Four Artemisinin-Based Treatments in African Pregnant Women with Malaria

Pekyi, Divine; Ampromfi, Akua A.; Tinto, Halidou; Traoré-Coulibaly, Maminata; Tahita, Marc Christian; Valéa, Innocent; Mwapasa, Victor; Kalilani-Phiri, Linda; Kalanda, Gertrude; Madanitsa, Mwayiwawo; Ravinetto, Raffaella; Mutabingwa, Theonest K.; Gbekor, Prosper; Tagbor, Harry; Antwi, Gifty; Menten, Joris; Crop, Maaike De; Claeys, Yves; Schurmans, Céline; Overmeir, Chantal Van; Thriemer, Kamala; Geertruyden, Jean‐Pierre Van; D’Alessandro, Umberto; Nambozi, Michael; Mulenga, Modest; Hachizovu, Sebastian; Kabuya, Jean-Bertin; Mulenga, Joyce

doi:10.1056/nejmoa1508606

Cited by 84 publications

(97 citation statements)

References 25 publications

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“…A full piperaquine course provides a posttreatment prophylactic effect of around a month [28]. During the study period, treatment failures with DHA-PQ increased in Cambodia [4, 29], prompting a change in first-line treatment to artesunate-mefloquine.…”

Section: Discussionmentioning

confidence: 99%

A Controlled Trial of Mass Drug Administration to Interrupt Transmission of Multidrug-Resistant Falciparum Malaria in Cambodian Villages

Tripura

Peto

Nguon

et al. 2018

Clinical Infectious Diseases

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Section: Discussionmentioning

confidence: 99%

A Controlled Trial of Mass Drug Administration to Interrupt Transmission of Multidrug-Resistant Falciparum Malaria in Cambodian Villages

Tripura

Peto

Nguon

et al. 2018

Clinical Infectious Diseases

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“…The study design and results have previously been reported [21]. The criteria for enrolment in the study were: age ≥15 years old; gestation ≥16 weeks; P. falciparum mono-infection of any density, with or without symptoms; haemoglobin concentration ≥7 g/dL; residence within the health facility catchment area; willing to deliver at the health facility; and, ability to give informed consent.…”

Section: Methodsmentioning

confidence: 99%

The return of chloroquine-susceptible Plasmodium falciparum malaria in Zambia

Mwanza

Joshi

Nambozi

et al. 2016

Malar J

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Background Plasmodium falciparum resistance to anti-malarial drugs remains a major obstacle to malaria control and elimination. The parasite has developed resistance to every anti-malarial drug introduced for wide-scale treatment. However, the spread of resistance may be reversible. Malawi was the first country to discontinue chloroquine use due to widespread resistance. Within a decade of the removal of drug pressure, the molecular marker of chloroquine-resistant malaria had disappeared and the drug was shown to have excellent clinical efficacy. Many countries have observed decreases in the prevalence of chloroquine resistance with the discontinuation of chloroquine use. In Zambia, chloroquine was used as first-line treatment for uncomplicated malaria until treatment failures led the Ministry of Health to replace it with artemether-lumefantrine in 2003. Specimens from a recent study were analysed to evaluate prevalence of chloroquine-resistant malaria in Nchelenge district a decade after chloroquine use was discontinued.MethodsParasite DNA was extracted from dried blood spots collected by finger-prick in pregnant women who were enrolling in a clinical trial. The specimens underwent pyrosequencing to determine the genotype of the P. falciparum chloroquine resistance transporter, the gene that is associated with CQ resistance.ResultsThree-hundred and two specimens were successfully analysed. No chloroquine-resistant genotypes were detected.ConclusionThe study found the disappearance of chloroquine-resistant malaria after the removal of chloroquine drug pressure. Chloroquine may have a role for malaria prevention or treatment in Zambia and throughout the region in the future.

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“…This study was part of a multi-centre trial carried out also in Burkina Faso, Ghana and Malawi. Each site tested 3 ACT medicines so that each country dataset could be analysed separately [6] and give detailed site specific data. This paper reports results collected in the Zambian site, Nchelenge, Luapula Province.…”

Section: Introductionmentioning

confidence: 99%

Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria

Nambozi

Kabuya

Hachizovu

et al. 2017

Malar J

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BackgroundIn Zambia, malaria is one of the leading causes of morbidity and mortality, especially among under five children and pregnant women. For the latter, the World Health Organization recommends the use of artemisinin-based combination therapy (ACT) in the second and third trimester of pregnancy. In a context of limited information on ACT, the safety and efficacy of three combinations, namely artemether–lumefantrine (AL), mefloquine–artesunate (MQAS) and dihydroartemisinin–piperaquine (DHAPQ) were assessed in pregnant women with malaria.MethodsThe trial was carried out between July 2010 and August 2013 in Nchelenge district, Luapula Province, an area of high transmission, as part of a multi-centre trial. Women in the second or third trimester of pregnancy and with malaria were recruited and randomized to one of the three study arms. Women were actively followed up for 63 days, and then at delivery and 1 year post-delivery.ResultsNine hundred pregnant women were included, 300 per arm. PCR-adjusted treatment failure was 4.7% (12/258) (95% CI 2.7–8.0) for AL, 1.3% (3/235) (95% CI 0.4–3.7) for MQAS and 0.8% (2/236) (95% CI 0.2–3.0) for DHAPQ, with significant risk difference between AL and DHAPQ (p = 0.01) and between AL and MQAS (p = 0.03) treatments. Re-infections during follow up were more frequent in the AL (HR: 4.71; 95% CI 3.10–7.2; p < 0.01) and MQAS (HR: 1.59; 95% CI 1.02–2.46; p = 0.04) arms compared to the DHAPQ arm. PCR-adjusted treatment failure was significantly associated with women under 20 years [Hazard Ratio (HR) 5.35 (95% CI 1.07–26.73; p = 0.04)] and higher malaria parasite density [3.23 (95% CI 1.03–10.10; p = 0.04)], and still women under 20 years [1.78, (95% CI 1.26–2.52; p < 0.01)] had a significantly higher risk of re-infection. The three treatments were generally well tolerated. Dizziness, nausea, vomiting, headache and asthenia as adverse events (AEs) were more common in MQAS than in AL or DHAPQ (p < 0.001). Birth outcomes were not significantly different between treatment arms.ConclusionAs new infections can be prevented by a long acting partner drug to the artemisinins, DHAPQ should be preferred in places as Nchelenge district where transmission is intense while in areas of low transmission intensity AL or MQAS may be used.

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Four Artemisinin-Based Treatments in African Pregnant Women with Malaria

Cited by 84 publications

References 25 publications

A Controlled Trial of Mass Drug Administration to Interrupt Transmission of Multidrug-Resistant Falciparum Malaria in Cambodian Villages

A Controlled Trial of Mass Drug Administration to Interrupt Transmission of Multidrug-Resistant Falciparum Malaria in Cambodian Villages

The return of chloroquine-susceptible Plasmodium falciparum malaria in Zambia

Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria

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