Efficacy of artesunate–amodiaquine in the treatment of falciparum uncomplicated malaria in Madagascar

Abstract

BackgroundSince 2006, the artemisinin-based combination therapy (ACT) are recommended to treat uncomplicated malaria including non Plasmodium falciparum malaria in Madagascar. Artesunate–amodiaquine (ASAQ) and artemether–lumefantrine are the first- and second-line treatment in uncomplicated falciparum malaria, respectively. No clinical drug efficacy study has been published since 2009 to assess the efficacy of these two artemisinin-based combinations in Madagascar, although the incidence of malaria cases has increased from 2010 to 2016. In this context, new data about the efficacy of the drug combinations currently used to treat malaria are needed.MethodsTherapeutic efficacy studies evaluating the efficacy of ASAQ were conducted in 2012, 2013 and 2016 among falciparum malaria-infected patients aged between 6 months and 56 years, in health centres in 6 sites representing different epidemiological patterns. The 2009 World Health Organization protocol for monitoring anti-malarial drug efficacy was followed.ResultsA total of 348 enrolled patients met the inclusion criteria including 108 patients in 2012 (n = 64 for Matanga, n = 44 for Ampasipotsy), 123 patients in 2013 (n = 63 for Ankazomborona, n = 60 for Anjoma Ramartina) and 117 patients in 2016 (n = 67 for Tsaratanana, n = 50 for Antanimbary). The overall cumulative PCR-corrected day 28 cure rate was 99.70% (95% IC 98.30–99.95). No significant difference in cure rates was observed overtime: 99.02% (95% IC 94.65–99.83) in 2012; 100% (95% IC 96.8–100) in 2013 and 100% (95% IC 96.65–100) in 2016.ConclusionThe ASAQ combination remains highly effective for the treatment of uncomplicated falciparum malaria in Madagascar.

Increased Sensitivity of Plasmodium falciparum to Artesunate/Amodiaquine Despite 14 Years as First-Line Malaria Treatment, Zanzibar

“…High in vivo efficacy is in agreement with previous findings from Madagascar (27) and Côte d'Ivoire (28) after 6 and 10 years of ASAQ use as first-line treatment, respectively. It might be argued that the observed higher cure rate in 2017 may be caused by a different study age group; added single low-dose primaquine; fixed-dose versus a loose combination of ASAQ compounds; or reduced malaria transmission compared with that in 2002-2003 and 2005.…”

Chloroquine against malaria, cancers and viral diseases

“…Amodiaquine, piperaquine, pyronaridine, and lumefantrine are recommended by WHO as partner drugs for artemisinin derivatives. Some common drug combinations include dihydroartemisinin-piperaquine (DHA-PPQ) [17] , artesunate-amodiaquine (AS-AQ) [18] , pyronaridine-artesunate (PY-AS) [19] , and artemether-lumefantrine (AL) [20] .…”

Genetic Diversity of Plasmodium Falciparum Populations in three Malaria Transmission Settings in Madagascar

“…Study sites and blood sample collection.P. falciparum clinical samples were obtained from patients presenting to the local health centers enrolled in clinical drug e cacy studies conducted to assess artesunate-amodiaquine e cacy in 2013 and 2016 [12]. Included patients were individuals aged > 6 months, presenting uncomplicated falciparum malaria (de ned as positive smear for P. falciparum and presence of fever ≥ 37.5°C) and residents in three different endemic zones in Madagascar: Anjoma Ramartina city located in the fringes, Tsaratanana on the eastern coast (equatorial facies) and Antanimbary on the western coast (tropical facies) (Fig.…”