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1.
Antimicrob Agents Chemother ; 65(8): e0087321, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34060901

RESUMO

A recent randomized controlled trial, the WANECAM (West African Network for Clinical Trials of Antimalarial Drugs) trial, conducted at seven centers in West Africa, found that artemether-lumefantrine, artesunate-amodiaquine, pyronaridine-artesunate, and dihydroartemisinin-piperaquine all displayed good efficacy. However, artemether-lumefantrine was associated with a shorter interval between clinical episodes than the other regimens. In a further comparison of these therapies, we identified cases of persisting submicroscopic parasitemia by quantitative PCR (qPCR) at 72 h posttreatment among WANECAM participants from 5 sites in Mali and Burkina Faso, and we compared treatment outcomes for this group to those with complete parasite clearance by 72 h. Among 552 evaluable patients, 17.7% had qPCR-detectable parasitemia at 72 h during their first treatment episode. This proportion varied among sites, reflecting differences in malaria transmission intensity, but did not differ among pooled drug treatment groups. However, patients who received artemether-lumefantrine and were qPCR positive at 72 h were significantly more likely to have microscopically detectable recurrent Plasmodium falciparum parasitemia by day 42 than those receiving other regimens and experienced, on average, a shorter interval before the next clinical episode. Haplotypes of pfcrt and pfmdr1 were also evaluated in persisting parasites. These data identify a possible threat to the parasitological efficacy of artemether-lumefantrine in West Africa, over a decade since it was first introduced on a large scale.


Assuntos
Antimaláricos , Malária Falciparum , Antimaláricos/uso terapêutico , Artemeter/uso terapêutico , Combinação Arteméter e Lumefantrina , Burkina Faso , Combinação de Medicamentos , Etanolaminas/uso terapêutico , Humanos , Malária Falciparum/tratamento farmacológico , Mali , Parasitemia/tratamento farmacológico , Plasmodium falciparum/genética , Falha de Tratamento
2.
Pan Afr Med J ; 35: 68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32537072

RESUMO

INTRODUCTION: Artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) are the first line therapy of uncomplicated malaria in Burkina Faso. We assessed the treatment efficacy, tolerability of these drugs 11 years following its adoption as first line treatment. METHODS: In this opened randomized controlled trial carried out in 2016, participants with age over 6 months who consented to participate were randomly assigned treatment with artemether-lumefantrine or artesunate-amodiaquine and followed up for 28 days. Primary endpoint was the treatment efficacy over 28 days of follow up unadjusted by Polymerase chain reaction (PCR). RESULTS: Two hundred and eighty-one (281) participants were enrolled and the completion rate was 92.9%. No early treatment failure was found. Adequate clinical and parasitological responses were significantly higher in artesunate-amodiaquine group (97% versus 85.2%, p = 0.0008). On day 28, the risk of failure was 4 times higher in AL group 20.14%, 95% CI (13-30.47) against 5.16%, 95% CI (1.91-13.54) in ASAQ group. All treatments had a similar and good tolerability profile. CONCLUSION: Eleven years following artemether-lumefantrine and artesunate-amodiaquine adoption as first line therapy for uncomplicated malaria in Burkina Faso, artemether-lumefantrine retained fairly good efficacy even though its efficacy fell below WHO threshold of 90% considering uncorrected outcome.


Assuntos
Amodiaquina/administração & dosagem , Antimaláricos/administração & dosagem , Combinação Arteméter e Lumefantrina/administração & dosagem , Artemisininas/administração & dosagem , Malária/tratamento farmacológico , Adolescente , Amodiaquina/efeitos adversos , Antimaláricos/efeitos adversos , Combinação Arteméter e Lumefantrina/efeitos adversos , Artemisininas/efeitos adversos , Burkina Faso , Criança , Pré-Escolar , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Lactente , Masculino , Reação em Cadeia da Polimerase , Falha de Tratamento , Resultado do Tratamento
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