, and had similar effects at day 42 on risk of recurrent malaria. No signs of Plasmodium falciparum tolerance to artemisinins were noted.Trial registrationPACTR201111000316370.

【 授权许可】

CC BY   
© Ogutu et al.; licensee BioMed Central Ltd. 2014