Effectiveness and safety of 3 and 5 day courses of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in an area of emerging artemisinin resistance in Myanmar

Malaria Journal
Kyaw Myo TunFrank M Smithuis

Abstract

Artemisinin resistance in Plasmodium falciparum has emerged and spread in Southeast Asia. In areas where resistance is established longer courses of artemisinin-based combination therapy have improved cure rates. The standard 3-day course of artemether-lumefantrine (AL) was compared with an extended 5-day regimen for the treatment of uncomplicated falciparum malaria in Kayin state in South-East Myanmar, an area of emerging artemisinin resistance. Late parasite clearance dynamics were described by microscopy and quantitative ultra-sensitive PCR. Patients were followed up for 42 days. Of 154 patients recruited (105 adults and 49 children < 14 years) 78 were randomized to 3 days and 76 to 5 days AL. Mutations in the P. falciparum kelch13 propeller gene (k13) were found in 46% (70/152) of infections, with F446I the most prevalent propeller mutation (29%; 20/70). Both regimens were well-tolerated. Parasite clearance profiles were biphasic with a slower submicroscopic phase which was similar in k13 wild-type and mutant infections. The cure rates were 100% (70/70) and 97% (68/70) in the 3- and 5-day arms respectively. Genotyping of the two recurrences was unsuccessful. Despite a high prevalence of k13 mutations, the current first-line...Continue Reading

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Citations

Oct 24, 2019·The American Journal of Tropical Medicine and Hygiene·Matthew R Hassett, Paul D Roepe
Feb 6, 2019·Tropical Medicine and Infectious Disease·Christian Nsanzabana
Jan 25, 2021·Malaria Journal·Khalid A J Al Khaja, Reginald P Sequeira
Nov 9, 2019·Trends in Parasitology·Arthur M TalmanFrédéric Ariey
Aug 6, 2021·Expert Review of Anti-infective Therapy·Charlotte RasmussenPascal Ringwald
Jul 17, 2021·Current Opinion in Infectious Diseases·Mehul DhordaArjen M Dondorp

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Methods Mentioned

BETA
PCR
genotyping

Software Mentioned

GraphPad Prism
Stata14
Macro

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