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Clinical Trial
. 2019 Jul 11;18(1):231.
doi: 10.1186/s12936-019-2864-1.

High therapeutic efficacy of artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated falciparum malaria in Somalia

Marian Warsame  1   2 , Abdillahi Mohamed Hassan  3 , Abdikarim Hussein Hassan  4 , Ali Mohamed Jibril  5 , Nimol Khim  6 , Abdulkadir Mohamed Arale  7 , Ahamed Hassan Gomey  5 , Zainab Said Nur  4 , Said Mohamed Osman  4 , Marian Said Mohamed  4 , Ali Abdulrahman  7 , Fahmi Essa Yusuf  8 , Jamal Ghilan Hefzullah Amran  8 , Benoit Witkowski  6   9 , Pascal Ringwald  10
Affiliations
Clinical Trial

High therapeutic efficacy of artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated falciparum malaria in Somalia

Marian Warsame et al. Malar J. .

Abstract

Background: Artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DHA/PPQ) are the recommended first- and second-line treatments, respectively, for uncomplicated falciparum malaria in Somalia. The studies reported here were conducted to assess the efficacy of these artemisinin-based combinations and the mutations in Plasmodium falciparum K13-propeller (Pfk13) domain and amplification in Pfplasmepsin 2 (Pfpm2) gene in Somalia.

Methods: One-arm prospective studies were conducted to assess the clinical and parasitological responses to DHA/PPQ and AL at two sites in 2016 and 2017, respectively, using the standard WHO protocol. The patterns of molecular markers associated with artemisinin and PPQ resistance were investigated for the first time in Somalia.

Results: A total of 339 patients were enrolled with 139 for AL and 200 for DHA/PPQ. With AL, no parasite recurrence was observed among patients treated at either site, corresponding to 100% clinical and parasitological responses. For DHA-PPQ, an adequate clinical and parasitological response rate > 97% was observed. All study patients on both treatments at both sites were parasite-free on day 3. Of the 138 samples with interpretable results for the polymorphism in Pfk13, only one (0.7%), from Bosaso, contained a non-synonymous mutation (R622I), which is not one of the known markers of artemisinin resistance. No Pfpm2 amplification was observed among the 135 samples with interpretable results.

Conclusions: AL and DHA/PPQ were highly effective in the treatment of uncomplicated falciparum malaria, and there was no evidence of resistance to artemisinin or PPQ. These two combinations are thus relevant in the chemotherapeutic strategy for malaria control in Somalia. Trial registration ACTRN12616001005448 (Jowhar DP study), ACTRN12616000553471 (Bosaso DP study), ACTRN12617001055392 (AL study in Bosaso and Jowhar).

Keywords: Artemether–lumefantrine; Artemisinin resistance; Dihydroartemisinin–piperaquine; Piperaquine resistance; Plasmodium falciparum; Somalia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Map of Somalia showing the study sites (Jowhar and Bosaso)
Fig. 2
Fig. 2
Patient flow chart for AL and DHA/PPQ cohorts in Jowhar and Bosaso sites. AL, artemether–lumefantrine; DHA/PPQ, dihydroartemisinin–piperaquine; Pf, Plasmodium falciparum; Pv, Plasmodium vivax
Fig. 3
Fig. 3
Gametocyte clearance after treatment evaluated in patients with gametocytaemia at recruitment
See this image and copyright information in PMC

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