Therapeutic efficacy of artemether–lumefantrine and artesunate–amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Mali, 2015–2016

Abstract

Background The current first-line treatments for uncomplicated malaria recommended by the National Malaria Control Programme in Mali are artemether–lumefantrine (AL) and artesunate–amodiaquine (ASAQ). From 2015 to 2016, an in vivo study was carried out to assess the clinical and parasitological responses to AL and ASAQ in Sélingué, Mali. Methods Children between 6 and 59 months of age with uncomplicated Plasmodium falciparum infection and 2000–200,000 asexual parasites/μL of blood were enrolled, randomly assigned to either AL or ASAQ, and followed up for 42 days. Uncorrected and PCR-corrected efficacy results at days 28 and 42. were calculated. Known markers of resistance in the Pfk13, Pfmdr1, and Pfcrt genes were assessed using Sanger sequencing. Results A total of 449 patients were enrolled: 225 in the AL group and 224 in the ASAQ group. Uncorrected efficacy at day 28 was 83.4% (95% CI 78.5–88.4%) in the AL arm and 93.1% (95% CI 89.7–96.5%) in the ASAQ arm. The per protocol PCR-corrected efficacy at day 28 was 91.0% (86.0–95.9%) in the AL arm and 97.1% (93.6–100%) in the ASAQ arm. ASAQ was significantly (p < 0.05) better than AL for each of the aforementioned efficacy outcomes. No mutations associated with artemisinin resistance were identified in the Pfk13 gene. Overall, for Pfmdr1, the N86 allele and the NFD haplotype were the most common. The NFD haplotype was significantly more prevalent in the post-treatment than in the pre-treatment isolates in the AL arm (p < 0.01) but not in the ASAQ arm. For Pfcrt, the CVIET haplotype was the most common. Conclusions The findings indicate that both AL and ASAQ remain effective for the treatment of uncomplicated malaria in Sélingué, Mali.

Therapeutic efficacy and tolerability of artemether–lumefantrine for uncomplicated Plasmodium falciparum malaria in Niger, 2020

“…All three study sites demonstrated an AL efficacy of over the WHO threshold, with ACPRs in Agadez, Tessaoua, and Gaya of 97.05%, 98.87% and 92.18%, respectively. Several studies have evaluated the efficacy of AL in Niger and the sub region and have demonstrated its continued efficacy in West Africa: 91% efficacy in Sélingué, Mali in 2015 [ 20 ], 96.7% and 96.3% efficacy in Bohicon and Kandi, Benin, respectively, in 2018 [ 21 ], 98.8% efficacy in Kédougou, Senegal, in 2018 [ 22 ] and 98.8% efficacy in Abidjan, Côte d’Ivoire, in 2016 [ 23 ]. In addition to its efficacy, this molecule is well tolerated by patients and no adverse events were reported during the study.…”

In Vitro and In Vivo Validation of CYP6A14 and CYP6N6 Participation in Deltamethrin Metabolic Resistance in Aedes albopictus

“…This phenomenon is similar to the CYP450s proteins, CYP6A14, and CYP6N6, which are involved in mosquito resistance by directly metabolizing deltamethrin. 4 , 36 …”

“…Studies show that compared with past success in the Mali and Uganda regions of Africa, mosquito-borne infectious disease prevention and control programs have come to a standstill; even with the use of strengthened pesticides, malaria incidence is not decreasing any further but is, in fact, showing a trend of increase. 3 – 5 Therefore, research into the mechanism of mosquito resistance is vital to carry out an effective resistance program. Mosquito resistance emerges from the selection of adaptive insecticides involving multiple genes.…”

Assessing the Therapeutic Efficacy of Artemether-Lumefantrine for Uncomplicated Malaria in Lagos, Nigeria: A Comprehensive Study on Treatment Response and Resistance Markers

“…It remains a signi cant global health concern particularly in sub-Saharan Africa [1]. Central to antimalarial strategies are artemisinin-based combination therapies (ACTs), with artemether-lumefantrine standing out for its widely recognized e cacy in treating uncomplicated P. falciparum malaria [2][3][4]. The unique mechanism of action of ACTs involves rapid clearance of circulating parasites with artemisinin, coupled with the sustained action of the partner drug, making this combination a key component in the global malaria control toolkit.…”