Therapeutic Efficacies of Artemisinin-Based Combination Therapies in Nigerian Children with Uncomplicated Falciparum Malaria during Five Years of Adoption as First-Line Treatments

Abstract

Abstract. The therapeutic efficacies of 3-day regimens of artesunate-amodiaquine and artemether-lumefantrine during 5 years of adoption as first-line treatments were evaluated in 811 ≤ 12-year-old malarious children. Compared with artemether-lumefantrine, amodiaquine-artesunate significantly reduced the proportion of children with fever and parasitemia 1 day after treatment (day 1; P < 0.008 for both). The proportion of parasitemic children on day 2 and gametocytemia on presentation and carriage reduced significantly over the years ( P < 0.000001 and P < 0.03, respectively; test for trend). Overall efficacy was 96.5% (95% confidence interval [CI] = 94.5-98.6) and remained unchanged over the years ( P = 0.87; test for trend). Kinetics of parasitemias after treatments were estimated by a non-compartmental model. Declines of parasitemias were monoexponential, with a mean elimination half-life of 1.09 hours (95% CI = 1.0-1.16). Parasitemia half-lives and efficacy were similar for both regimens and in all ages. Artesunate-amodiaquine and artemether-lumefantrine remain efficacious treatments of uncomplicated falciparum malaria in Nigerian children 5 years after adoption.

Assessment of the efficacy of first-line antimalarial drugs after 5 years of deployment by the National Malaria Control Programme in C&ocirc;te d'Ivoire

“…The results showed a high cure rate for both regimens after a standard 28-day follow-up. These results are consistent with efficacy results reported from several sub-Saharan African countries, [34][35][36] indicating a high overall cure rate with these regimens in the short term (28-day). Therefore, the data are in line with studies conducted in Ghanaian children showing lower parasitological and clinical failure rates in the ASAQ compared with the AL arm.…”

“…These findings are in agreement with previous drug safety monitoring. [32][33][34] This may suggest a lower intrinsic tolerance of ASAQ.…”

Efficacy of Artemisinin-Based Combination Treatments of Uncomplicated Falciparum Malaria in Under-Five-Year-Old Nigerian Children

“…It is noteworthy that despite high grade chloroquine resistance and the association between transporter genes and resistance to chloroquine or amodiaquine in the area,20–24 artesunate-amodiaquine was still effective in the children < 5 years of age. The latter may be a result of the very limited use of amodiaquine monotherapy before the adoption of artesunate-amodiaquine as one of the first-line antimalarial drugs 10,25,26. and the fact that amodiaquine is more effective even in areas with considerable chloroquine resistance 27.…”

Efficacy of artemisinin combination therapy for the treatment of uncomplicated falciparum malaria in Nigerian children

“…This may raise a question about the long-term utility of amodiaquine as a partner drug for ACT in Nigeria. Although the impact of mutant pfcrt T76 and pfmdr1 Y86 allele prevalence on the treatment outcome in the study could not be assessed because there was no treatment failure, the artesunate plus amodiaquine combination has been associated with a high cure rate in areas where pfcrt K76T alleles are prevalent [31,32]. Thus, the argument remains about whether the pfcrt and pfmdr1 chloroquine-resistant molecular markers can also be used as resistance markers for amodiaquine.…”

“…The number of patients included in this study was determined using the formula and a difference in the event rate of 0.10 was considered to be clinically relevant [12]. On the basis of a previous study in Nigeria, the cure rate of Coartem was estimated to be 96.5% [13]; the cure rate of artesunate-amodiaquine was estimated to be 97.9% [7]. The minimum sample size for each experimental arm was determined to be approximately 40 patients.…”