In vivo efficacy and safety of artemetherlumefantrine and amodiaquineartesunate for uncomplicated Plasmodium falciparum malaria in Mozambique, 2018
Malar. j. (Online)
; 20(390): 1-12, 2021. Mapas, Tab.
Article
em En
| AIM, RSDM
| ID: biblio-1352541
Biblioteca responsável:
MZ1.1
ABSTRACT
Background:
Artemisinin-based combination therapy (ACT) has been the recommended first-line treatment for uncomplicated malaria in Mozambique since 2006, with artemetherlumefantrine (AL) and amodiaquineartesunate (ASAQ) as the first choice. To assess efficacy of currently used ACT, an in vivo therapeutic efficacy study was conducted.Methods:
The study was conducted in four sentinel sites Montepuez, Moatize, Mopeia and Massinga. Patients between 6 and 59 months old with uncomplicated Plasmodium falciparum malaria (2000200,000 parasites/µl) were enrolled between February and September of 2018, assigned to either an AL or ASAQ treatment arm, and monitored for 28 days. A Bayesian algorithm was applied to differentiate recrudescence from new infection using genotyping data of seven neutral microsatellites. Uncorrected and PCR-corrected efficacy results at day 28 were calculated.Results:
Totals of 368 and 273 patients were enrolled in the AL and ASAQ arms, respectively. Of these, 9.5% (35/368) and 5.1% (14/273) were lost to follow-up in the AL and ASAQ arms, respectively. There were 48 and 3 recurrent malaria infections (late clinical and late parasitological failures) in the AL and ASAQ arms, respectively. The day 28 uncorrected efficacy was 85.6% (95% confidence interval (CI) 81.389.2%) for AL and 98.8% (95% CI 96.799.8%) for ASAQ, whereas day 28 PCR-corrected efficacy was 97.9% (95% CI 95.699.2%) for AL and 99.6% (95% CI 97.9100%) for ASAQ. Molecular testing confirmed that 87.4% (42/48) and 33.3% (1/3) of participants with a recurrent malaria infection in the AL and ASAQ arms were new infections; an expected finding in a high malaria transmission area. Adverse events were documented in less than 2% of participants for both drugs.Conclusion:
Both AL and ASAQ have therapeutic efficacies well above the 90% WHO recommended threshold and remain well-tolerated in Mozambique. Routine monitoring of therapeutic efficacy should continue to ensure the treatments remain efficacious.
Texto completo:
1
Base de dados:
AIM
/
RSDM
Assunto principal:
Malária Falciparum
/
Malária
Tipo de estudo:
Diagnostic_studies
Limite:
Child, preschool
País como assunto:
Africa
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article