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Zida A, Tchekounou C, Soulama I, Zongo C, Sombié S, Nikiema S, Yanogo NJ, Sawadogo S, Kaboré FCA, Zoure OAZD, Sawadogo H, Sawadogo PM, Tibiri YNG, Guiguemde KT, Ily RP, Ouedraogo-Traoré R, Ouedraogo Y, Savadogo A. Characterization of Plasmodium Falciparum Resistance Genes to Common Antimalarial Drugs in Semi-urban Areas of Burkina Faso. Acta Parasitol 2024; 69:910-921. [PMID: 38478177 DOI: 10.1007/s11686-024-00826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/31/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Malaria still remains the most frequent parasitic disease on the world with, in 2022, 249 million cases and 608,000 deaths worldwide. Malaria control is compromised by the spread of the parasite's resistance to available antimalarials. The objective of our study is to characterize the Plasmodium falciparum resistance genes to common antimalarial drugs in semi-urban areas of Burkina Faso. MATERIALS AND METHODS This is a prospective cross-sectional study whose collection took place from June to October 2021 and from June to October 2022 in five health facilities in Burkina Faso. The molecular analysis based on PCR-RFLP took place from January to June 2023 at Centre National de Recherche et de Formation (CNRFP) to determine resistance genes such as Pfcrt, Pfmdr1, Pfdhps, and Pfdhfr. RESULTS A total of 150 samples were analyzed giving a prevalence of 46.67, 1.33, 0.67, 20, 82, and 4.67%, for Pfcrt 76 T, Pfmdr1 86Y, Pfdhps 437G, Pfdhfr 51I, Pfdhfr 59R, and Pfdhfr 108N mutations, respectively. There are no mutations observed Pfdhps 540E and Pfdhfr 164L positions. However, mutation on Pfdhfr 59R position was the most common. In addition, triple mutation (Pfdhps 437G + Pfdhfr 59R + Pfdhfr 108N) was found with a low frequency which is 0.67%. CONCLUSION Surveillance of Plasmodium falciparum resistance markers to antimalarial drugs, remains one of the priorities in the context of the control or malaria elimination.
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Affiliation(s)
- Adama Zida
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO), 03 BP 7022, Ouagadougou 03, Burkina Faso
- Institut International des Sciences et Technologie (IISTech), 07 BP 5562, Ouagadougou 07, Burkina Faso
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | - Chanolle Tchekounou
- Laboratoire de Biochimie et Immunologie Appliquées (LABIA), Département de Biochimie-Microbiologie, Université Joseph Ki-Zerbo, 03 BP 7021, Ouagadougou 03, Burkina Faso.
- Institut International des Sciences et Technologie (IISTech), 07 BP 5562, Ouagadougou 07, Burkina Faso.
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso.
| | - Issiaka Soulama
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
- Institut de Recherche en Science de La Santé (IRSS), 03 BP 7192, Ouagadougou 03, Burkina Faso
| | - Cheikna Zongo
- Laboratoire de Biochimie et Immunologie Appliquées (LABIA), Département de Biochimie-Microbiologie, Université Joseph Ki-Zerbo, 03 BP 7021, Ouagadougou 03, Burkina Faso
| | - Salif Sombié
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | - Seni Nikiema
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | - Nassandba J Yanogo
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | - Salam Sawadogo
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | - Farida C A Kaboré
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | - Oumou A Z D Zoure
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | - Haffsatou Sawadogo
- Laboratoire de Biochimie et Immunologie Appliquées (LABIA), Département de Biochimie-Microbiologie, Université Joseph Ki-Zerbo, 03 BP 7021, Ouagadougou 03, Burkina Faso
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO), 03 BP 7022, Ouagadougou 03, Burkina Faso
| | - Patindoilba M Sawadogo
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO), 03 BP 7022, Ouagadougou 03, Burkina Faso
- Institut International des Sciences et Technologie (IISTech), 07 BP 5562, Ouagadougou 07, Burkina Faso
| | - Yssimini N G Tibiri
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | - Kiswendsida T Guiguemde
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulles (CHUP-CDG), 01 BP 1198, Ouagadougou 01, Burkina Faso
| | - Raissa P Ily
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | - Rasmata Ouedraogo-Traoré
- Institut International des Sciences et Technologie (IISTech), 07 BP 5562, Ouagadougou 07, Burkina Faso
| | - Youssoufou Ouedraogo
- Institut International des Sciences et Technologie (IISTech), 07 BP 5562, Ouagadougou 07, Burkina Faso
| | - Aly Savadogo
- Laboratoire de Biochimie et Immunologie Appliquées (LABIA), Département de Biochimie-Microbiologie, Université Joseph Ki-Zerbo, 03 BP 7021, Ouagadougou 03, Burkina Faso
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Kua KP, Lee SWH, Chongmelaxme B. The impact of home-based management of malaria on clinical outcomes in sub-Saharan African populations: a systematic review and meta-analysis. Trop Med Health 2024; 52:7. [PMID: 38191459 PMCID: PMC10773121 DOI: 10.1186/s41182-023-00572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/24/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Malaria remains a significant cause of morbidity and mortality globally and continues to disproportionately afflict the African population. We aimed to evaluate the effect of home management of malaria intervention on health outcomes. METHODS In our systematic review and meta-analysis, six databases (Pubmed, Cochrane CENTRAL, EMBASE, CAB Abstracts and Global Health, CINAHL Complete, and BIOSIS) were searched for studies of home management of malaria from inception until November 15, 2023. We included before-after studies, observational studies, and randomised controlled trials of home management intervention delivered in community settings. The primary outcomes were malaria mortality and all-cause mortality. The risk of bias in individual observational studies was assessed using the ROBINS-I tool, whilst randomised controlled trials were judged using a revised Cochrane risk of bias tool and cluster-randomised controlled trials were evaluated using an adapted Cochrane risk of bias tool for cluster-randomised trials. We computed risk ratios with accompanying 95% confidence intervals for health-related outcomes reported in the studies and subsequently pooled the results by using a random-effects model (DerSimonian-Laird method). RESULTS We identified 1203 citations through database and hand searches, from which 56 articles from 47 studies encompassing 234,002 participants were included in the systematic review. All studies were conducted in people living in sub-Saharan Africa and were rated to have a low or moderate risk of bias. Pooled analyses showed that mortality rates due to malaria (RR = 0.40, 95% CI = 0.29-0.54, P = 0.00001, I2 = 0%) and all-cause mortality rates (RR = 0.62, 95% CI = 0.53-0.72, P = 0.00001, I2 = 0%) were significantly lower among participants receiving home management intervention compared to the control group. However, in children under 5 years of age, there was no significant difference in mortality rates before and after implementation of home management of malaria. In terms of secondary outcomes, home management of malaria was associated with a reduction in the risk of febrile episodes (RR = 1.27, 95% CI = 1.09-1.47, P = 0.002, I2 = 97%) and higher effective rates of antimalarial treatments (RR = 2.72, 95% CI = 1.90-3.88, P < 0.00001, I2 = 96%) compared to standard care. Home malaria management combined with intermittent preventive treatment showed a significantly lower incidence risk of malaria than home management intervention that exclusively provided treatment to individuals with febrile illness suggestive of malaria. The risks for adverse events were found to be similar for home management intervention using different antimalarial drugs. Cost-effectiveness findings depicted that home malaria management merited special preferential scale-up. CONCLUSIONS Home management of malaria intervention was associated with significant reductions in malaria mortality and all-cause mortality. The intervention could help decrease health and economic burden attributable to malaria. Further clinical studies are warranted to enable more meaningful interpretations with regard to wide-scale implementation of the intervention, settings of differing transmission intensity, and new antimalarial drugs.
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Affiliation(s)
- Kok Pim Kua
- Department of Civil and Environmental Engineering, School of Engineering and Doerr School of Sustainability, Stanford University, Stanford, CA, 94305, USA
- MIT Alumni Association, Massachusetts Institute of Technology, Cambridge, MA, 02139-4822, USA
- Pharmacy Unit, Puchong Health Clinic, Petaling District Health Office, Ministry of Health Malaysia, 47100, Puchong, Selangor, Malaysia
- A.S. Watson Group, Watson's Personal Care Stores, 55188, Kuala Lumpur, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
- Asian Center for Evidence Synthesis in Population, Implementation, and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
- Gerontechnology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
- Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, 47500, Lakeside CampusSelangor, Malaysia
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Bunchai Chongmelaxme
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, 254 Phayathai Road, Patumwan, Bangkok, 10330, Thailand.
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Mansoor R, Commons RJ, Douglas NM, Abuaku B, Achan J, Adam I, Adjei GO, Adjuik M, Alemayehu BH, Allan R, Allen EN, Anvikar AR, Arinaitwe E, Ashley EA, Ashurst H, Asih PBS, Bakyaita N, Barennes H, Barnes KI, Basco L, Bassat Q, Baudin E, Bell DJ, Bethell D, Bjorkman A, Boulton C, Bousema T, Brasseur P, Bukirwa H, Burrow R, Carrara VI, Cot M, D’Alessandro U, Das D, Das S, Davis TME, Desai M, Djimde AA, Dondorp AM, Dorsey G, Drakeley CJ, Duparc S, Espié E, Etard JF, Falade C, Faucher JF, Filler S, Fogg C, Fukuda M, Gaye O, Genton B, Ghulam Rahim A, Gilayeneh J, Gonzalez R, Grais RF, Grandesso F, Greenwood B, Grivoyannis A, Hatz C, Hodel EM, Humphreys GS, Hwang J, Ishengoma D, Juma E, Kachur SP, Kager PA, Kamugisha E, Kamya MR, Karema C, Kayentao K, Kazienga A, Kiechel JR, Kofoed PE, Koram K, Kremsner PG, Lalloo DG, Laman M, Lee SJ, Lell B, Maiga AW, Mårtensson A, Mayxay M, Mbacham W, McGready R, Menan H, Ménard D, Mockenhaupt F, Moore BR, Müller O, Nahum A, Ndiaye JL, Newton PN, Ngasala BE, Nikiema F, Nji AM, Noedl H, Nosten F, Ogutu BR, Ojurongbe O, Osorio L, Ouédraogo JB, Owusu-Agyei S, Pareek A, Penali LK, Piola P, Plucinski M, Premji Z, Ramharter M, Richmond CL, Rombo L, Roper C, Rosenthal PJ, Salman S, Same-Ekobo A, Sibley C, Sirima SB, Smithuis FM, Somé FA, Staedke SG, Starzengruber P, Strub-Wourgaft N, Sutanto I, Swarthout TD, Syafruddin D, Talisuna AO, Taylor WR, Temu EA, Thwing JI, Tinto H, Tjitra E, Touré OA, Tran TH, Ursing J, Valea I, Valentini G, van Vugt M, von Seidlein L, Ward SA, Were V, White NJ, Woodrow CJ, Yavo W, Yeka A, Zongo I, Simpson JA, Guerin PJ, Stepniewska K, Price RN. Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data. BMC Med 2022; 20:85. [PMID: 35249546 PMCID: PMC8900374 DOI: 10.1186/s12916-022-02265-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/18/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. METHODS Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. RESULTS A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0-19.7 g/dL) in Africa, 11.6 g/dL (range 5.0-20.0 g/dL) in Asia and 12.3 g/dL (range 6.9-17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39-3.05], p < 0.001). CONCLUSIONS In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery.
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Niba PTN, Nji AM, Ali IM, Akam LF, Dongmo CH, Chedjou JPK, Fomboh CT, Nana WD, Oben OLA, Selly-Ngaloumo AA, Moyeh MN, Ngu JA, Ludovic AJ, Aboh PM, Ambani MCE, Omgba PAM, Kotcholi GB, Adzemye LM, Nna DRA, Douanla A, Ango Z, Ewane MS, Ticha JT, Tatah FM, Dinza G, Ndikum VN, Fosah DA, Bigoga JD, Alifrangis M, Mbacham WF. Effectiveness and safety of artesunate-amodiaquine versus artemether-lumefantrine for home-based treatment of uncomplicated Plasmodium falciparum malaria among children 6-120 months in Yaoundé, Cameroon: a randomized trial. BMC Infect Dis 2022; 22:166. [PMID: 35189818 PMCID: PMC8862275 DOI: 10.1186/s12879-022-07101-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Many studies have reported high efficacy and safety of artesunate-amodiaquine (AS-AQ) and artemether-lumefantrine (AL) when administered under direct observation in Cameroon. There is paucity of data to support their continuous use in home-based treatment of uncomplicated Plasmodium falciparum malaria in Cameroon. Hence, this study aimed to assess the effectiveness and safety of AS-AQ versus AL for home-based treatment of uncomplicated P. falciparum malaria among children 6–120 months in Yaoundé, Cameroon. Methods A two-arm, open-label, randomized, controlled trial comparing the equivalence of AS-AQ (experimental group) and AL (control group) was carried out from May 2019 to April 2020 at two secondary hospitals in Yaoundé. Participants were randomized to receive either AS-AQ or AL. After the first dose, antimalarial drugs were given at home, rather than under direct observation by a study staff. The conventional on-treatment and post-treatment laboratory and clinical evaluations were not done until day 3 of the full antimalarial treatment course. The evaluation of effectiveness was mainly based on per protocol polymerase chain reaction adjusted adequate clinical and parasitological response (PP PCR adjusted ACPR) on day 28 post-treatment. Safety was based on assessment of adverse events (AEs) and severe adverse events (SAEs) from day 1 to day 28. Results A total of 242 children were randomized to receive AS-AQ (n = 114) and AL (n = 128). The PP PCR adjusted day 28 cure rates were [AS-AQ = 96.9% (95% CI, 91.2–99.4) versus AL = 95.5% (95% CI, 89.9–98.5), P = 0.797]. Expected mild to moderate adverse events were reported in both arms [AS-AQ = 83 (84.7%) versus AL = 99 (86.1%), P = 0.774]. The most common adverse events included: transient changes of hematologic indices and fever. Conclusions This study demonstrated that AS-AQ and AL are effective and safe for home management of malaria in Yaoundé. The evidence from this study supports the parallel use of the two drugs in routine practice. However, the findings from this study do not describe the likely duration of antimalarial effectiveness in holoendemic areas where multiple courses of treatment might be required. Trial registration: This study is a randomized controlled trial and it was retrospectively registered on 23/09/2020 at ClinicalTrials.gov with registration number NCT04565184. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07101-2.
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Affiliation(s)
- Peter Thelma Ngwa Niba
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Akindeh Mbuh Nji
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Innocent Mbulli Ali
- The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
| | - Lawrence Fonyonga Akam
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Cedric Hermann Dongmo
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Paul Kengne Chedjou
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Calvino Tah Fomboh
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - William Dorian Nana
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Ornella Laetitia Ayem Oben
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Abdel Aziz Selly-Ngaloumo
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Marcel N Moyeh
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.,Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Jude Achidi Ngu
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Ambassa Jean Ludovic
- District Medical Center, Minkoa-Meyos, Yaoundé, Cameroon.,District Hospital, Cité Verte, Yaoundé, Cameroon
| | | | | | | | | | | | | | - Adèle Douanla
- District Medical Center, Minkoa-Meyos, Yaoundé, Cameroon
| | - Ze Ango
- District Medical Center, Minkoa-Meyos, Yaoundé, Cameroon
| | | | - Joel Tewara Ticha
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Fritz Mbuh Tatah
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Golwa Dinza
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon
| | - Valentine Nchafor Ndikum
- Department of Pharmacology and African Traditional Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Dorothy A Fosah
- National Malaria Control Program, Ministry of Public Health, Yaoundé, Cameroon
| | - Jude D Bigoga
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon.,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.,Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Wilfred F Mbacham
- MARCAD-DELTAS Program, Laboratory for Public Health Research Biotechnologies, University of Yaoundé I, Yaoundé, Cameroon. .,The Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon. .,Cameroon Coalition Against Malaria, P.O. Box 8094, Yaoundé, Cameroon.
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Rasmussen C, Ringwald P. Is there evidence of anti-malarial multidrug resistance in Burkina Faso? Malar J 2021; 20:320. [PMID: 34281562 PMCID: PMC8287766 DOI: 10.1186/s12936-021-03845-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
Recently, Gansané and colleagues published an article on inadequate efficacy of two different forms of artemisinin-based combination therapy (ACT) in Burkina Faso. The development of Plasmodium falciparum resistance to different ACT partner drugs at levels that could affect the efficacy of two ACT would both be startling and a cause for great concern. In reviewing the available data collected since 2008 on ACT efficacy in Burkina Faso, the analysis shows that the reported efficacy of the tested ACT varies greatly. Most of the studies have considerable methodological deviations and challenges, especially in PCR correction done to distinguish between recrudescence and re-infection, and in the failure to omit re-infections in the calculation of efficacy rates. So far, there is no convincing evidence in the articles reviewed that multidrug resistance has emerged in Burkina Faso. However, the potential consequence of failing ACT means that the results published by Gansané et al. urgently need to be confirmed. Furthermore, articles reporting on efficacy data need to include an examination of the potential consequences of any methodological deviations.
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Affiliation(s)
| | - Pascal Ringwald
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
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Diarra Y, Koné O, Sangaré L, Doumbia L, Haidara DBB, Diallo M, Maiga A, Sango HA, Sidibé H, Mihigo J, Nace D, Ljolje D, Talundzic E, Udhayakumar V, Eckert E, Woodfill CJ, Moriarty LF, Lim P, Krogstad DJ, Halsey ES, Lucchi NW, Koita OA. Therapeutic efficacy of artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Mali, 2015-2016. Malar J 2021; 20:235. [PMID: 34034754 PMCID: PMC8146210 DOI: 10.1186/s12936-021-03760-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 05/11/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The current first-line treatments for uncomplicated malaria recommended by the National Malaria Control Programme in Mali are artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ). From 2015 to 2016, an in vivo study was carried out to assess the clinical and parasitological responses to AL and ASAQ in Sélingué, Mali. METHODS Children between 6 and 59 months of age with uncomplicated Plasmodium falciparum infection and 2000-200,000 asexual parasites/μL of blood were enrolled, randomly assigned to either AL or ASAQ, and followed up for 42 days. Uncorrected and PCR-corrected efficacy results at days 28 and 42. were calculated. Known markers of resistance in the Pfk13, Pfmdr1, and Pfcrt genes were assessed using Sanger sequencing. RESULTS A total of 449 patients were enrolled: 225 in the AL group and 224 in the ASAQ group. Uncorrected efficacy at day 28 was 83.4% (95% CI 78.5-88.4%) in the AL arm and 93.1% (95% CI 89.7-96.5%) in the ASAQ arm. The per protocol PCR-corrected efficacy at day 28 was 91.0% (86.0-95.9%) in the AL arm and 97.1% (93.6-100%) in the ASAQ arm. ASAQ was significantly (p < 0.05) better than AL for each of the aforementioned efficacy outcomes. No mutations associated with artemisinin resistance were identified in the Pfk13 gene. Overall, for Pfmdr1, the N86 allele and the NFD haplotype were the most common. The NFD haplotype was significantly more prevalent in the post-treatment than in the pre-treatment isolates in the AL arm (p < 0.01) but not in the ASAQ arm. For Pfcrt, the CVIET haplotype was the most common. CONCLUSIONS The findings indicate that both AL and ASAQ remain effective for the treatment of uncomplicated malaria in Sélingué, Mali.
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Affiliation(s)
- Youssouf Diarra
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Oumar Koné
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Lansana Sangaré
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Lassina Doumbia
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Mouctar Diallo
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ababacar Maiga
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Hamadoun A Sango
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Halidou Sidibé
- National Malaria Control Programme, Ministry of Health and Public Hygiene, Bamako, Mali
| | - Jules Mihigo
- U.S. President's Malaria Initiative, USAID Office, Bamako, Mali
| | - Douglas Nace
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dragan Ljolje
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eldin Talundzic
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Leah F Moriarty
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. President's Malaria Initiative, Atlanta, GA, USA
| | - Pharath Lim
- Medical Care Development International, Silver Spring, MD, USA
| | - Donald J Krogstad
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Eric S Halsey
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
- U.S. President's Malaria Initiative, Atlanta, GA, USA
| | - Naomi W Lucchi
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ousmane A Koita
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.
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7
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Compaoré YD, Zongo I, Somé AF, Barry N, Nikiéma F, Kaboré TN, Ouattara A, Kabré Z, Wermi K, Zongo M, Yerbanga RS, Sagara I, Djimdé A, Ouédraogo JB. Hepatic safety of repeated treatment with pyronaridine-artesunate versus artemether-lumefantrine in patients with uncomplicated malaria: a secondary analysis of the WANECAM 1 data from Bobo-Dioulasso, Burkina Faso. Malar J 2021; 20:64. [PMID: 33514368 PMCID: PMC7847156 DOI: 10.1186/s12936-021-03593-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/15/2021] [Indexed: 12/04/2022] Open
Abstract
Background The use of pyronaridine-artesunate (PA) has been associated with scarce transaminitis in patients. This analysis aimed to evaluate the hepatic safety profile of repeated treatment with PA versus artemether–lumefantrine (AL) in patients with consecutive uncomplicated malaria episodes in Bobo-Dioulasso, Burkina Faso. Methods This study analysed data from a clinical trial conducted from 2012 to 2015, in which participants with uncomplicated malaria were assigned to either PA or AL arms and followed up to 42 days. Subsequent malaria episodes within a 2-years follow up period were also treated with the same ACT initially allocated. Transaminases (AST/ALT), alkaline phosphatase (ALP), total and direct bilirubin were measured at days 0 (baseline), 3, 7, 28 and on some unscheduled days if required. The proportions of non-clinical hepatic adverse events (AEs) following first and repeated treatments with PA and AL were compared within study arms. The association of these AEs with retreatment in each arm was also determined using a logistic regression model. Results A total of 1379 malaria episodes were included in the intention to treat analysis with 60% of all cases occurring in the AL arm. Overall, 179 non-clinical hepatic AEs were recorded in the AL arm versus 145 in the PA arm. Elevated ALT was noted in 3.05% of treated malaria episodes, elevated AST 3.34%, elevated ALP 1.81%, and elevated total and direct bilirubin in 7.90% and 7.40% respectively. Retreated participants were less likely to experience elevated ALT and AST than first episode treated participants in both arms. One case of Hy’s law condition was recorded in a first treated participant of the PA arm. Participants from the retreatment group were 76% and 84% less likely to have elevated ALT and AST, respectively, in the AL arm and 68% less likely to present elevated ALT in the PA arm. In contrast, they were almost 2 times more likely to experience elevated total bilirubin in both arms. Conclusions Pyronaridine-artesunate and artemether–lumefantrine showed similar hepatic safety when used repeatedly in participants with uncomplicated malaria. Pyronaridine-artesunate represents therefore a suitable alternative to the current first line anti-malarial drugs in use in endemic areas. Trial registration Pan African Clinical Trials Registry. PACTR201105000286876
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Affiliation(s)
- Yves Daniel Compaoré
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo Dioulasso, Burkina Faso.
| | - Issaka Zongo
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo Dioulasso, Burkina Faso
| | - Anyirékun F Somé
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo Dioulasso, Burkina Faso
| | - Nouhoun Barry
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso
| | - Frederick Nikiéma
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo Dioulasso, Burkina Faso
| | | | | | - Zachari Kabré
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo Dioulasso, Burkina Faso
| | - Kadidiatou Wermi
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo Dioulasso, Burkina Faso
| | - Moussa Zongo
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo Dioulasso, Burkina Faso
| | - Rakiswende S Yerbanga
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo Dioulasso, Burkina Faso
| | - Issaka Sagara
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Abdoulaye Djimdé
- Malaria Research and Training Center, Department of Epidemiology of Parasitic Diseases, Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Jean Bosco Ouédraogo
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo Dioulasso, Burkina Faso
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8
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Gansané A, Moriarty LF, Ménard D, Yerbanga I, Ouedraogo E, Sondo P, Kinda R, Tarama C, Soulama E, Tapsoba M, Kangoye D, Compaore CS, Badolo O, Dao B, Tchwenko S, Tinto H, Valea I. Anti-malarial efficacy and resistance monitoring of artemether-lumefantrine and dihydroartemisinin-piperaquine shows inadequate efficacy in children in Burkina Faso, 2017-2018. Malar J 2021; 20:48. [PMID: 33468147 PMCID: PMC7816451 DOI: 10.1186/s12936-021-03585-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background The World Health Organization recommends regularly assessing the efficacy of artemisinin-based combination therapy (ACT), which is a critical tool in the fight against malaria. This study evaluated the efficacy of two artemisinin-based combinations recommended to treat uncomplicated Plasmodium falciparum malaria in Burkina Faso in three sites: Niangoloko, Nanoro, and Gourcy. Methods This was a two-arm randomized control trial of the efficacy of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP). Children aged 6–59 months old were monitored for 42 days. The primary outcomes of the study were uncorrected and PCR-corrected efficacies to day 28 for AL and 42 for DP. Molecular markers of resistance to artemisinin derivatives and partner drugs were also analysed. Results Of 720 children enrolled, 672 reached study endpoints at day 28, 333 in the AL arm and 339 in the DP arm. PCR-corrected 28-day per protocol efficacy in the AL arm was 74% (64–83%) in Nanoro, 76% (66–83%) in Gourcy, and 92% (84–96%) in Niangoloko. The PCR-corrected 42-day per protocol efficacy in the DP arm was 84% (75–89%) in Gourcy, 89% (81–94%) in Nanoro, and 97% (92–99%) in Niangoloko. No Pfk13 mutation previously associated with artemisinin-resistance was observed. No statistically significant association was found between treatment outcome and presence of the 86Y mutation in the Pfmdr1 gene. There was also no association observed between treatment outcome and Pfpm2 or Pfmdr1 copy number variation. Conclusion The results of this study indicate evidence of inadequate efficacy of AL at day 28 and DP at day 42 in the same two sites. A change of first-line ACT may be warranted in Burkina Faso. Trial Registry Pan African Clinical Trial Registry Identifier: PACTR201708002499311. Date of registration: 8/3/2017 https://pactr.samrc.ac.za/Search.aspx
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Affiliation(s)
- Adama Gansané
- Centre National de Recherche Et de Formation Sur Le Paludisme, Ouagadougou, Burkina Faso.
| | - Leah F Moriarty
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, US President's Malaria Initiative, Atlanta, GA, USA
| | - Didier Ménard
- Malaria Genetics and Resistance Unit, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Isidore Yerbanga
- IRSS / Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Esperance Ouedraogo
- Centre National de Recherche Et de Formation Sur Le Paludisme, Ouagadougou, Burkina Faso
| | - Paul Sondo
- IRSS / Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Rene Kinda
- Centre National de Recherche Et de Formation Sur Le Paludisme, Ouagadougou, Burkina Faso
| | - Casimir Tarama
- Centre National de Recherche Et de Formation Sur Le Paludisme, Ouagadougou, Burkina Faso
| | - Edwige Soulama
- Centre National de Recherche Et de Formation Sur Le Paludisme, Ouagadougou, Burkina Faso
| | - Madou Tapsoba
- Centre National de Recherche Et de Formation Sur Le Paludisme, Ouagadougou, Burkina Faso
| | - David Kangoye
- Centre National de Recherche Et de Formation Sur Le Paludisme, Ouagadougou, Burkina Faso
| | | | - Ousmane Badolo
- JHPIEGO/ Improving Malaria Care, Ouagadougou, Burkina Faso
| | - Blami Dao
- JHPIEGO/ Improving Malaria Care, Ouagadougou, Burkina Faso
| | - Samuel Tchwenko
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, US President's Malaria Initiative, Atlanta, GA, USA
| | - Halidou Tinto
- IRSS / Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
| | - Innocent Valea
- IRSS / Unité de Recherche Clinique de Nanoro, Nanoro, Burkina Faso
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9
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Rouamba T, Sondo P, Derra K, Nakanabo-Diallo S, Bihoun B, Rouamba E, Tarnagda Z, Kazienga A, Valea I, Sorgho H, Pagnoni F, Samadoulougou-Kirakoya F, Tinto H. Optimal Approach and Strategies to Strengthen Pharmacovigilance in Sub-Saharan Africa: A Cohort Study of Patients Treated with First-Line Artemisinin-Based Combination Therapies in the Nanoro Health and Demographic Surveillance System, Burkina Faso. Drug Des Devel Ther 2020; 14:1507-1521. [PMID: 32368010 PMCID: PMC7174163 DOI: 10.2147/dddt.s224857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/08/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Resource-limited countries face challenges in setting up effective pharmacovigilance systems. This study aimed to monitor the occurrence of adverse events (AEs) after the use of artemisinin-based combination therapies (ACTs), identify potential drivers of reporting suspected adverse drug reactions (ADRs) and monitor AEs among women who were inadvertently exposed to ACTs in the first trimester of pregnancy. PATIENTS AND METHODS We conducted a prospective observational study from May 2010 to July 2012 in Nanoro Health and Demographic Surveillance System (HDSS), Burkina Faso. The HDSS area was divided into active and passive surveillance areas to monitor AEs among patients (regardless of age or sex) who received a first-line ACT (artemether-lumefantrine or artesunate-amodiaquine). In the active surveillance area, patients were followed up for 28 days, while in the passive surveillance area, patients were encouraged to return voluntarily to the health facility to report any occurrence of AEs until day 28 after drug intake. We assessed the crude incidence rates of AEs in both cohorts and performed Cox regression with mixed random effects to identify potential drivers of ADR occurrence. RESULTS In total, 3170 participants were included in the study. Of these, 40.3% had reported at least one AE, with 39.6% and 44.4% from active and passive surveillance groups, respectively. The types of ADRs were similar in both groups. The most frequent reported ADRs were anorexia, weakness, cough, dizziness and pruritus. One case of abortion and eight cases of death were reported, but none of them was related to the ACT. The variance in random factors showed a high variability of ADR occurrence between patients in both groups, whereas variability between health facilities was low in the active surveillance group and high in passive surveillance group. Taking more than two concomitant medications was associated with high hazard in ADR occurrence, whereas the rainy season was associated with low hazard. CONCLUSION This study showed that both passive and active surveillance approaches were useful tools. The HDSS allowed us to capture a few cases of exposure during the first trimester of pregnancy. The passive surveillance approach, which is more likely to be implemented by malaria control programs, seems to be more relevant in the Sub-Saharan African context.
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Affiliation(s)
- Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
- Center for Research in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Paul Sondo
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Karim Derra
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Seydou Nakanabo-Diallo
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
- Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Biebo Bihoun
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Eli Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Zekiba Tarnagda
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Adama Kazienga
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Innocent Valea
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Hermann Sorgho
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | | | - Fati Samadoulougou-Kirakoya
- Center for Research in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
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10
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Zongo I, Compaoré YD, Nikiéma F, Zongo M, Barry N, Somé FA, Kaboré N, Ouédraogo JB. Efficacy of artemether-lumefantrine and artesunate-amodiaquine as first line therapy of uncomplicated malaria in Burkina Faso, 11 years after policy change. Pan Afr Med J 2020; 35:68. [PMID: 32537072 PMCID: PMC7250195 DOI: 10.11604/pamj.2020.35.68.20849] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/23/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) are the first line therapy of uncomplicated malaria in Burkina Faso. We assessed the treatment efficacy, tolerability of these drugs 11 years following its adoption as first line treatment. Methods In this opened randomized controlled trial carried out in 2016, participants with age over 6 months who consented to participate were randomly assigned treatment with artemether-lumefantrine or artesunate-amodiaquine and followed up for 28 days. Primary endpoint was the treatment efficacy over 28 days of follow up unadjusted by Polymerase chain reaction (PCR). Results Two hundred and eighty-one (281) participants were enrolled and the completion rate was 92.9%. No early treatment failure was found. Adequate clinical and parasitological responses were significantly higher in artesunate-amodiaquine group (97% versus 85.2%, p = 0.0008). On day 28, the risk of failure was 4 times higher in AL group 20.14%, 95% CI (13-30.47) against 5.16%, 95% CI (1.91-13.54) in ASAQ group. All treatments had a similar and good tolerability profile. Conclusion Eleven years following artemether-lumefantrine and artesunate-amodiaquine adoption as first line therapy for uncomplicated malaria in Burkina Faso, artemether-lumefantrine retained fairly good efficacy even though its efficacy fell below WHO threshold of 90% considering uncorrected outcome.
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Affiliation(s)
- Issaka Zongo
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Yves Daniel Compaoré
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Frédéric Nikiéma
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Moussa Zongo
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Nouhoun Barry
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Fabrice Anyirékun Somé
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Naomie Kaboré
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
| | - Jean Bosco Ouédraogo
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, Bobo-Dioulasso, Burkina Faso
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11
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Lingani M, Bonkian LN, Yerbanga I, Kazienga A, Valéa I, Sorgho H, Ouédraogo JB, Mens PF, Schallig HDFH, Ravinetto R, d'Alessandro U, Tinto H. In vivo/ex vivo efficacy of artemether-lumefantrine and artesunate-amodiaquine as first-line treatment for uncomplicated falciparum malaria in children: an open label randomized controlled trial in Burkina Faso. Malar J 2020; 19:8. [PMID: 31906948 PMCID: PMC6945612 DOI: 10.1186/s12936-019-3089-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Artemisinin-based combination therapy (ACT) is recommended to improve malaria treatment efficacy and limit drug-resistant parasites selection in malaria endemic areas. 5 years after they were adopted, the efficacy and safety of artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ), the first-line treatments for uncomplicated malaria were assessed in Burkina Faso. METHODS In total, 440 children with uncomplicated Plasmodium falciparum malaria were randomized to receive either AL or ASAQ for 3 days and were followed up weekly for 42 days. Blood samples were collected to investigate the ex vivo susceptibility of P. falciparum isolates to lumefantrine, dihydroartemisinin (the active metabolite of artemisinin derivatives) and monodesethylamodiaquine (the active metabolite of amodiaquine). The modified isotopic micro test technique was used to determine the 50% inhibitory concentration (IC50) values. Primary endpoints were the risks of treatment failure at days 42. RESULTS Out of the 440 patients enrolled, 420 (95.5%) completed the 42 days follow up. The results showed a significantly higher PCR unadjusted cure rate in ASAQ arm (71.0%) than that in the AL arm (49.8%) on day 42, and this trend was similar after correction by PCR, with ASAQ performing better (98.1%) than AL (91.1%). Overall adverse events incidence was low and not significantly different between the two treatment arms. Ex vivo results showed that 6.4% P. falciparum isolates were resistant to monodesthylamodiaquine. The coupled in vivo/ex vivo analysis showed increased IC50 values for lumefantrine and monodesethylamodiaquine at day of recurrent parasitaemia compared to baseline values while for artesunate, IC50 values remained stable at baseline and after treatment failure (p > 0.05). CONCLUSION These findings provide substantial evidence that AL and ASAQ are highly efficacious for the treatment of uncomplicated malaria in children in Burkina Faso. However, the result of P. falciparum susceptibility to the partner drugs advocates the need to regularly replicate such surveillance studies. This would be particularly indicated when amodiaquine is associated in seasonal malaria chemoprophylaxis (SMC) mass drug administration in children under 5 years in Burkina Faso. Trial registration clinicaltrials, NCT00808951. Registered 05 December 2008,https://clinicaltrials.gov/ct2/show/NCT00808951?cond=NCT00808951&rank=1.
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Affiliation(s)
- Moussa Lingani
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso. .,Unité de Recherche Clinique de Nanoro (URCN), Nanoro, Burkina Faso. .,École de Santé Publique, Université Libre de Bruxelles, CP594, Route de Lennik 808, 1070, Bruxelles, Belgique.
| | - Léa Nadège Bonkian
- Unité de Recherche sur le Paludisme et Maladies Tropicales Négligées, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Isidore Yerbanga
- Unité de Recherche Clinique de Nanoro (URCN), Nanoro, Burkina Faso
| | - Adama Kazienga
- Unité de Recherche Clinique de Nanoro (URCN), Nanoro, Burkina Faso
| | - Innocent Valéa
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso.,Unité de Recherche Clinique de Nanoro (URCN), Nanoro, Burkina Faso
| | - Hermann Sorgho
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso.,Unité de Recherche Clinique de Nanoro (URCN), Nanoro, Burkina Faso
| | - Jean Bosco Ouédraogo
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso
| | - Petronella Francisca Mens
- Department of Medical Microbiology, Experimental Parasitology Unit, Amsterdam University Medical Centres, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
| | - Henk D F H Schallig
- Department of Medical Microbiology, Experimental Parasitology Unit, Amsterdam University Medical Centres, Academic Medical Centre at the University of Amsterdam, Amsterdam, The Netherlands
| | | | - Umberto d'Alessandro
- Medical Research Council Unit, The Gambia, Disease Control & Elimination Theme, Fajara, The Gambia
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), Nanoro, Burkina Faso.,Unité de Recherche Clinique de Nanoro (URCN), Nanoro, Burkina Faso
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Improving Methods for Analyzing Antimalarial Drug Efficacy Trials: Molecular Correction Based on Length-Polymorphic Markers msp-1, msp-2, and glurp. Antimicrob Agents Chemother 2019; 63:AAC.00590-19. [PMID: 31307982 PMCID: PMC6709465 DOI: 10.1128/aac.00590-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/02/2019] [Indexed: 01/14/2023] Open
Abstract
Drug efficacy trials monitor the continued efficacy of front-line drugs against falciparum malaria. Overestimating efficacy results in a country retaining a failing drug as first-line treatment with associated increases in morbidity and mortality, while underestimating drug effectiveness leads to removal of an effective treatment with substantial practical and economic implications. Drug efficacy trials monitor the continued efficacy of front-line drugs against falciparum malaria. Overestimating efficacy results in a country retaining a failing drug as first-line treatment with associated increases in morbidity and mortality, while underestimating drug effectiveness leads to removal of an effective treatment with substantial practical and economic implications. Trials are challenging: they require long durations of follow-up to detect drug failures, and patients are frequently reinfected during that period. Molecular correction based on parasite genotypes distinguishes reinfections from drug failures to ensure the accuracy of failure rate estimates. Several molecular correction “algorithms” have been proposed, but which is most accurate and/or robust remains unknown. We used pharmacological modeling to simulate parasite dynamics and genetic signals that occur in patients enrolled in malaria drug clinical trials. We compared estimates of treatment failure obtained from a selection of proposed molecular correction algorithms against the known “true” failure rate in the model. Our findings are as follows. (i) Molecular correction is essential to avoid substantial overestimates of drug failure rates. (ii) The current WHO-recommended algorithm consistently underestimates the true failure rate. (iii) Newly proposed algorithms produce more accurate failure rate estimates; the most accurate algorithm depends on the choice of drug, trial follow-up length, and transmission intensity. (iv) Long durations of patient follow-up may be counterproductive; large numbers of new infections accumulate and may be misclassified, overestimating drug failure rate. (v) Our model was highly consistent with existing in vivo data. The current WHO-recommended method for molecular correction and analysis of clinical trials should be reevaluated and updated.
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Dama S, Niangaly H, Djimde M, Sagara I, Guindo CO, Zeguime A, Dara A, Djimde AA, Doumbo OK. A randomized trial of dihydroartemisinin-piperaquine versus artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Mali. Malar J 2018; 17:347. [PMID: 30290808 PMCID: PMC6173860 DOI: 10.1186/s12936-018-2496-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/28/2018] [Indexed: 11/28/2022] Open
Abstract
Background Artemether–lumefantrine (AL) and artesunate–amodiaquine are first-line treatment for uncomplicated malaria in many endemic countries, including Mali. Dihydroartemisinin–piperaquine (DHA–PQ) is also an alternative first-line artemisinin-based combination therapy, but only few data are available on DHA–PQ efficacy in sub-Saharan Africa. The main aim of this study was to compare clinical efficacy of DHA–PQ versus AL, using the World Health Organization (WHO) 42-day in vivo protocol. Methods The efficacy of three-dose regimens of DHA–PQ was compared to AL combination in a randomized, comparative open label trial using the WHO 42-day follow-up protocol from 2013 to 2015 in Doneguebougou and Torodo, Mali. The primary endpoint was to access the PCR-corrected Adequate Clinical and Parasitological Responses at day 28. Results A total of 317 uncomplicated malaria patients were enrolled, with 159 in DHA–PQ arm and 158 in AL arm. The parasite positivity rate decreased from 68.4% (95% CI 60.5–75.5) on day 1 to 3.8% (95% CI 1.4–8.1) on day 2 for DHA–PQ and 79.8% (95% CI 72.3–85.7) on day 1 to 9.5% (95% CI 5.4–15.2) on day 2 for AL, (p = 0.04). There was a significant difference in the uncorrected ACPR between DHA–PQ and AL, both at 28-day and 42-day follow-up with 97.4% (95% CI 93.5–99.3) in DHA–PQ vs 84.5% (95% CI 77.8–89.8) in AL (p < 0.001) and 94.2% (95% CI 89.3–97.3) in DHA–PQ vs 73.4% (95% CI 65.7–80.2) in AL, respectively (p < 0.001). After molecular correction, there was no significant difference in ACPRc between DHA–PQ and AL, both at the 28-day and 42-day follow-up with 99.4% (95% CI 96.5–100) in DHA–PQ versus 98.1% (95% CI 94.5–99.6) in AL (p = 0.3) and 99.3% (95% CI 96.5–100) in DHA–PQ vs 97.4% (95% CI 93.5–99.3) in AL (p = 0.2). There was no significant difference between DHA–PQ and AL in QTc prolongation 12.1% vs 7%, respectively (p = 0.4). Conclusion The results showed that dihydroartemisinin–piperaquine and artemether–lumefantrine were clinically efficacious on Plasmodium falciparum parasites in Mali.
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Affiliation(s)
- Souleymane Dama
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali.
| | - Hamidou Niangaly
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Moussa Djimde
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Issaka Sagara
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Cheick Oumar Guindo
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Amatigue Zeguime
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Antoine Dara
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Abdoulaye A Djimde
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
| | - Ogobara K Doumbo
- Malaria Research and Training Centre, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technology of Bamako, P.O. Box 1805, Bamako, Mali
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Ndounga Diakou LA, Ntoumi F, Ravaud P, Boutron I. Published randomized trials performed in Sub-Saharan Africa focus on high-burden diseases but are frequently funded and led by high-income countries. J Clin Epidemiol 2017; 82:29-36.e6. [DOI: 10.1016/j.jclinepi.2016.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/10/2016] [Accepted: 10/26/2016] [Indexed: 01/05/2023]
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Somé AF, Sorgho H, Zongo I, Bazié T, Nikiéma F, Sawadogo A, Zongo M, Compaoré YD, Ouédraogo JB. Polymorphisms in K13, pfcrt, pfmdr1, pfdhfr, and pfdhps in parasites isolated from symptomatic malaria patients in Burkina Faso. ACTA ACUST UNITED AC 2016; 23:60. [PMID: 28004634 PMCID: PMC5178381 DOI: 10.1051/parasite/2016069] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/06/2016] [Indexed: 11/22/2022]
Abstract
Background: The emergence of resistance to artemisinin derivatives in western Cambodia is threatening to revert the recent advances made toward global malaria control and elimination. Known resistance-mediating polymorphisms in the K13, pfcrt, pfmdr1, pfdhfr, and pfdhps genes are of greatest importance for monitoring the spread of antimalarial drug resistance. Methods: Samples for the present study were collected from 244 patients with uncomplicated malaria in health centers of Bobo-Dioulasso, Burkina Faso. Blood sample was collected on filter paper before the subject received any treatment. The parasite DNA was then extracted and amplified by Polymerase Chain Reaction (PCR) to evaluate the prevalence of polymorphism of pfcrtK76T, pfmdr1 (N86Y, Y184F), and pfdhps (A437G, K540E). The K13 gene polymorphism was analyzed by nested PCR followed by sequencing. Results: The overall results showed 2.26% (5/221) of K13 synonymous mutant alleles (two C469C, one Y493Y, one G496G, and one V589V), 24.78%, 19.58%, 68.75%, 60.9%, 53.7%, 63.8%, and 64.28%, respectively, for mutant pfcrt 76T, pfmdr1-86Y, pfmdr1-184F, pfdhfr51I, pfdhfr59R, pfdhfr108N, and pfdhps 437G. We did not report any mutation at codon 540 of pfdhps. Conclusion: These results provide baseline prevalence of known drug resistance polymorphisms and suggest that artemisinin combination therapies may retain good efficacy in the treatment of uncomplicated malaria in Burkina Faso.
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Affiliation(s)
- Anyirékun Fabrice Somé
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, 399 Avenue de la liberté, 01 BP 545, Bobo-Dioulasso 01, Burkina Faso
| | - Hermann Sorgho
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro, BP 218 Ouaga CMS 11, Burkina Faso
| | - Issaka Zongo
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, 399 Avenue de la liberté, 01 BP 545, Bobo-Dioulasso 01, Burkina Faso
| | - Thomas Bazié
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, 399 Avenue de la liberté, 01 BP 545, Bobo-Dioulasso 01, Burkina Faso
| | - Frédéric Nikiéma
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, 399 Avenue de la liberté, 01 BP 545, Bobo-Dioulasso 01, Burkina Faso
| | - Amadé Sawadogo
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, 399 Avenue de la liberté, 01 BP 545, Bobo-Dioulasso 01, Burkina Faso
| | - Moussa Zongo
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, 399 Avenue de la liberté, 01 BP 545, Bobo-Dioulasso 01, Burkina Faso
| | - Yves-Daniel Compaoré
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, 399 Avenue de la liberté, 01 BP 545, Bobo-Dioulasso 01, Burkina Faso
| | - Jean-Bosco Ouédraogo
- Institut de Recherche en Sciences de la Santé, Direction Régionale de l'Ouest, 399 Avenue de la liberté, 01 BP 545, Bobo-Dioulasso 01, Burkina Faso
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Sondo P, Derra K, Diallo Nakanabo S, Tarnagda Z, Kazienga A, Zampa O, Valéa I, Sorgho H, Owusu-Dabo E, Ouédraogo JB, Guiguemdé TR, Tinto H. Artesunate-Amodiaquine and Artemether-Lumefantrine Therapies and Selection of Pfcrt and Pfmdr1 Alleles in Nanoro, Burkina Faso. PLoS One 2016; 11:e0151565. [PMID: 27031231 PMCID: PMC4816516 DOI: 10.1371/journal.pone.0151565] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 03/01/2016] [Indexed: 11/18/2022] Open
Abstract
The adoption of Artemisinin based combination therapies (ACT) constitutes a basic strategy for malaria control in sub-Saharan Africa. Moreover, since cases of ACT resistance have been reported in South-East Asia, the need to understand P. falciparum resistance mechanism to ACT has become a global research goal. The selective pressure of ACT and the possibility that some specific Pfcrt and Pfmdr1 alleles are associated with treatment failures was assessed in a clinical trial comparing ASAQ to AL in Nanoro. Dried blood spots collected on Day 0 and on the day of recurrent parasitaemia during the 28-day follow-up were analyzed using the restriction fragments length polymorphism (PCR-RFLP) method to detect single nucleotide polymorphisms (SNPs) in Pfcrt (codon76) and Pfmdr1 (codons 86, 184, 1034, 1042, and 1246) genes. Multivariate analysis of the relationship between the presence of Pfcrt and Pfmdr1 alleles and treatment outcome was performed. AL and ASAQ exerted opposite trends in selecting Pfcrt K76T and Pfmdr1-N86Y alleles, raising the potential beneficial effect of using diverse ACT at the same time as first line treatments to reduce the selective pressure by each treatment regimen. No clear association between the presence of Pfcrt and Pfmdr1 alleles carried at baseline and treatment failure was observed.
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Affiliation(s)
- Paul Sondo
- IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
- * E-mail:
| | - Karim Derra
- IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Seydou Diallo Nakanabo
- IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
- Centre Muraz of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Zekiba Tarnagda
- IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Adama Kazienga
- IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Odile Zampa
- Centre Muraz of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Innocent Valéa
- IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
- Centre Muraz of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Hermann Sorgho
- IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Ellis Owusu-Dabo
- Kumasi Center for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | | | | | - Halidou Tinto
- IRSS / Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
- Centre Muraz of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
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Ogouyèmi-Hounto A, Azandossessi C, Lawani S, Damien G, de Tove YSS, Remoue F, Kinde Gazard D. Therapeutic efficacy of artemether-lumefantrine for the treatment of uncomplicated falciparum malaria in northwest Benin. Malar J 2016; 15:37. [PMID: 26801767 PMCID: PMC4722724 DOI: 10.1186/s12936-016-1091-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background Artemether/lumefantrine (Coartem®) has been used as a treatment for uncomplicated Plasmodium falciparum infection since 2004 in Benin. This open-label, non-randomized study evaluated efficacy of artemether–lumefantrine (AL) in treatment of uncomplicated falciparum malaria in children aged 6–59 months in two malaria transmission sites in northwest Benin. Methods
A 42-day therapeutic efficacy study was conducted between August and November 2014, in accordance with 2009 WHO guidelines. One-hundred and twenty-three children, aged 6 months to 5 years, with uncomplicated falciparum malaria were recruited into the study. The primary endpoint was parasitological cure on day 28 and day 42 while the secondary endpoints included: parasite and fever clearance, improvement in haemoglobin levels. Outcomes were classified as early treatment failure (ETF), late clinical failure, late parasitological failure, and adequate clinical and parasitological response (ACPR). Results Before PCR correction, ACPR rates were 87 % (95 % CI 76.0–94.7) and 75.6 %, respectively (95 % CI 67.0–82.9) on day 28 and day 42. In each study site, ACPR rates were 78.3 % in Djougou and 73 % in Cobly on day 42. There was no ETF and after PCR correction ACPR was 100 % in study population. All treatment failures were shown to be due to new infections. Fever was significantly cleared in 24 h and approximately 90 % of parasites where cleared on day 1 and almost all parasites were cleared on day 2. Haemoglobin concentration showed a slight increase with parasitic clearance. Conclusion AL remains an efficacious drug for the treatment of uncomplicated falciparum malaria in Benin, although higher rates of re-infection remain a concern. Surveillance needs to be continued to detect future changes in parasite sensitivity to artemisinin-based combination therapy.
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Affiliation(s)
- Aurore Ogouyèmi-Hounto
- Unité d'Enseignement et de Recherche en Parasitologie Mycologie/Faculté des Sciences de la Santé, laboratoire du Centre de Lutte intégrée contre le paludisme, 01 BP188, Cotonou, Benin. .,Laboratoire du Centre de Lutte intégrée contre le paludisme, 01 BP188, Cotonou, Benin.
| | | | - Souliatou Lawani
- Laboratoire du Centre de Lutte intégrée contre le paludisme, 01 BP188, Cotonou, Benin.
| | - Georgia Damien
- UMR 224-MIVEGEC, Institut de Recherche pour le Développement, 08 BP 841, Cotonou, Benin.
| | - Yolande Sissinto Savi de Tove
- Unité d'Enseignement et de Recherche en Parasitologie Mycologie/Faculté des Sciences de la Santé, laboratoire du Centre de Lutte intégrée contre le paludisme, 01 BP188, Cotonou, Benin. .,Laboratoire du Centre de Lutte intégrée contre le paludisme, 01 BP188, Cotonou, Benin.
| | - Franck Remoue
- UMR 224-MIVEGEC, Institut de Recherche pour le Développement, 08 BP 841, Cotonou, Benin.
| | - Dorothée Kinde Gazard
- Unité d'Enseignement et de Recherche en Parasitologie Mycologie/Faculté des Sciences de la Santé, laboratoire du Centre de Lutte intégrée contre le paludisme, 01 BP188, Cotonou, Benin. .,Laboratoire du Centre de Lutte intégrée contre le paludisme, 01 BP188, Cotonou, Benin.
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Sondo P, Derra K, Diallo-Nakanabo S, Tarnagda Z, Zampa O, Kazienga A, Valea I, Sorgho H, Owusu-Dabo E, Ouedraogo JB, Guiguemde TR, Tinto H. Effectiveness and safety of artemether-lumefantrine versus artesunate-amodiaquine for unsupervised treatment of uncomplicated falciparum malaria in patients of all age groups in Nanoro, Burkina Faso: a randomized open label trial. Malar J 2015; 14:325. [PMID: 26289949 PMCID: PMC4545998 DOI: 10.1186/s12936-015-0843-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/10/2015] [Indexed: 11/14/2022] Open
Abstract
Background Several studies have reported high efficacy and safety of artemisinin-based combination therapy (ACT) mostly under strict supervision of drug intake and limited to children less than 5 years of age. Patients over 5 years of age are usually not involved in such studies. Thus, the findings do not fully reflect the reality in the field. This study aimed to assess the effectiveness and safety of ACT in routine treatment of uncomplicated malaria among patients of all age groups in Nanoro, Burkina Faso. Methods A randomized open label trial comparing artesunate–amodiaquine (ASAQ) and artemether–lumefantrine (AL) was carried out from September 2010 to October 2012 at two primary health centres (Nanoro and Nazoanga) of Nanoro health district. A total of 680 patients were randomized to receive either ASAQ or AL without any distinction by age. Drug intake was not supervised as pertains in routine practice in the field. Patients or their parents/guardians were advised on the time and mode of administration for the 3 days treatment unobserved at home. Follow-up visits were performed on days 3, 7, 14, 21, and 28 to evaluate clinical and parasitological resolution of their malaria episode as well as adverse events. PCR genotyping of merozoite surface proteins 1 and 2 (msp-1, msp-2) was used to differentiate recrudescence and new infection. Results By day 28, the PCR corrected adequate clinical and parasitological response was 84.1 and 77.8 % respectively for ASAQ and AL. The cure rate was higher in older patients than in children under 5 years old. The risk of re-infection by day 28 was higher in AL treated patients compared with those receiving ASAQ (p < 0.00001). Both AL and ASAQ treatments were well tolerated. Conclusion This study shows a lowering of the efficacy when drug intake is not directly supervised. This is worrying as both rates are lower than the critical threshold of 90 % required by the WHO to recommend the use of an anti-malarial drug in a treatment policy. Trial registration: NCT01232530
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Affiliation(s)
- Paul Sondo
- IRSS, Clinical Research Unit of Nanoro (CRUN), CMA Saint Camille of Nanoro, BP 218 Ouagadougou CMS 11, Nanoro, Burkina Faso.
| | - Karim Derra
- IRSS, Clinical Research Unit of Nanoro (CRUN), CMA Saint Camille of Nanoro, BP 218 Ouagadougou CMS 11, Nanoro, Burkina Faso.
| | - Seydou Diallo-Nakanabo
- IRSS, Clinical Research Unit of Nanoro (CRUN), CMA Saint Camille of Nanoro, BP 218 Ouagadougou CMS 11, Nanoro, Burkina Faso.
| | - Zekiba Tarnagda
- IRSS, Clinical Research Unit of Nanoro (CRUN), CMA Saint Camille of Nanoro, BP 218 Ouagadougou CMS 11, Nanoro, Burkina Faso.
| | - Odile Zampa
- Centre Muraz of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso.
| | - Adama Kazienga
- IRSS, Clinical Research Unit of Nanoro (CRUN), CMA Saint Camille of Nanoro, BP 218 Ouagadougou CMS 11, Nanoro, Burkina Faso.
| | - Innocent Valea
- IRSS, Clinical Research Unit of Nanoro (CRUN), CMA Saint Camille of Nanoro, BP 218 Ouagadougou CMS 11, Nanoro, Burkina Faso. .,Centre Muraz of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso.
| | - Hermann Sorgho
- IRSS, Clinical Research Unit of Nanoro (CRUN), CMA Saint Camille of Nanoro, BP 218 Ouagadougou CMS 11, Nanoro, Burkina Faso.
| | - Ellis Owusu-Dabo
- Kumasi Center for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana.
| | - Jean-Bosco Ouedraogo
- IRSS, Clinical Research Unit of Nanoro (CRUN), CMA Saint Camille of Nanoro, BP 218 Ouagadougou CMS 11, Nanoro, Burkina Faso.
| | | | - Halidou Tinto
- IRSS, Clinical Research Unit of Nanoro (CRUN), CMA Saint Camille of Nanoro, BP 218 Ouagadougou CMS 11, Nanoro, Burkina Faso. .,Centre Muraz of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso.
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Djimde AA, Makanga M, Kuhen K, Hamed K. The emerging threat of artemisinin resistance in malaria: focus on artemether-lumefantrine. Expert Rev Anti Infect Ther 2015; 13:1031-45. [PMID: 26081265 DOI: 10.1586/14787210.2015.1052793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The development of artemisinin resistance in the Greater Mekong Subregion poses a significant threat to malaria elimination. Artemisinin-based combination therapies including artemether-lumefantrine (AL) are recommended by WHO as first-line treatment for uncomplicated Plasmodium falciparum malaria. This article provides a comprehensive review of the existing and latest data as a basis for interpretation of observed variability in parasite sensitivity to AL over the last 5 years. Clinical efficacy and preclinical data from a range of endemic countries are summarized, including potential molecular markers of resistance. Overall, AL remains effective in the treatment of uncomplicated P. falciparum malaria in most regions. Establishing validated molecular markers for resistance and strict efficacy monitoring will reinforce timely updates of treatment policies.
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Affiliation(s)
- Abdoulaye A Djimde
- Malaria Research and Training Center, University of Science, Techniques and Technologies of Bamako, Bamako, Mali
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20
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Sondo P, Derra K, Tarnagda Z, Nakanabo SD, Zampa O, Kazienga A, Valea I, Sorgho H, Ouedraogo JB, Guiguemde TR, Tinto H. Dynamic of plasmodium falciparum chloroquine resistance transporter gene Pfcrt K76T mutation five years after withdrawal of chloroquine in Burkina Faso. Pan Afr Med J 2015; 21:101. [PMID: 26516402 PMCID: PMC4606025 DOI: 10.11604/pamj.2015.21.101.6437] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/18/2015] [Indexed: 11/28/2022] Open
Abstract
We investigated the evolution of Pfcrt K76T mutation five years after the withdrawal of chloroquine in Burkina Faso. A total of 675 clinical isolates collected from October 2010 to September 2012 were successfully genotyped. Single nucleotide polymorphism in Pfcrt (codon 76) gene was analyzed. The prevalence of resistant Pfcrt 76T allele was 20.55%. There was a progressive decrease of the proportion of mutant type pfcrt T76 from 2010 to 2012 (X2=5.508 p=0.0189). Our results suggest a progressive return of the wild type Pfcrt K76 in Burkina Faso but the prevalence of the mutants Pfcrt T76 still remains high.
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Affiliation(s)
- Paul Sondo
- IRSS, Clinical Research Unit of Nanoro, CMA Saint Camille de Nanoro, Ouagadougou CMS 11, Burkina Faso
| | - Karim Derra
- IRSS, Clinical Research Unit of Nanoro, CMA Saint Camille de Nanoro, Ouagadougou CMS 11, Burkina Faso
| | - Zekiba Tarnagda
- IRSS, Clinical Research Unit of Nanoro, CMA Saint Camille de Nanoro, Ouagadougou CMS 11, Burkina Faso
| | - Seydou Diallo Nakanabo
- IRSS, Clinical Research Unit of Nanoro, CMA Saint Camille de Nanoro, Ouagadougou CMS 11, Burkina Faso
| | - Odile Zampa
- Center Muraz of Bobo-Dioulasso, Burkina Faso
| | - Adama Kazienga
- IRSS, Clinical Research Unit of Nanoro, CMA Saint Camille de Nanoro, Ouagadougou CMS 11, Burkina Faso
| | - Innocent Valea
- IRSS, Clinical Research Unit of Nanoro, CMA Saint Camille de Nanoro, Ouagadougou CMS 11, Burkina Faso ; Center Muraz of Bobo-Dioulasso, Burkina Faso
| | - Hermann Sorgho
- IRSS, Clinical Research Unit of Nanoro, CMA Saint Camille de Nanoro, Ouagadougou CMS 11, Burkina Faso
| | - Jean-Bosco Ouedraogo
- IRSS, Clinical Research Unit of Nanoro, CMA Saint Camille de Nanoro, Ouagadougou CMS 11, Burkina Faso
| | | | - Halidou Tinto
- IRSS, Clinical Research Unit of Nanoro, CMA Saint Camille de Nanoro, Ouagadougou CMS 11, Burkina Faso ; Center Muraz of Bobo-Dioulasso, Burkina Faso
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Impact of antimalarial treatment and chemoprevention on the drug sensitivity of malaria parasites isolated from ugandan children. Antimicrob Agents Chemother 2015; 59:3018-30. [PMID: 25753626 DOI: 10.1128/aac.05141-14] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/01/2015] [Indexed: 12/28/2022] Open
Abstract
Changing treatment practices may be selecting for changes in the drug sensitivity of malaria parasites. We characterized ex vivo drug sensitivity and parasite polymorphisms associated with sensitivity in 459 Plasmodium falciparum samples obtained from subjects enrolled in two clinical trials in Tororo, Uganda, from 2010 to 2013. Sensitivities to chloroquine and monodesethylamodiaquine varied widely; sensitivities to quinine, dihydroartemisinin, lumefantrine, and piperaquine were generally good. Associations between ex vivo drug sensitivity and parasite polymorphisms included decreased chloroquine and monodesethylamodiaquine sensitivity and increased lumefantrine and piperaquine sensitivity with pfcrt 76T, as well as increased lumefantrine sensitivity with pfmdr1 86Y, Y184, and 1246Y. Over time, ex vivo sensitivity decreased for lumefantrine and piperaquine and increased for chloroquine, the prevalences of pfcrt K76 and pfmdr1 N86 and D1246 increased, and the prevalences of pfdhfr and pfdhps polymorphisms associated with antifolate resistance were unchanged. In recurrent infections, recent prior treatment with artemether-lumefantrine was associated with decreased ex vivo lumefantrine sensitivity and increased prevalence of pfcrt K76 and pfmdr1 N86, 184F, and D1246. In children assigned chemoprevention with monthly dihydroartemisinin-piperaquine with documented circulating piperaquine, breakthrough infections had increased the prevalence of pfmdr1 86Y and 1246Y compared to untreated controls. The noted impacts of therapy and chemoprevention on parasite polymorphisms remained significant in multivariate analysis correcting for calendar time. Overall, changes in parasite sensitivity were consistent with altered selective pressures due to changing treatment practices in Uganda. These changes may threaten the antimalarial treatment and preventive efficacies of artemether-lumefantrine and dihydroartemisinin-piperaquine, respectively.
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Abstract
INTRODUCTION Chemotherapy of malaria has become a rapidly changing field. Less than two decades ago, treatment regimens were increasingly bound to fail due to emerging drug resistance against 4-aminoquinolines and sulfa compounds. By now, artemisinin-based combination therapies (ACTs) constitute the standard of care for uncomplicated falciparum malaria and are increasingly also taken into consideration for the treatment of non-falciparum malaria. AREAS COVERED This narrative review provides an overview of the state-of-art antimalarial drug therapy, highlights the global portfolio of current Phase III/IV clinical trials and summarizes current developments. EXPERT OPINION Malaria chemotherapy remains a dynamic field, with novel drugs and drug combinations continuing to emerge in order to outpace the development of large-scale drug resistance against the currently most important drug class, the artemisinin derivatives. More randomized controlled studies are urgently needed especially for the treatment of malaria in first trimester pregnant women. ACTs should be used for the treatment of imported malaria more consequently. Gaining sufficient efficacy and safety information on ACT use for non-falciparum species including Plasmodium ovale and malariae should be a research priority. Continuous investment into malaria drug development is a vital factor to combat artemisinin resistance and successfully improve malaria control toward the ultimate goal of elimination.
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Affiliation(s)
- Benjamin J Visser
- University of Amsterdam, Academic Medical Centre, Center of Tropical Medicine and Travel Medicine, Division of Infectious Diseases , Amsterdam , The Netherlands
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