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Mawuli MA, Amoah LE, Cui L, Quashie NB, Afrane YA. Effectiveness of artemether-lumefantrine for treating uncomplicated malaria in low- and high-transmission areas of Ghana. Malar J 2024; 23:40. [PMID: 38317164 PMCID: PMC10845584 DOI: 10.1186/s12936-024-04850-0] [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: 09/04/2023] [Accepted: 01/11/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Artemisinin-based combination therapy (ACT) has been effective in the supervised treatment of uncomplicated malaria in Ghana. Since ACT usage is primarily unsupervised, this study aimed to determine the effectiveness of artemether-lumefantrine (AL) for treating malaria patients in two transmission settings in Ghana. METHODS Eighty-four individuals with uncomplicated Plasmodium falciparum malaria were recruited from Lekma Hospital (LH) in Accra (low-transmission area; N = 28), southern Ghana, and King's Medical Centre (KMC) in Kumbungu (high-transmission area; N = 56), northern Ghana. Participants were followed up for 28 days after unsupervised treatment with AL. The presence of asexual parasites was determined by microscopic examination of Giemsa-stained blood smears. Plasmodium species identification was confirmed using species-specific primers targeting the 18S rRNA gene. Parasite recrudescence or reinfection was determined by genotyping the Pfmsp 1 and Pfmsp 2 genes. RESULTS After AL treatment, 3.6% (2/56) of the patients from KMC were parasitaemic on day 3 compared to none from the LH patients. One patient from KMC with delayed parasite clearance on day 3 remained parasite-positive by microscopy on day 7 but was parasite-free by day 14. While none of the patients from LH experienced parasite recurrence during the 28-day follow-up, three and two patients from KMC had recurrent parasitaemia on days 21 and 28, respectively. Percentage reduction in parasite densities from day 1, 2, and 3 for participants from the KMC was 63.2%, 89.5%, and 84.5%. Parasite densities for participants from the LH reduced from 98.2%, 99.8% on day 1, and 2 to 100% on day 3. The 28-day cumulative incidence rate of treatment failure for KMC was 12.8% (95% confidence interval: 1.9-23.7%), while the per-protocol effectiveness of AL in KMC was 89.47%. All recurrent cases were assigned to recrudescence after parasite genotyping by Pfmsp 1 and Pfmsp 2. CONCLUSION While AL is efficacious in treating uncomplicated malaria in Ghana, when taken under unsupervised conditions, it showed an 89.4% PCR-corrected cure rate in northern Ghana, which is slightly below the WHO-defined threshold.
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Affiliation(s)
- Mawusi Adepa Mawuli
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana.
- Department of Pathology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana.
| | - Linda Eva Amoah
- Department of Immunology, Noguchi Memorial Institute for Medical Research College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Liwang Cui
- Department of Internal Medicine, University of South Florida, 3720 Spectrum Blvd, Tampa, FL, 33612, USA
| | - Neils Ben Quashie
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), College of Basic and Applied Sciences, University of Ghana, Legon, Accra, Ghana
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Yaw Asare Afrane
- Department of Medical Microbiology, University of Ghana Medical School College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
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2
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Bédia-Tanoh AV, Kassi KF, Touré OA, Assi SB, Gnagne AP, Adoubryn KD, Bissagnene E, Konaté A, Miezan JS, Angora KE, Vanga-Bosson H, Kiki-Barro PC, Djohan V, Yavo W, Hervé Menan EI. Meta-Analysis of Data from Four Clinical Trials in the Ivory Coast Assessing the Efficacy of Two Artemisinin-Based Combination Therapies (Artesunate-Amodiaquine and Artemether-Lumefantrine) between 2009 and 2016. Trop Med Infect Dis 2023; 9:10. [PMID: 38251206 PMCID: PMC10819967 DOI: 10.3390/tropicalmed9010010] [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: 10/27/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
The combinations of artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) are used as first-line treatments for uncomplicated malaria in the Ivory Coast. Different studies document the efficacy of two artemisinin-based combination therapies (ACTs) (AL and ASAQ) in the Ivory Coast. However, there is no meta-analysis examining the data set of these studies. The purpose of this work was to determine the prevalence of malaria treatment failure cases in randomized control trials with two artemisinin-based combination therapies (AL versus ASAQ) in the Ivory Coast between 2009 to 2016. This study is a meta-analysis of data from the results of four previous multicenter, open-label, randomized clinical trial studies evaluating the clinical and parasitological efficacy of artemether-lumefantrine and artesunate-amodiaquine conducted between 2009 and 2016 following World Health Organization (WHO) protocol at sentinel sites in the Ivory Coast. These drug efficacy data collected between 2009 and 2016 were analyzed. During these studies, to distinguish between recrudescence and new infection, molecular genotyping of genes encoding merozoite surface protein 1 and 2 was carried out using nested polymerase chain reaction (PCR). A total of 1575 patients enrolled in the four studies, including 768 in the AL arm and 762 in the ASAQ arm, which were fully followed either for 28 days or 42 days according to WHO protocol. The adequate clinical and parasitological response (ACPR) was higher than 95% in the two groups (intention to treat (ITT): AL = 96.59% and ASAQ = 96.81; Per Protocol (PP): AL = 99.48% and ASAQ = 99.61%) after PCR correction at day 28. Aggregate data analysis (2009-2016) showed that at day 28, the proportions of patients with recurrent infection was higher in the AL group (ITT: 3.79%, PP: 3.9%) than in the ASAQ group (ITT: 2.17%, PP: 2.23%). After PCR correction, most treatment failures were classified as new infections (AL group (ITT: 0.13%, PP: 0.13%); ASAQ group (ITT: 0.39%, PP: 0.39%). The recrudescent infections rate was high, at 0.39% compared to 0.13% for ASAQ and AL, respectively, for both ITT and PP, no significant difference. However, the Kaplan-Meier curve of cumulative treatment success showed a significant difference between the two groups after PCR from 2012-2013 (p = 0.032). Overall, ASAQ and AL have been shown to be effective drugs for the treatment of uncomplicated P. falciparum malaria in the study areas, 14 years after deployment of these drugs.
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Affiliation(s)
- Akoua Valérie Bédia-Tanoh
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Malaria Research and Control Center/National Institute of Public Health, Abidjan P.O. Box V47, Côte d’Ivoire;
| | - Kondo Fulgence Kassi
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Diagnostic and Research Center on AIDS and Others Infectious Diseases (CeDReS), University Hospital Center, Treichville, Abidjan P.O. Box V13, Côte d’Ivoire
| | - Offianan André Touré
- Malariology Department Institut Pasteur of Ivory Coast, Abidjan P.O. Box 490, Côte d’Ivoire
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
| | - Serge Brice Assi
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
- Pierre Richet Institute (IPR) Bouake/National Institute of Public Health, Bouaké P.O. Box 1500, Côte d’Ivoire
| | - Akpa Paterne Gnagne
- Malaria Research and Control Center/National Institute of Public Health, Abidjan P.O. Box V47, Côte d’Ivoire;
| | - Koffi Daho Adoubryn
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
- Parasitology and Mycology Department, Training and Research Unit of Medical Sciences, University Alassane Ouattara, Bouaké P.O. Box 1801, Côte d’Ivoire
| | - Emmanuel Bissagnene
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
| | - Abibatou Konaté
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
| | - Jean Sebastien Miezan
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
| | - Kpongbo Etienne Angora
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
| | - Henriette Vanga-Bosson
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Malariology Department Institut Pasteur of Ivory Coast, Abidjan P.O. Box 490, Côte d’Ivoire
| | - Pulchérie Christiane Kiki-Barro
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
| | - Vincent Djohan
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Pierre Richet Institute (IPR) Bouake/National Institute of Public Health, Bouaké P.O. Box 1500, Côte d’Ivoire
| | - William Yavo
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Malaria Research and Control Center/National Institute of Public Health, Abidjan P.O. Box V47, Côte d’Ivoire;
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
| | - Eby Ignace Hervé Menan
- Parasitology and Mycology Departement, Training and Research Unit of Pharmaceutical and Biological Sciences, University Félix Houphouët-Boigny, Abidjan P.O. Box V34, Côte d’Ivoire
- Scientific Advisory Board of National Malaria Control Program, Abidjan P.O. Box V4, Côte d’Ivoire
- Pierre Richet Institute (IPR) Bouake/National Institute of Public Health, Bouaké P.O. Box 1500, Côte d’Ivoire
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Marwa K, Kapesa A, Baraka V, Konje E, Kidenya B, Mukonzo J, Kamugisha E, Swedberg G. Therapeutic efficacy of artemether-lumefantrine, artesunate-amodiaquine and dihydroartemisinin-piperaquine in the treatment of uncomplicated Plasmodium falciparum malaria in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2022; 17:e0264339. [PMID: 35271592 PMCID: PMC8912261 DOI: 10.1371/journal.pone.0264339] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background Sub-Saharan Africa has the highest burden of malaria in the world. Artemisinin-based combination therapies (ACTs) have been the cornerstone in the efforts to reduce the global burden of malaria. In the effort to facilitate early detection of resistance for artemisinin derivatives and partner drugs, WHO recommends monitoring of ACT’s efficacy in the malaria endemic countries. The present systematic meta-analysis study summarises the evidence of therapeutic efficacy of the commonly used artemisinin-based combinations for the treatment of uncomplicated P. falciparum malaria in Sub-Saharan Africa after more than a decade since the introduction of the drugs. Methods Fifty two studies carried out from 2010 to 2020 on the efficacy of artemether-lumefantrine or dihydro-artemisinin piperaquine or artesunate amodiaquine in patients with uncomplicated P. falciparum malaria in Sub-Saharan Africa were searched for using the Google Scholar, Cochrane Central Register of controlled trials (CENTRAL), PubMed, Medline, LILACS, and EMBASE online data bases. Data was extracted by two independent reviewers. Random analysis effect was performed in STATA 13. Heterogeneity was established using I2 statistics. Results Based on per protocol analysis, unadjusted cure rates in malaria infected patients treated with artemether-lumefantrine (ALU), artesunate-amodiaquine (ASAQ) and dihydroartemisinin-piperaquine (DHP) were 89%, 94% and 91% respectively. However, the cure rates after PCR correction were 98% for ALU, 99% for ASAQ and 99% for DHP. Conclusion The present meta-analysis reports the overall high malaria treatment success for artemether-lumefantrine, artesunate-amodiaquine and dihydroartemisinin-piperaquine above the WHO threshold value in Sub-Saharan Africa.
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Affiliation(s)
- Karol Marwa
- Department of Pharmacology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- * E-mail: ,
| | - Anthony Kapesa
- Department of Community Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Vito Baraka
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Evelyne Konje
- Department of Epidemiology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Benson Kidenya
- Department of Biochemistry, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Jackson Mukonzo
- Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda
| | - Erasmus Kamugisha
- Department of Biochemistry, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Gote Swedberg
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
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4
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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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5
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Sondo P, Bihoun B, Kabore B, Tahita MC, Derra K, Rouamba T, Diallo SN, Kazienga A, Ilboudo H, Valea I, Tarnagda Z, Sorgho H, Lefevre T, Tinto H. [Polymorphisms in Plasmodium falciparum parasites and mutations in the resistance genes Pfcrt and Pfmdr1 in Nanoro area, Burkina Faso]. Pan Afr Med J 2021; 39:118. [PMID: 34512854 PMCID: PMC8396377 DOI: 10.11604/pamj.2021.39.118.26959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/01/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction sur le plan génétique, Plasmodium falciparum(P. falciparum) est une espèce extrêmement polymorphe. Il existe une diversité de souches parasitaires qui infestent les individus vivant en zone d´endémie palustre. La présente étude vise à étudier la relation entre le polymorphisme de P. falciparum et les mutations au niveau des gènes Pfcrt et Pfmdr1 dans la zone de Nanoro au Burkina Faso. Méthodes les échantillons sanguins de porteurs de plasmodiums résidant dans le district sanitaire de Nanoro ont fait l´objet d´un génotypage par PCR nichée. Les mutations au niveau des gènes de résistance du parasite aux antipaludiques ont été détectées par la technique PCR-RFLP. Résultats les échantillons de 672 patients ont été génotypés avec succès. Aucune famille allélique des gènes msp1et msp2n´avaient une susceptibilité accrue à développer des mutations au niveau des gènes de résistance. Par contre, les souches mutantes de ces gènes étaient significativement plus importantes dans les infections monoclonales que dans les infections multi clonales. Conclusion cette étude fournit un aperçu global de la relation entre le polymorphisme de P. falciparum et les mutations au niveau des gènes de résistance. Ces données contribueront sans doute à améliorer les connaissances sur la biologie du parasite et de ses mécanismes de résistance aux antipaludiques.
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Affiliation(s)
- Paul Sondo
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
| | - Biebo Bihoun
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
| | - Bérenger Kabore
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
| | - Marc Christian Tahita
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
| | - Karim Derra
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
| | - Toussaint Rouamba
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
| | - Seydou Nakanabo Diallo
- Institut National de Santé Publique, Centre Muraz de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Adama Kazienga
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
| | - Hamidou Ilboudo
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
| | - Innocent Valea
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
| | - Zekiba Tarnagda
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
| | - Hermann Sorgho
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
| | - Thierry Lefevre
- Laboratoire Mixte International sur les Vecteurs (LAMIVECT), Bobo Dioulasso, Burkina Faso.,Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle (MIVEGEC), Université de Montpellier, Institut de Recherche pour le Développement (IRD), Centre National pour la Recherche Scientifique (CNRS), Montpellier, France.,Centre de Recherche en Écologie et Évolution de la Santé (CREES), Montpellier, France
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé, Unité de Recherche Clinique de Nanoro (IRSS-URCN), Bobo-Dioulasso, Burkina Faso
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6
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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: 6] [Impact Index Per Article: 2.0] [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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7
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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: 31] [Impact Index Per Article: 10.3] [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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8
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Sondo P, Bihoun B, Tahita MC, Derra K, Rouamba T, Nakanabo Diallo S, Kazienga A, Ilboudo H, Valea I, Tarnagda Z, Sorgho H, Lefèvre T, Tinto H. Plasmodium falciparum gametocyte carriage in symptomatic patients shows significant association with genetically diverse infections, anaemia, and asexual stage density. Malar J 2021; 20:31. [PMID: 33413393 PMCID: PMC7791700 DOI: 10.1186/s12936-020-03559-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background Multi-genotype malaria infections are frequent in endemic area, and people commonly harbour several genetically distinct Plasmodium falciparum variants. The influence of genetic multiplicity and whether some specific genetic variants are more or less likely to invest into gametocyte production is not clearly understood. This study explored host and parasite-related risk factors for gametocyte carriage, and the extent to which some specific P. falciparum genetic variants are associated with gametocyte carriage. Methods Gametocytes and asexual forms were detected by light microscopy on thick smears collected between 2010 and 2012 in Nanoro, Burkina Faso. Merozoite surface protein 1 and 2 were genotyped by nested PCR on clinical samples. Associations between gametocyte carriage and factors, including multiplicity of infection, parasite density, patient age, gender, haemoglobin (Hb) level, and body temperature were assessed. The relationship between the presence of a particular msp1 and msp2 genetic variants and gametocyte carriage was also explored. Results Of the 724 samples positive to P. falciparum and successfully genotyped, gametocytes were found in 48 samples (6.63%). There was no effect of patient gender, age and body temperature on gametocyte carriage. However, the probability of gametocyte carriage significantly increased with increasing values of multiplicity of infection (MOI). Furthermore, there was a negative association between parasite density and gametocyte carriage. MOI decreased with parasite density in gametocyte-negative patients, but increased in gametocyte carriers. The probability of gametocyte carriage decreased with Hb level. Finally, the genetic composition of the infection influenced gametocyte carriage. In particular, the presence of RO33 increased the odds of developing gametocytes by 2 while the other allelic families K1, MAD20, FC27, and 3D7 had no significant impact on the occurrence of gametocytes in infected patients. Conclusion This study provides insight into potential factors influencing gametocyte production in symptomatic patients. The findings contribute to enhance understanding of risk factors associated with gametocyte carriage in humans. Trial registration NCT01232530.
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Affiliation(s)
- Paul Sondo
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso.
| | - Biebo Bihoun
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Marc Christian Tahita
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Karim Derra
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Seydou Nakanabo Diallo
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso.,Institut National de Santé Publique/Centre Muraz de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Adama Kazienga
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Hamidou Ilboudo
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Innocent Valea
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso.,Institut National de Santé Publique/Centre Muraz de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Zekiba Tarnagda
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Hermann Sorgho
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Thierry Lefèvre
- Laboratoire Mixte International Sur Les Vecteurs (LAMIVECT), Bobo Dioulasso, Burkina Faso.,MIVEGEC, Université de Montpellier, IRD, CNRS, Montpellier, France.,Centre de Recherche en Écologie Et Évolution de La Santé (CREES), Montpellier, France
| | - Halidou Tinto
- Institut de Recherche en Sciences de La Santé/ Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
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9
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Therapeutic Efficacy of Artemether-Lumefantrine (Coartem®) for the Treatment of Uncomplicated Falciparum Malaria in Africa: A Systematic Review. J Parasitol Res 2020; 2020:7371681. [PMID: 33145101 PMCID: PMC7599419 DOI: 10.1155/2020/7371681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 09/09/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022] Open
Abstract
Background Africa still bears the largest burden of malaria as the majority of infections in the continent are caused by P. falciparum. Artemether-lumefantrine (AL, Coartem®) is the most widely used artemisinin-based combination therapy (ACT), for treating uncomplicated falciparum malaria globally. However, the development of resistance to antimalarial drugs is a major challenge for malaria control. In this review, the efficacy of AL for the treatment of uncomplicated falciparum malaria in Africa was evaluated. Methods Articles published between January 2015 and July 2019 were systematically searched using comprehensive search strings from PubMed/Medline, SCOPUS, and grey literature from Google Scholar. Interventional studies that followed patients for at least 28 days were included. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. All the included articles were measured to be good quality. While computing the efficacy of AL, polymerase chain reaction (PCR)–corrected cure rate (adequate clinical and parasitological response, ACPR) at day 28 was considered as the main endpoint. Meta-analysis was computed using STATA v 15 to calculate the pooled ACPR. Results In this review, 39 articles that reported the treatment outcome of 8,320 patients were included. After 28 days of follow-up, the pooled PCR uncorrected and corrected APCR was at 87% (95% CI: 85-90%) and 97.0% (95% CI: 96-98%), respectively. Moreover, the proportion of early treatment failure (ETF) was almost 0%, while most of the included articles reported <8% late treatment failures. The reinfection and recrudescence rate was less than 10% and 2.6%, respectively, within 28 days. We noted rapid fever and parasite clearance in which greater than 93% and 94% patients were parasite and fever free at day three following AL treatment. Conclusions This review discovered that despite more than a decade since its introduction, Coartem® remains effective and thus could continue to be the drug of choice for the treatment of uncomplicated falciparum malaria for all age groups in Africa. However, the risk of new emerging resistance for this combination warrants regular monitoring of its efficacy across the continent.
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10
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Sondo P, Derra K, Rouamba T, Nakanabo Diallo S, Taconet P, Kazienga A, Ilboudo H, Tahita MC, Valéa I, Sorgho H, Lefèvre T, Tinto H. Determinants of Plasmodium falciparum multiplicity of infection and genetic diversity in Burkina Faso. Parasit Vectors 2020; 13:427. [PMID: 32819420 PMCID: PMC7441709 DOI: 10.1186/s13071-020-04302-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Investigating malaria transmission dynamics is essential to inform policy decision making. Whether multiplicity of infection (MOI) dynamic from individual infections could be a reliable malaria metric in high transmission settings with marked variation in seasons of malaria transmission has been poorly assessed. This study aimed at investigating factors driving Plasmodium falciparum MOI and genetic diversity in a hyperendemic area of Burkina Faso. METHODS Blood samples collected from a pharmacovigilance trial were used for polymerase chain reaction genotyping of the merozoite surface proteins 1 and 2. MOI was defined as the number of distinct parasite genotypes co-existing within a particular infection. Monthly rainfall data were obtained from satellite data of the Global Precipitation Measurement Database while monthly malaria incidence aggregated data were extracted from District Health Information Software 2 medical data of the Center-West health regional direction. RESULTS In the study area, infected people harboured an average of 2.732 (± 0.056) different parasite genotypes. A significant correlation between the monthly MOI and the monthly malaria incidence was observed, suggesting that MOI could be a good predictor of transmission intensity. A strong effect of season on MOI was observed, with infected patients harbouring higher number of parasite genotypes during the rainy season as compared to the dry season. There was a negative relationship between MOI and host age. In addition, MOI decreased with increasing parasite densities, suggesting that there was a within-host competition among co-infecting genetically distinct P. falciparum variants. Each allelic family of the msp1 and msp2 genes was present all year round with no significant monthly fluctuation. CONCLUSIONS In high malaria endemic settings with marked variation in seasons of malaria transmission, MOI represents an appropriate malaria metric which provides useful information about the longitudinal changes in malaria transmission in a given area. Besides transmission season, patient age and parasite density are important factors to consider for better understanding of variations in MOI. All allelic families of msp1 and msp2 genes were found in both dry and rainy season. The approach offers the opportunity of translating genotyping data into relevant epidemiological information for malaria control.
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Affiliation(s)
- Paul Sondo
- Institut de Recherche en Sciences de la Santé/Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso.
| | - Karim Derra
- Institut de Recherche en Sciences de la Santé/Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Institut de Recherche en Sciences de la Santé/Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Seydou Nakanabo Diallo
- Institut National de Santé Publique/Centre Muraz de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Paul Taconet
- Centre de Recherche en Écologie et Évolution de la Santé (CREES), Montpellier, France
| | - Adama Kazienga
- Institut de Recherche en Sciences de la Santé/Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Hamidou Ilboudo
- Institut de Recherche en Sciences de la Santé/Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Marc Christian Tahita
- Institut de Recherche en Sciences de la Santé/Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Innocent Valéa
- Institut de Recherche en Sciences de la Santé/Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Hermann Sorgho
- Institut de Recherche en Sciences de la Santé/Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
| | - Thierry Lefèvre
- Centre de Recherche en Écologie et Évolution de la Santé (CREES), Montpellier, France.,Laboratoire Mixte International sur les Vecteurs (LAMIVECT), Bobo-Dioulasso, Burkina Faso.,Institut de Recherche pour le Développement (IRD), Centre National pour la Recherche Scientifique (CNRS), Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle (MIVEGEC), Université de Montpellier, Montpellier, France
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé/Clinical Research Unit of Nanoro (IRSS-URCN), Nanoro, Burkina Faso
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11
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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 DESIGN DEVELOPMENT AND THERAPY 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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/08/2020] [Indexed: 12/21/2022]
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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12
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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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13
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Funck-Brentano C, Ouologuem N, Duparc S, Felices M, Sirima SB, Sagara I, Soulama I, Ouedraogo JB, Beavogui AH, Borghini-Fuhrer I, Khan Y, Djimdé AA, Voiriot P. Evaluation of the effects on the QT-interval of 4 artemisinin-based combination therapies with a correction-free and heart rate-free method. Sci Rep 2019; 9:883. [PMID: 30696921 PMCID: PMC6351684 DOI: 10.1038/s41598-018-37113-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 12/04/2018] [Indexed: 12/04/2022] Open
Abstract
Several antimalarial drugs are known to prolong ventricular repolarization as evidenced by QT/QTc interval prolongation. This can lead to Torsades de Pointes, a potentially lethal ventricular arrhythmia. Whether this is the case with artemisinin-based combination therapies (ACTs) remains uncertain. Assessment of the extent of QTc prolongation with antimalarials is hampered by important variations of heart rate during malaria crises and previous studies have reported highly variable values of QTc prolongations with ACTs. We assessed QTc prolongation with four ACTs, using high quality ECG recording and measurement techniques, during the first episode of malaria in 2,091 African patients enrolled in the WANECAM study which also monitored clinical safety. Using an original and robust method of QTc assessment, independent from heart rate changes and from the method of QT correction, we were able to accurately assess the extent of mean maximum QTc prolongation with the four ACTs tested. There was no evidence of proarrhythmia with any treatment during the study although dihydroartemisinin-piperaquine, artesunate-amodiaquine and artemether-lumefantrine significantly prolonged QTc. The extent of prolongation of ventricular repolarization can be accurately assessed in studies where heart rate changes impede QTc assessment.
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Affiliation(s)
- Christian Funck-Brentano
- INSERM, CIC-1421 and UMR ICAN 1166, Sorbonne Université, Faculty of Medicine, AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology and Clinical Investigation Center, Institute of Cardiometabolism and Nutrition (ICAN), F-75013, Paris, France.
| | - Nouhoum Ouologuem
- Malaria research and training center. Département d'épidémiologie des affections parasitaires, Faculté de médecine de pharmacie et d'odonto-stomatologie. P.O. Box 1805, Point G, Bamako, Mali
| | - Stephan Duparc
- Medicines for Malaria Venture, International Center Cointrin, 20 route de Pré-Bois, 1215, Geneva 15, Switzerland
| | - Mathieu Felices
- Phinc Development, Immeuble Genavenir 8, 5 rue Henri Desbruères, 91030, Evry Cedex, France
| | - Sodiomon B Sirima
- Centre national de recherche et de formation sur le paludisme, 01 P.O. Box 2208, Ouagadougou 01, Burkina Faso
| | - Issaka Sagara
- Malaria research and training center. Département d'épidémiologie des affections parasitaires, Faculté de médecine de pharmacie et d'odonto-stomatologie. P.O. Box 1805, Point G, Bamako, Mali
| | - Issiaka Soulama
- Centre national de recherche et de formation sur le paludisme, 01 P.O. Box 2208, Ouagadougou 01, Burkina Faso
| | - Jean-Bosco Ouedraogo
- IRSS, Direction Régionale de l'Ouest, 399, Avenue de la Liberté 01, P.O. Box 545, Bobo-Dioulasso 01, Burkina Faso
| | - Abdoul H Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Mafèrinyah, P.O. Box 2649, Conakry, Guinea
| | - Isabelle Borghini-Fuhrer
- Medicines for Malaria Venture, International Center Cointrin, 20 route de Pré-Bois, 1215, Geneva 15, Switzerland
| | - Yasmin Khan
- Cardiabase, 84 avenue du XXème Corps, 54000, Nancy, France
| | - Abdoulaye A Djimdé
- Malaria research and training center. Département d'épidémiologie des affections parasitaires, Faculté de médecine de pharmacie et d'odonto-stomatologie. P.O. Box 1805, Point G, Bamako, Mali
| | - Pascal Voiriot
- Cardiabase, 84 avenue du XXème Corps, 54000, Nancy, France
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Sondo P, Derra K, Lefevre T, Diallo-Nakanabo S, Tarnagda Z, Zampa O, Kazienga A, Valea I, Sorgho H, Ouedraogo JB, Guiguemde TR, Tinto H. Genetically diverse Plasmodium falciparum infections, within-host competition and symptomatic malaria in humans. Sci Rep 2019; 9:127. [PMID: 30644435 PMCID: PMC6333925 DOI: 10.1038/s41598-018-36493-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/16/2018] [Indexed: 11/17/2022] Open
Abstract
There is a large genetic diversity of Plasmodium falciparum strains that infect people causing diverse malaria symptoms. This study was carried out to explore the effect of mixed-strain infections and the extent to which some specific P. falciparum variants are associated with particular malaria symptoms. P. falciparum isolates collected during pharmacovigilance study in Nanoro, Burkina Faso were used to determine allelic variation in two polymorphic antigens of the merozoite surface (msp1 and msp2). Overall, parasite density did not increase with additional strains, suggesting the existence of within-host competition. Parasite density was influenced by msp1 allelic families with highest parasitaemia observed in MAD20 allelic family. However, when in mixed infections with allelic family K1, MAD20 could not grow to the same levels as it would alone, suggesting competitive suppression in these mixed infections. Host age was associated with parasite density. Overall, older patients exhibited lower parasite densities than younger patients, but this effect varied with the genetic composition of the isolates for the msp1 gene. There was no effect of msp1 and msp2 allelic family variation on body temperature. Haemoglobin level was influenced by msp2 family with patients harboring the FC27 allele showing lower haemoglobin level than mono-infected individuals by the 3D7 allele. This study provides evidence that P. falciparum genetic diversity influenced the severity of particular malaria symptoms and supports the existence of within-host competition in genetically diverse P. falciparum.
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Affiliation(s)
- Paul Sondo
- Institut de Recherche en Sciences de la Santé (IRSS)/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.
| | - Karim Derra
- Institut de Recherche en Sciences de la Santé (IRSS)/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Thierry Lefevre
- Institut de Recherche en Sciences de la Santé (IRSS)/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.,MIVEGEC, IRD, CNRS, University of Montpellier, Montpellier, France
| | - Seydou Diallo-Nakanabo
- Institut de Recherche en Sciences de la Santé (IRSS)/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Zekiba Tarnagda
- Institut de Recherche en Sciences de la Santé (IRSS)/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Odile Zampa
- Centre Muraz of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Adama Kazienga
- Institut de Recherche en Sciences de la Santé (IRSS)/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Innocent Valea
- Institut de Recherche en Sciences de la Santé (IRSS)/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.,Centre Muraz of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Hermann Sorgho
- Institut de Recherche en Sciences de la Santé (IRSS)/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Jean-Bosco Ouedraogo
- Institut de Recherche en Sciences de la Santé (IRSS)/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | | | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé (IRSS)/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso.,Centre Muraz of Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
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15
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K13 Propeller Alleles, mdr1 Polymorphism, and Drug Effectiveness at Day 3 after Artemether-Lumefantrine Treatment for Plasmodium falciparum Malaria in Colombia, 2014-2015. Antimicrob Agents Chemother 2017; 61:AAC.01036-17. [PMID: 28947476 DOI: 10.1128/aac.01036-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/11/2017] [Indexed: 12/22/2022] Open
Abstract
High treatment failure rates for Plasmodium falciparum malaria have been reported in Colombia for chloroquine, amodiaquine, and sulfadoxine-pyrimethamine. Artemisinin combination therapies were introduced in 2006 in Colombia, where artemether-lumefantrine (AL) is currently used to treat uncomplicated P. falciparum malaria. Artemisinin (ART) resistance was initially observed in Southeast Asia as an increased parasite clearance time, manifesting as a positive thick-blood smear on day 3 after treatment (D3 positivity). Recently, mutations in the propeller domain of the P. falciparumkelch13 gene (K13 propeller) have been associated with ART resistance. In this study, we surveyed AL effectiveness at D3 and molecular markers of drug resistance among 187 uncomplicated P. falciparum cases in 4 regions of Colombia from June 2014 to July 2015. We found that 3.2% (4/125) of patients showed D3 positivity, 100% (163/163) of isolates carried wild-type K13 propeller alleles, 12.9% (23/178) of isolates had multiple copies of the multidrug resistance 1 gene (mdr1), and 75.8% (113/149) of isolates harbored the double mutant NFSDD mdr1 haplotype (the underlining indicates mutant alleles). These data suggest that ART resistance is not currently suspected in Colombia but that monitoring for lumefantrine resistance and AL failures should continue.
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Whegang Youdom S, Tahar R, Basco LK. Comparison of anti-malarial drugs efficacy in the treatment of uncomplicated malaria in African children and adults using network meta-analysis. Malar J 2017; 16:311. [PMID: 28774303 PMCID: PMC5543626 DOI: 10.1186/s12936-017-1963-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/29/2017] [Indexed: 02/04/2023] Open
Abstract
Background Artemisinin-based combination therapy (ACT) and novel drug combinations are available and used in African countries to treat uncomplicated malaria. Network meta-analysis methods are rarely and poorly applied for the comparison of their efficacies. This method was applied on a set of randomized controlled trials to illustrate its usefulness. Methods A literature review available in Pubmed was conducted in July 2016. Eligible studies, conducted in sub-Saharan Africa, published between 2002 and 2016, focused on randomized controlled trials of at least two artemisinin-based combinations to treat uncomplicated malaria in children and adults. Agglomerate data were: the number of PCR-corrected adequate clinical and parasitological response (ACPR) on day 28, used as the primary endpoint in all interventions, the number of participants and the list of treatments. A Bayesian random effect meta-analysis using a binary outcome was the method to compare the efficacy. Ranking measure was used to obtain a hierarchy of the competing interventions. Results In total, 76 articles were included; 13 treatment regimens were involved and tested in 36,001 patients. Using artemether–lumefantrine (AL) as the common comparator for the entire network, 12 relative treatment effects were estimated and indirect comparisons were obtained. Dihydroartemisinin–piperaquine (DHAP) was shown to be more effective than AL (odds ratio [OR] = 1.92; 95% CI 1.30–2.82; 19,163 patients), ASAQ (OR = 1.70; 95% CI 1.10–2.64; 14,433 patients), and amodiaquine–sulfadoxine–pyrimethamine (AQSP): OR = 2.20; 95% CI 1.21–3.96; 8863 patients. Artesunate–amodiaquine (ASAQ) was comparable to AL (OR = 1.11; 95% CI 0.84–1.45; 21,235 patients). No significant difference was found between artesunate and mefloquine (ASMQ) and AL (OR = 1.20; 95% CI = 0.52-2.8; 13,824 participants). According to treatment ranking, among the WHO-recommended ACT medicines, DHAP was shown to be the most efficacious. Conclusions Based on the available evidence, this study demonstrated the superiority of DHAP among currently recommended artemisinin-based combinations. The application of the methods described here may be helpful to gain better understanding of treatment efficacy and improve future decisions. However, more data are needed to allow robust conclusions about the results in comparison with novel drugs. Further surveillance of the efficacy of anti-malarial drugs and clinical trials are needed to closely follow the evolution of the epidemiology of drug-resistant malaria in Africa. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1963-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Solange Whegang Youdom
- University of Yaounde I, National Advanced School of Engineering, PO Box 8390, Yaounde, Cameroon.
| | - Rachida Tahar
- Unité Mixte de Recherche 216 Mère et Enfant face aux Infections Tropicales (MERIT), Institut de Recherche pour le Développement (IRD), Université Paris Descartes, Laboratoire de Parasitologie, Faculté de Pharmacie, 4 avenue de l'Observatoire, 75006, Paris, France
| | - Leonardo K Basco
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix Marseille Université, UM 63, CNRS 7278, IRD 198, INSERM 1095, Institut Hospitalo-Universitaire (IHU), Méditerranée Infection, 19-21 boulevard Jean Moulin, 13385, Marseille, France
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17
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Mischlinger J, Lagler H, Harrison N, Ramharter M. Dalbavancin for outpatient parenteral antimicrobial therapy of skin and soft tissue infections in a returning traveller : Proposal for novel treatment indications. Wien Klin Wochenschr 2017; 129:642-645. [PMID: 28776100 DOI: 10.1007/s00508-017-1243-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022]
Abstract
Skin and soft tissue infections (SSTIs) are among the most common health problems in travellers returning from tropical and subtropical countries. Importantly, the prevalence of Staphylococcus aureus, the most common pathogen for purulent SSTIs, with specific drug resistance, such as methicillin resistant Staphylococcus aureus (MRSA) and those expressing virulence genes, such as Panton-Valentine-leukocidin is higher in tropical regions than in most high resource settings. This poses challenges for the empirical antimicrobial treatment of SSTIs in returning travellers. This short report describes a patient with a recent travel history to Hong Kong, Singapore and the Philippines who presented with multiple mosquito bites on both upper extremities and secondary bacterial superinfection. He had previously been prescribed oral beta-lactam antimicrobial therapy but lacked adherence to this treatment. Based on the risk for MRSA infection and problems with treatment adherence to oral therapy an outpatient parenteral antimicrobial therapy with dalbavancin was administered on days 0 and 7. Microbiological culture confirmed presence of MRSA and clinical follow-up demonstrated complete remission of the SSTI within 2 weeks. Dalbavancin is a promising treatment option for empirical parenteral treatment of SSTIs in returning travellers, a population at high risk for beta-lactam resistant S. aureus skin infections.
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Affiliation(s)
- Johannes Mischlinger
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria. .,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon. .,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
| | - Heimo Lagler
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Nicole Harrison
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Ramharter
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
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18
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Niang M, Thiam LG, Loucoubar C, Sow A, Sadio BD, Diallo M, Sall AA, Toure-Balde A. Spatio-temporal analysis of the genetic diversity and complexity of Plasmodium falciparum infections in Kedougou, southeastern Senegal. Parasit Vectors 2017; 10:33. [PMID: 28103905 PMCID: PMC5244544 DOI: 10.1186/s13071-017-1976-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 01/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genetic analyses of the malaria parasite population and its temporal and spatial dynamics could provide an assessment of the effectiveness of disease control strategies. The genetic diversity of Plasmodium falciparum has been poorly documented in Senegal, and limited data are available from the Kedougou Region. This study examines the spatial and temporal variation of the genetic diversity and complexity of P. falciparum infections in acute febrile patients in Kedougou, southeastern Senegal. A total of 263 sera from patients presenting with acute febrile illness and attending Kedougou health facilities between July 2009 and July 2013 were obtained from a collection established as part of arbovirus surveillance in Kedougou. Samples identified as P. falciparum by nested PCR were characterized for their genetic diversity and complexity using msp-1 and msp-2 polymorphic markers. RESULTS Samples containing only P. falciparum accounted for 60.83% (160/263) of the examined samples. All three msp-1 allelic families (K1, MAD20 and RO33) and two msp-2 allelic families (FC27 and 3D7) were detected in all villages investigated over the 5-year collection period. The average genotype per allelic family was comparable between villages. Frequencies of msp-1 and msp-2 allelic types showed no correlation with age (Fisher's exact test, P = 0.59) or gender (Fisher's exact test, P = 0.973), and were similarly distributed throughout the 5-year sampling period (Fisher's exact test, P = 0.412) and across villages (Fisher's exact test, P = 0.866). Mean multiplicity of infection (MOI) for both msp-1 and msp-2 was highest in Kedougou village (2.25 and 2.21, respectively) and among younger patients aged ≤ 15 years (2.12 and 2.00, respectively). The mean MOI was highest in 2009 and decreased progressively onward. CONCLUSION Characterization of the genetic diversity and complexity of P. falciparum infections in Kedougou revealed no spatio-temporal variation in the genetic diversity of P. falciparum isolates. However, mean MOI varied with time of sera collection and decreased over the course of the study (July 2009 to July 2013). This suggests a slow progressive decrease of malaria transmission intensity in Kedougou Region despite the limited impact of preventive and control measures implemented by the National Malaria Control Programme on malaria morbidity and mortality.
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Affiliation(s)
- Makhtar Niang
- Institut Pasteur Dakar, Immunology Unit, 36 Avenue Pasteur, BP 220, Dakar, Senegal.
| | - Laty G Thiam
- Institut Pasteur Dakar, Immunology Unit, 36 Avenue Pasteur, BP 220, Dakar, Senegal.,Department of Animal Biology, Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - Cheikh Loucoubar
- Institut Pasteur Dakar, Biostatistics, Bioinformatics and Modeling Group, 36 Avenue Pasteur, BP 220, Dakar, Senegal
| | - Abdourahmane Sow
- Institut Pasteur Dakar, Arbovirus and Viral Hemorrhagic Fevers Unit, 36 Avenue Pasteur, BP 220, Dakar, Senegal
| | - Bacary D Sadio
- Institut Pasteur Dakar, Arbovirus and Viral Hemorrhagic Fevers Unit, 36 Avenue Pasteur, BP 220, Dakar, Senegal
| | - Mawlouth Diallo
- Institut Pasteur Dakar, Medical Entomology Unit, 36 Avenue Pasteur, BP 220, Dakar, Senegal
| | - Amadou A Sall
- Institut Pasteur Dakar, Arbovirus and Viral Hemorrhagic Fevers Unit, 36 Avenue Pasteur, BP 220, Dakar, Senegal
| | - Aissatou Toure-Balde
- Institut Pasteur Dakar, Immunology Unit, 36 Avenue Pasteur, BP 220, Dakar, Senegal
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Mischlinger J, Agnandji ST, Ramharter M. Single dose treatment of malaria - current status and perspectives. Expert Rev Anti Infect Ther 2016; 14:669-78. [PMID: 27254098 DOI: 10.1080/14787210.2016.1192462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Despite increased international efforts for control and ultimate elimination, malaria remains a major health problem. Currently, artemisinin-based combination therapies are the treatment of choice for uncomplicated malaria exhibiting high efficacy in clinical trial settings in sub-Saharan Africa. However, their administration over a three-day period is associated with important problems of treatment adherence resulting in markedly reduced effectiveness of currently recommended antimalarials under real world settings. AREAS COVERED Antimalarial drug candidates and antimalarial drug combinations currently under advanced clinical development for the indication as single dose antimalarial therapy. Expert commentary: Several new drug candidates and combinations are currently undergoing pivotal proof-of-concept studies or clinical development programmes. The development of a single dose combination therapy would constitute a breakthrough in the control of malaria. Such an innovative treatment approach would simultaneously close the effectiveness gap of current three-day therapies and revolutionize population based interventions in the context of malaria elimination campaigns.
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Affiliation(s)
- Johannes Mischlinger
- a Centre de Recherches Médicales de Lambaréné , Lambaréné , Gabon.,b Institut für Tropenmedizin , Universität Tübingen , Tübingen , Germany
| | - Selidji T Agnandji
- a Centre de Recherches Médicales de Lambaréné , Lambaréné , Gabon.,b Institut für Tropenmedizin , Universität Tübingen , Tübingen , Germany
| | - Michael Ramharter
- a Centre de Recherches Médicales de Lambaréné , Lambaréné , Gabon.,b Institut für Tropenmedizin , Universität Tübingen , Tübingen , Germany.,c Department of Medicine I, Division of Infectious Diseases and Tropical Medicine , Medical University of Vienna , Vienna , Austria
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20
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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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21
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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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