Sustained High Cure Rate of Artemether–Lumefantrine against Uncomplicated Plasmodium falciparum Malaria after 8 Years of Its Wide-Scale Use in Bagamoyo District, Tanzania

Abstract

We assessed the temporal trend of artemether-lumefantrine (AL) cure rate after 8 years of its wide-scale use for treatment of uncomplicated malaria from 2006 to 2014 in Bagamoyo district, Tanzania. Trend analysis was performed for four studies conducted in 2006, 2007-2008, 2012-2013, and 2014. Patients with acute uncomplicated malaria were enrolled, treated with standard AL regimen and followed-up for 3 (2006), 28 (2014), 42 (2012-2013), or 56 (2007-2008) days for clinical and laboratory evaluation. Primary outcome was day 28 polymerase chain reaction (PCR)-adjusted cure rate across years from 2007 to 2014. Parasite clearance was slower for the 2006 and 2007-2008 cohorts with less than 50% of patients cleared of parasitemia on day 1, but was rapid for the 2012-2013 and 2014 cohorts. Day 28 PCR-adjusted cure rate was 168/170 (98.8%) (95% confidence interval [CI], 97.2-100), 122/127 (96.1%) (95% CI, 92.6-99.5), and 206/207 (99.5%) (95% CI, 98.6-100) in 2007-2008, 2012-2013, and 2014, respectively. There was no significant change in the trend of cure rate between 2007 and 2014 (χ test = 0.06, = 0.90). Pretreatment multidrug-resistant gene 1 () N86 prevalence increased significantly across years from 13/48 (27.1%) in 2006 to 183/213 (85.9%) in 2014 ( < 0.001), and chloroquine resistance transporter gene () K76 prevalence increased significantly from 24/47 (51.1%) in 2006 to 198/205 (96.6%) in 2014 ( < 0.001). The AL cure rate remained high after 8 years of its wide-scale use in Bagamoyo district for the treatment of uncomplicated malaria despite an increase in prevalence of pretreatment N86 and K76 between 2006 and 2014.

Efficacy and safety of artesunate-amodiaquine and artemether-lumefantrine and prevalence of molecular markers associated with resistance, Guinea, 2016

“…The results showed high efficacy of ASAQ and AL (microsatellite-corrected D28 efficacies > 99%) to treat uncomplicated malaria, despite their use for more than a decade in Guinea. These results are consistent with the high ACT efficacies observed prior to introduction of ACTs in Guinea and with other studies from Africa [9,[31][32][33][34].…”

Efficacy and safety of artesunate–amodiaquine and artemether–lumefantrine and prevalence of molecular markers associated with resistance, Guinea: an open-label two-arm randomised controlled trial

“…The results showed high efficacy of ASAQ and AL (microsatellite-corrected D28 efficacies > 99%) to treat uncomplicated malaria, despite their use for more than a decade in Guinea. These results are consistent with the high ACT efficacies observed prior to introduction of ACT in Guinea and with other studies from Africa [8,11,32,33].…”

Efficacy and safety of artesunate-amodiaquine and artemether-lumefantrine and prevalence of molecular markers associated with resistance, Guinea: an open-label two-arm randomised controlled trial

“…The results showed high e cacy of ASAQ and AL (microsatellite-corrected D28 e cacies > 99%) to treat uncomplicated malaria, despite their use for more than a decade in Guinea. These results are consistent with the high ACT e cacies observed prior to introduction of ACT in Guinea and with other studies from Africa [8,11,32,33].…”