Efficacy of Artemether-Lumefantrine for the Treatment of Plasmodium falciparum Malaria in Bohicon and Kandi, Republic of Benin, 2018–2019

Abstract

In 2005, artemether-lumefantrine (AL), an artemisinin-based combination therapy, was introduced as the first-line treatment of uncomplicated Plasmodium falciparum malaria in Benin. Per World Health Organization recommendations to monitor the efficacy of antimalarial treatment, we conducted a therapeutic efficacy study with AL for uncomplicated P. falciparum malaria in Bohicon and Kandi, Benin, from 2018 to 2019. Febrile patients aged 6 to 59 months with confirmed P. falciparum monoinfection received supervised doses of AL for 3 days. We monitored patients clinically and parasitologically on days 1, 2, 3, 7, 14, 21, and 28. A molecular analysis to detect mutations in the P. falciparum Kelch propeller gene (Pfk13) gene was carried out on day 0 samples. A total of 205 patients were included in the study. In Bohicon, the uncorrected adequate clinical and parasitological response (ACPR) proportion was 91.3% (95% confidence interval [CI]: 84.6–95.8%), whereas in Kandi this proportion was 96.7% (95% CI: 90.6–99.3%). Genotype-corrected ACPR proportions were 96.3% (95% CI: 90.9–99.0%) and 96.7% (95% CI: 90.6–99.3%) in Bohicon and Kandi, respectively. On day 3, 100% of patients in Bohicon and 98.9% of patients in Kandi had undetectable parasitemia. The C580Y mutation in the Pfk13 gene was not observed. AL remains effective for P. falciparum malaria in these two sites in Benin. Monitoring antimalarial efficacy and prevalence of molecular-resistance markers in Benin should be continued to allow for early detection of antimalarial resistance and to guide treatment policies.

Efficacy of artemether-lumefantrine and dihydroartemisinin-piperaquine and prevalence of molecular markers of anti-malarial drug resistance in children in Togo in 2021

“…The study also assessed, for the first time, the efficacy of DP, a second-line treatment introduced in 2016, and demonstrated high efficacy (PCR corrected cure rates of 100% in Kouvé and Anié on day 28 and 98.9% in Kouvé and 100% in Anié on day 42, respectively). These results are similar to those reported in neighboring countries such as Ghana [ 45 ] and Benin [ 46 ], but also as well as other West African countries [ 47 – 54 ], and Central and East African countries [ 55 – 57 ]. This contrasts with recent reports of the reduced PCR-corrected cure rates of AL (< 90%) found, in the absence of a Pfkelch13 validated variants, in Burkina Faso [ 58 ], Angola [ 59 ], and the Democratic Republic of Congo [ 60 ], suggesting lumefantrine resistance.…”

Therapeutic efficacy and tolerability of artemether–lumefantrine for uncomplicated Plasmodium falciparum malaria in Niger, 2020

“…All three study sites demonstrated an AL efficacy of over the WHO threshold, with ACPRs in Agadez, Tessaoua, and Gaya of 97.05%, 98.87% and 92.18%, respectively. Several studies have evaluated the efficacy of AL in Niger and the sub region and have demonstrated its continued efficacy in West Africa: 91% efficacy in Sélingué, Mali in 2015 [ 20 ], 96.7% and 96.3% efficacy in Bohicon and Kandi, Benin, respectively, in 2018 [ 21 ], 98.8% efficacy in Kédougou, Senegal, in 2018 [ 22 ] and 98.8% efficacy in Abidjan, Côte d’Ivoire, in 2016 [ 23 ]. In addition to its efficacy, this molecule is well tolerated by patients and no adverse events were reported during the study.…”