BACKGROUND:Combination antimalarial therapy is advocated to improve treatment efficacy and limit selection of drug-resistant parasites. We compared the efficacies of 3 combination regimens in Bobo-Dioulasso, Burkina Faso: amodiaquine plus sulfadoxine-pyrimethamine, which was recently shown to be highly efficacious at this site; artemether-lumefantrine, the new national first-line antimalarial regimen; and dihydroartemisinin-piperaquine (DP), a newer regimen. METHODS: We enrolled 559 patients >or=6 months of age with uncomplicated Plasmodium falciparum malaria and randomized them to the 3 regimens. We analyzed the risk of recurrent parasitemia by day 28 and day 42, both unadjusted and adjusted by PCR methods to distinguish recrudescence and new infection. RESULTS: Complete data were available for 517 (92.5%) of the enrolled subjects. Early treatment failures occurred in 5 patients treated with amodiaquine plus sulfadoxine-pyrimethamine and in 2 patients each treated with the other regimens. The day 28 risk of recurrent parasitemia, unadjusted by genotyping, was significantly higher for patients receiving artemether-lumefantrine than for patients receiving amodiaquine plus sulfadoxine-pyrimethamine (20.1% vs. 6.2%; risk difference, 13.8%; 95% confidence interval, 7.0%-20.7%) or dihydroartemisinin-piperaquine (20.1% vs. 2.2%; risk difference, 17.9%; 95% confidence interval, 11.6%-24.1%). Similar differences were seen for children <5 years of age (54% of the study population) and when outcomes were extended to 42 days. Significant differences were not seen between outcomes for patients receiving amodiaquine plus sulfadoxine-pyrimethamine and outcomes for those receiving dihydroartemisinin-piperaquine. Recrudescences were uncommon (occurring in <5% of patients) in all treatment groups. No serious adverse events were noted. CONCLUSIONS: All regimens were highly efficacious in clearing infection, but considering the risks of recurrent malaria after therapy, the amodiaquine plus sulfadoxine-pyrimethamine and dihydroartemisinin-piperaquine regimens were more efficacious than the artemether-lumefantrine regimen (the new national regimen in Burkina Faso) for the treatment of uncomplicated P. falciparum malaria.
RCT Entities:
BACKGROUND: Combination antimalarial therapy is advocated to improve treatment efficacy and limit selection of drug-resistant parasites. We compared the efficacies of 3 combination regimens in Bobo-Dioulasso, Burkina Faso: amodiaquine plus sulfadoxine-pyrimethamine, which was recently shown to be highly efficacious at this site; artemether-lumefantrine, the new national first-line antimalarial regimen; and dihydroartemisinin-piperaquine (DP), a newer regimen. METHODS: We enrolled 559 patients >or=6 months of age with uncomplicated Plasmodium falciparum malaria and randomized them to the 3 regimens. We analyzed the risk of recurrent parasitemia by day 28 and day 42, both unadjusted and adjusted by PCR methods to distinguish recrudescence and new infection. RESULTS: Complete data were available for 517 (92.5%) of the enrolled subjects. Early treatment failures occurred in 5 patients treated with amodiaquine plus sulfadoxine-pyrimethamine and in 2 patients each treated with the other regimens. The day 28 risk of recurrent parasitemia, unadjusted by genotyping, was significantly higher for patients receiving artemether-lumefantrine than for patients receiving amodiaquine plus sulfadoxine-pyrimethamine (20.1% vs. 6.2%; risk difference, 13.8%; 95% confidence interval, 7.0%-20.7%) or dihydroartemisinin-piperaquine (20.1% vs. 2.2%; risk difference, 17.9%; 95% confidence interval, 11.6%-24.1%). Similar differences were seen for children <5 years of age (54% of the study population) and when outcomes were extended to 42 days. Significant differences were not seen between outcomes for patients receiving amodiaquine plus sulfadoxine-pyrimethamine and outcomes for those receiving dihydroartemisinin-piperaquine. Recrudescences were uncommon (occurring in <5% of patients) in all treatment groups. No serious adverse events were noted. CONCLUSIONS: All regimens were highly efficacious in clearing infection, but considering the risks of recurrent malaria after therapy, the amodiaquine plus sulfadoxine-pyrimethamine and dihydroartemisinin-piperaquine regimens were more efficacious than the artemether-lumefantrine regimen (the new national regimen in Burkina Faso) for the treatment of uncomplicated P. falciparum malaria.
Authors: Abel Kakuru; Prasanna Jagannathan; Emmanuel Arinaitwe; Humphrey Wanzira; Mary Muhindo; Victor Bigira; Emmanuel Osilo; Jaco Homsy; Moses R Kamya; Jordan W Tappero; Grant Dorsey Journal: Am J Trop Med Hyg Date: 2013-02-04 Impact factor: 2.345
Authors: Félix Tietche; David Chelo; Njiki Kinkela Mina Ntoto; Florence Minjiwa Djoukoue; Christoph Hatz; Sarabel Frey; Adrian Frentzel; Sonja Trapp; Roland Zielonka; Edgar A Mueller Journal: Am J Trop Med Hyg Date: 2010-06 Impact factor: 2.345
Authors: Mayke J A M Oesterholt; Michael Alifrangis; Colin J Sutherland; Sabah A Omar; Patrick Sawa; Christina Howitt; Louis C Gouagna; Robert W Sauerwein; Teun Bousema Journal: PLoS One Date: 2009-02-05 Impact factor: 3.240
Authors: Shereen Katrak; Anne Gasasira; Emmanuel Arinaitwe; Abel Kakuru; Humphrey Wanzira; Victor Bigira; Taylor G Sandison; Jaco Homsy; Jordan W Tappero; Moses R Kamya; Grant Dorsey Journal: Malar J Date: 2009-11-30 Impact factor: 2.979
Authors: Zul Premji; Rich E Umeh; Seth Owusu-Agyei; Fabian Esamai; Emmanuel U Ezedinachi; Stephen Oguche; Steffen Borrmann; Akintunde Sowunmi; Stephan Duparc; Paula L Kirby; Allan Pamba; Lynda Kellam; Robert Guiguemdé; Brian Greenwood; Stephen A Ward; Peter A Winstanley Journal: PLoS One Date: 2009-08-19 Impact factor: 3.240