Efficacy and safety of artemether-lumefantrine and dihydroartemisinin-piperaquine in the treatment of uncomplicated Plasmodium falciparum malaria in Kenyan children aged less than five years: results of an open-label, randomized, single-centre study
| Autor: | Edgar K Omondi, Godfrey Allan Otieno, Willis Akhwale, Charles O Obonyo, Raymond Omollo, John M. Ong’echa, Kevin Omondi Onyango, Elizabeth Juma, Lucas Otieno, Bernhards Ogutu, Nelly Koskei, Jacob D. Johnson, Douglas J Perkins, Fredrick L. Eyase |
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| Jazyk: | angličtina |
| Předmět: |
medicine.medical_specialty
Artemether/lumefantrine Plasmodium falciparum Population Pharmacology Polymerase Chain Reaction law.invention Antimalarials Dihydroartemisinin/piperaquine Randomized controlled trial law Internal medicine parasitic diseases medicine Humans Artemether Artemether-lumefantrine Malaria Falciparum education Adverse effect Fluorenes education.field_of_study business.industry Research Incidence (epidemiology) Artemether Lumefantrine Drug Combination Infant Kenya Artemisinins Drug Combinations Regimen Infectious Diseases Ethanolamines Child Preschool Quinolines Parasitology Uncomplicated Plasmodium falciparum malaria business Dihydroartemisinin-piperaquine Tablets medicine.drug |
| Zdroj: | Malaria Journal |
| ISSN: | 1475-2875 |
| DOI: | 10.1186/1475-2875-13-33 |
| Popis: | Background This open-label, randomized study evaluated efficacy and safety of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) in treatment of uncomplicated falciparum malaria in children below five years of age, to build evidence on use of AL as first-line treatment and DP as second-line treatment in Kenya. Methods A total of 454 children aged six to 59 months with uncomplicated falciparum malaria were randomized (1:1) to receive AL dispersible or DP paediatric tablets and followed up for 42 days. Primary efficacy variable was corrected adequate clinical and parasitological response (ACPR) rate on day 28. Secondary variables included corrected (day 14, 28 and 42), uncorrected (day 3, 14, 28 and 42) cure rates, parasitological failure at days 3, 14 and 42. Acceptability and tolerability of both drugs were assessed by caregiver questionnaire. Results On day 28, corrected ACPR rates for AL dispersible and DP paediatric were 97.8% (95% CI: 94.9-99.3) and 99.1% (95% CI: 96.8-99.9), respectively, in intention-to-treat population, with no significant treatment differences noted between AL dispersible and DP paediatric arms. Additionally, no significant differences were observed for PCR corrected cure rates on days 14 and ACPR on day 42 for AL dispersible (100%; 96.8%) and DP paediatric (100%; 98.7%). Similarly, for PCR uncorrected cure rates, no significant differences were seen on days 3, 14, 28, and 42 for AL dispersible (99.1%; 98.7%; 81.1%; 67.8%) and DP paediatric (100%; 100%; 87.7%; 70.5%). Parasite clearance was rapid, with approximately 90% clearance achieved in 40 hours in both treatment arms. Incidence of adverse events was related to underlying disease; malaria being reported in both treatment arms. One serious adverse event was noted in AL dispersible (0.42%) arm, not related to study drug. Adherence to treatment regimen was higher for children treated with AL dispersible (93.6%) compared to DP paediatric (85.6%). Acceptability of AL dispersible regimen was assessed as being significantly better than DP paediatric. Conclusions AL and DP were both efficacious and well tolerated, and had similar effects at day 42 on risk of recurrent malaria. No signs of Plasmodium falciparum tolerance to artemisinins were noted. Trial registration PACTR201111000316370. |
| Databáze: | OpenAIRE |
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