Therapeutic Efficacy of Artemisinin-Based Combination Therapies in Democratic Republic of the Congo and Investigation of Molecular Markers of Antimalarial Resistance
| Autor: | Mateusz M. Plucinski, Eric Mukomena Sompwe, Joris Losimba Likwela, Leah F. Moriarty, Patrick Mitashi Mulopo, Aboubacar Sadou, Dieudonné Mumba Ngoyi, Gireesh Subramaniam, Gauthier Mesia Kahunu, Gerardo Chowell-Puente, Eric S. Halsey, Hypolite Muhindo Mavoko, Sarah E. Schmedes, Sam Jones, Naomi W. Lucchi, Samaly S. Svigel, Junior Matangila Rika, Albert Kutekemeni Kaputu, Nsengi Ntamabyaliro, Mame Niang, Papy Mandoko Nkoli, Jean Jacques Muyembe Tamfum |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Treatment outcome Plasmodium falciparum Drug Resistance Early detection wa_395 Uncomplicated malaria Piperazines Article Antimalarials Virology Internal medicine parasitic diseases medicine Humans Artemisinin Malaria Falciparum wb_330 biology business.industry Artemether Lumefantrine Drug Combination Amodiaquine Infant medicine.disease biology.organism_classification Monitoring site Artemisinins wc_750 Drug Combinations Infectious Diseases Congo Child Preschool Quinolines Parasitology Female business Malaria medicine.drug |
| Zdroj: | Am J Trop Med Hyg |
| ISSN: | 0002-9637 |
| Popis: | Routine assessment of the efficacy of artemisinin-based combination therapies (ACTs) is critical for the early detection of antimalarial resistance. We evaluated the efficacy of ACTs recommended for treatment of uncomplicated malaria in five sites in Democratic Republic of the Congo (DRC): artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ), and dihydroartemisinin-piperaquine (DP). Children aged 6–59 months with confirmed Plasmodium falciparum malaria were treated with one of the three ACTs and monitored. The primary endpoints were uncorrected and polymerase chain reaction (PCR)-corrected 28-day (AL and ASAQ) or 42-day (DP) cumulative efficacy. Molecular markers of resistance were investigated. Across the sites, uncorrected efficacy estimates ranged from 63% to 88% for AL, 73% to 100% for ASAQ, and 56% to 91% for DP. PCR-corrected efficacy estimates ranged from 86% to 98% for AL, 91% to 100% for ASAQ, and 84% to 100% for DP. No pfk13 mutations previously found to be associated with ACT resistance were observed. Statistically significant associations were found between certain pfmdr1 and pfcrt genotypes and treatment outcome. There is evidence of efficacy below the 90% cutoff recommended by WHO to consider a change in first-line treatment recommendations of two ACTs in one site not far from a monitoring site in Angola that has shown similar reduced efficacy for AL. Confirmation of these findings in future therapeutic efficacy monitoring in DRC is warranted. |
| Databáze: | OpenAIRE |
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