Your browser doesn't support javascript.
loading
Efficacy of two versus three-day regimens of dihydroartemisinin-piperaquine for uncomplicated malaria in military personnel in northern Cambodia: an open-label randomized trial.
Lon, Chanthap; Manning, Jessica E; Vanachayangkul, Pattaraporn; So, Mary; Sea, Darapiseth; Se, Youry; Gosi, Panita; Lanteri, Charlotte; Chaorattanakawee, Suwanna; Sriwichai, Sabaithip; Chann, Soklyda; Kuntawunginn, Worachet; Buathong, Nillawan; Nou, Samon; Walsh, Douglas S; Tyner, Stuart D; Juliano, Jonathan J; Lin, Jessica; Spring, Michele; Bethell, Delia; Kaewkungwal, Jaranit; Tang, Douglas; Chuor, Char Meng; Satharath, Prom; Saunders, David.
Afiliação
  • Lon C; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia.
  • Manning JE; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
  • Vanachayangkul P; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
  • So M; Royal Cambodian Armed Forces, Phnom Penh, Cambodia.
  • Sea D; National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
  • Se Y; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia.
  • Gosi P; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
  • Lanteri C; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
  • Chaorattanakawee S; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
  • Sriwichai S; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
  • Chann S; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia.
  • Kuntawunginn W; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
  • Buathong N; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
  • Nou S; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia.
  • Walsh DS; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
  • Tyner SD; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
  • Juliano JJ; Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America.
  • Lin J; Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America.
  • Spring M; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
  • Bethell D; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
  • Kaewkungwal J; Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Mahidol University, Bangkok, Thailand.
  • Tang D; Fast Track Biologics, Potomac, Maryland, United States of America.
  • Chuor CM; National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia.
  • Satharath P; Royal Cambodian Armed Forces, Phnom Penh, Cambodia.
  • Saunders D; US Army Medical Component, Armed Forces Research Institute of Medical Sciences, Department of Immunology & Medicine, Bangkok, Thailand.
PLoS One ; 9(3): e93138, 2014.
Article em En | MEDLINE | ID: mdl-24667662
INTRODUCTION: Emerging antimalarial drug resistance in mobile populations remains a significant public health concern. We compared two regimens of dihydroartemisinin-piperaquine in military and civilians on the Thai-Cambodian border to evaluate national treatment policy. METHODS: Efficacy and safety of two and three-day regimens of dihydroartemisinin-piperaquine were compared as a nested open-label evaluation within a malaria cohort study in 222 otherwise healthy volunteers (18% malaria-infected at baseline). The first 80 volunteers with slide-confirmed Plasmodium falciparum or vivax malaria were randomized 1:1 to receive either regimen (total dose 360 mg dihydroartemisinin and 2880 mg piperaquine) and followed weekly for up to 6 months. The primary endpoint was malaria recurrence by day 42. Volunteers with vivax infection received primaquine at study discharge with six months follow-up. RESULTS: Eighty patients (60 vivax, 15 falciparum, and 5 mixed) were randomized to dihydroartemisinin-piperaquine. Intention-to-treat all-species efficacy at Day 42 was 85% for the two-day regimen (95% CI 69-94) and 90% for the three-day regimen (95% CI 75-97). PCR-adjusted falciparum efficacy was 75% in both groups with nearly half (45%) still parasitemic at Day 3. Plasma piperaquine levels were comparable to prior published reports, but on the day of recrudescence were below measurable in vitro piperaquine IC50 levels in all falciparum treatment failures. CONCLUSIONS: In the brief period since introduction of dihydroartemisinin-piperaquine, there is early evidence suggesting declining efficacy relative to previous reports. Parasite IC50 levels in excess of plasma piperaquine levels seen only in treatment failures raises concern for clinically significant piperaquine resistance in Cambodia. These findings warrant improved monitoring of clinical outcomes and follow-up, given few available alternative drugs. TRIAL REGISTRATION: ClinicalTrials.gov NCT01280162.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Quinolinas / Malária Vivax / Malária Falciparum / Artemisininas / Militares Tipo de estudo: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans / Male País como assunto: Asia Idioma: En Ano de publicação: 2014 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Quinolinas / Malária Vivax / Malária Falciparum / Artemisininas / Militares Tipo de estudo: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans / Male País como assunto: Asia Idioma: En Ano de publicação: 2014 Tipo de documento: Article