Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon

Abstract

BackgroundThe use of drug combinations, including non-artemisinin-based and artemisinin-based combination therapy (ACT), is a novel strategy that enhances therapeutic efficacy and delays the emergence of multidrug-resistant Plasmodium falciparum. Its use is strongly recommended in most sub-Saharan African countries, namely Cameroon, where resistance to chloroquine is widespread and antifolate resistance is emerging.MethodsStudies were conducted in Cameroonian children with acute uncomplicated P. falciparum malaria according to the standard World Health Organization protocol at four sentinel sites between 2003 and 2007. A total of 1,401 children were enrolled, of whom 1,337 were assigned to randomized studies and 64 were included in a single non-randomized study. The proportions of adequate clinical and parasitological response (PCR-uncorrected on day 14 and PCR-corrected on day 28) were the primary endpoints to evaluate treatment efficacy on day 14 and day 28. The relative effectiveness of drug combinations was compared by a multi-treatment Bayesian random-effect meta-analysis.FindingsThe results based on the meta-analysis suggested that artesunate-amodiaquine (AS-AQ) is as effective as other drugs (artesunate-sulphadoxine-pyrimethamine [AS-SP], artesunate-chlorproguanil-dapsone [AS-CD], artesunate-mefloquine [AS-MQ], dihydroartemisinin-piperaquine [DH-PP], artemether-lumefantrine [AM-LM], amodiaquine, and amodiaquine-sulphadoxine-pyrimethamine [AQ-SP]). AM-LM appeared to be the most effective with no treatment failure due to recrudescence, closely followed by DH-PP.ConclusionAlthough AM-LM requires six doses, rather than three doses for other artemisinin-based combinations, it has potential advantages over other forms of ACT. Further studies are needed to evaluate the clinical efficacy and tolerance of these combinations in different epidemiological context.

In Vivo Efficacy of Artesunate/Sulphadoxine-Pyrimethamine versus Artesunate/Amodiaquine in the Treatment of Uncomplicated P. falciparium Malaria in Children around the Slope of Mount Cameroon: A Randomized Controlled Trial

“…The ACPR recorded at day 28 in the AS/SP (83.8%) and AS/AQ (90.2%) groups is in line with a previous study conducted at four different urban centers in Cameroon, where ACPR at day 28 of 88.5% and 88.3% were reported in the AS/SP and AS/AQ groups, respectively [30]. Both combinations demonstrate good activity against the asexual forms of the parasite and, thus, remain effective in the treatment of malaria in Cameroon.…”

Adherence to Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria: A Systematic Review and Meta-Analysis

“…It has been reported that adherence to antimalarial agents is inversely proportional to length of therapy and frequency of taking dosages [51]. The complete treatment of uncomplicated malaria requires a patient to take 6 doses of AL as compared to 3 doses for other ACT-based combinations [5]. Despite the increased dosages of AL over AS/AQ, we did not observe a statistically significant difference in adherence to these antimalarial agents.…”

“…Several ACT combinations available include artemether-lumefantrine (AL), artesunate-amodiaquine (AS/AQ), artesunate-mefloquine (AS/MQ), artesunate-chlorproguanil-dapsone (AS/CD), artesunate-sulphadoxine-pyrimethamine (AS/SP), dihydroartemisinin-piperaquine (DA/PQ), artesunate-piperazine (AS/PZ), and artesunate-atovaquone-proguanil (A/AP) [5]. Out of these ACT combinations WHO recommended AL, AS/MQ, AS/AQ, and AS/SP [6].…”

Antiplasmodial activity of Vernonia adoensis aqueous, methanol and chloroform leaf extracts against chloroquine sensitive strain of Plasmodium berghei in vivo in mice

“…Currently quinine and artemisinin are the two effective drugs obtained from two traditional medicinal plants. Quinine was obtained from the bark of the Cinchona tree [6, 7] and artemisinin from the plant Artemisia annua [8, 9]. However, in the recent years these drugs show some degree of resistance [10, 11].…”