Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: A randomized trial


Kamya, MR; Yeka, A; Bukirwa, H; Lugemwa, M; Rwakimari, JB; Staedke, SG; Talisuna, AO; Greenhouse, B; Nosten, F; Rosenthal, PJ; Wabwire-Mangen, F; Dorsey, G; (2007) Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: A randomized trial. Plos Clinical Trials, 2 (5). e20. ISSN 1555-5887 DOI: https://doi.org/10.1371/journal.pctr.0020020

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Abstract

: To compare the efficacy and safety of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) for treating uncomplicated falciparum malaria in Uganda.<br/> : Randomized single-blinded clinical trial.<br/> : Apac, Uganda, an area of very high malaria transmission intensity.<br/> : Children aged 6 mo to 10 y with uncomplicated falciparum malaria.<br/> : Treatment of malaria with AL or DP, each following standard 3-d dosing regimens.<br/> : Risks of recurrent parasitemia at 28 and 42 d, unadjusted and adjusted by genotyping to distinguish recrudescences and new infections.<br/> : Of 421 enrolled participants, 417 (99%) completed follow-up. The unadjusted risk of recurrent falciparum parasitemia was significantly lower for participants treated with DP than for those treated with AL after 28 d (11% versus 29%; risk difference [RD] 18%, 95% confidence interval [CI] 11%-26%) and 42 d (43% versus 53%; RD 9.6%, 95% CI 0%-19%) of follow-up. Similarly, the risk of recurrent parasitemia due to possible recrudescence (adjusted by genotyping) was significantly lower for participants treated with DP than for those treated with AL after 28 d (1.9% versus 8.9%; RD 7.0%, 95% CI 2.5%-12%) and 42 d (6.9% versus 16%; RD 9.5%, 95% CI 2.8%-16%). Patients treated with DP had a lower risk of recurrent parasitemia due to non-falciparum species, development of gametocytemia, and higher mean increase in hemoglobin compared to patients treated with AL. Both drugs were well tolerated; serious adverse events were uncommon and unrelated to study drugs.<br/> : DP was superior to AL for reducing the risk of recurrent parasitemia and gametocytemia, and provided improved hemoglobin recovery. DP thus appears to be a good alternative to AL as first-line treatment of uncomplicated malaria in Uganda. To maximize the benefit of artemisinin-based combination therapy in Africa, treatment should be integrated with aggressive strategies to reduce malaria transmission intensity.<br/>

Item Type: Article
Keywords: PLASMODIUM-FALCIPARUM MALARIA, POPULATION PHARMACOKINETICS, UNCOMPLICATED MALARIA, ARTESUNATE, EFFICACY, CHILDREN, AFRICA, UGANDA, PYRIMETHAMINE, AMODIAQUINE
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: Malaria Centre
PubMed ID: 17525792
Web of Science ID: 246737200002
URI: http://researchonline.lshtm.ac.uk/id/eprint/9704

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