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. 2017 Feb 2;16(1):62.
doi: 10.1186/s12936-017-1712-4.

Efficacy of artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine for treatment of uncomplicated Plasmodium falciparum malaria in Angola, 2015

Mateusz M Plucinski  1   2 , Pedro Rafael Dimbu  3 , Aleixo Panzo Macaia  4 , Carolina Miguel Ferreira  3 , Claudete Samutondo  5 , Joltim Quivinja  5 , Marília Afonso  3 , Richard Kiniffo  6 , Eliane Mbounga  7 , Julia S Kelley  8   9 , Dhruviben S Patel  8 , Yun He  8 , Eldin Talundzic  8   9 , Denise O Garrett  8   10 , Eric S Halsey  8   10 , Venkatachalam Udhayakumar  8 , Pascal Ringwald  11 , Filomeno Fortes  3
Affiliations

Efficacy of artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine for treatment of uncomplicated Plasmodium falciparum malaria in Angola, 2015

Mateusz M Plucinski et al. Malar J. .

Abstract

Background: Recent anti-malarial resistance monitoring in Angola has shown efficacy of artemether-lumefantrine (AL) in certain sites approaching the key 90% lower limit of efficacy recommended for artemisinin-based combination therapy. In addition, a controversial case of malaria unresponsive to artemisinins was reported in a patient infected in Lunda Sul Province in 2013.

Methods: During January-June 2015, investigators monitored the clinical and parasitological response of children with uncomplicated Plasmodium falciparum infection treated with AL, artesunate-amodiaquine (ASAQ), or dihydroartemisinin-piperaquine (DP). The study comprised two treatment arms in each of three provinces: Benguela (AL, ASAQ), Zaire (AL, DP), and Lunda Sul (ASAQ, DP). Samples from treatment failures were analysed for molecular markers of resistance for artemisinin (K13) and lumefantrine (pfmdr1).

Results: A total of 467 children reached a study endpoint. Fifty-four treatment failures were observed: four early treatment failures, 40 re-infections and ten recrudescences. Excluding re-infections, the 28-day microsatellite-corrected efficacy was 96.3% (95% CI 91-100) for AL in Benguela, 99.9% (95-100) for ASAQ in Benguela, 88.1% (81-95) for AL in Zaire, and 100% for ASAQ in Lunda Sul. For DP, the 42-day corrected efficacy was 98.8% (96-100) in Zaire and 100% in Lunda Sul. All treatment failures were wild type for K13, but all AL treatment failures had pfmdr1 haplotypes associated with decreased lumefantrine susceptibility.

Conclusions: No evidence was found to corroborate the specific allegation of artemisinin resistance in Lunda Sul. The efficacy below 90% of AL in Zaire matches findings from 2013 from the same site. Further monitoring, particularly including measurement of lumefantrine blood levels, is recommended.

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Figures

Fig. 1
Fig. 1
Location of sentinel sites for therapeutic efficacy monitoring in Angola, 2015. AL artemether–lumefantrine, ASAQ artesunate–amodiaquine, DP dihydroartemisinin–piperaquine
See this image and copyright information in PMC

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