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Sowunmi A, Ntadom G, Akano K, Ibironke FO, Ayede AI, Agomo C, Folarin OA, Gbotosho GO, Happi C, Oguche S, Okafor HU, Meremikwu M, Agomo P, Ogala W, Watila I, Mokuolu O, Finomo F, Ebenebe JC, Jiya N, Ambe J, Wammanda R, Emechebe G, Oyibo W, Useh F, Aderoyeje T, Dokunmu TM, Alebiosu OT, Amoo S, Basorun OK, Wewe OA, Okafor C, Akpoborie O, Fatunmbi B, Adewoye EO, Ezeigwe NM, Oduola A. Declining responsiveness of childhood Plasmodium falciparum infections to artemisinin-based combination treatments ten years following deployment as first-line antimalarials in Nigeria. Infect Dis Poverty 2019; 8:69. [PMID: 31383040 PMCID: PMC6683392 DOI: 10.1186/s40249-019-0577-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/09/2019] [Indexed: 12/12/2022] Open
Abstract
Background The development and spread of artemisinin-resistant Plasmodium falciparum malaria in Greater Mekong Subregion has created impetus for continuing global monitoring of efficacy of artemisinin-based combination therapies (ACTs). This post analyses is aimed to evaluate changes in early treatment response markers 10 years after the adoption of ACTs as first-line treatments of uncomplicated falciparum malaria in Nigeria. Methods At 14 sentinel sites in six geographical areas of Nigeria, we evaluated treatment responses in 1341 children under 5 years and in additional 360 children under 16 years with uncomplicated malaria enrolled in randomized trials of artemether-lumefantrine versus artesunate-amodiaquine at 5-year interval in 2009–2010 and 2014–2015 and at 2-year interval in 2009–2010 and 2012–2015, respectively after deployment in 2005. Results Asexual parasite positivity 1 day after treatment initiation (APPD1) rose from 54 to 62% and 2 days after treatment initiation from 5 to 26% in 2009–2010 to 2014–2015 (P = 0.002 and P < 0.0001, respectively). Parasite clearance time increased significantly from 1.6 days (95% confidence interval [CI]: 1.55–1.64) to 1.9 days (95% CI, 1.9–2.0) and geometric mean parasite reduction ratio 2 days after treatment initiation decreased significantly from 11 000 to 4700 within the same time period (P < 0.0001 for each). Enrolment parasitaemia > 75 000 μl− 1, haematocrit > 27% 1 day post-treatment initiation, treatment with artemether-lumefantrine and enrolment in 2014–2015 independently predicted APPD1. In parallel, Kaplan-Meier estimated risk of recurrent infections by day 28 rose from 8 to 14% (P = 0.005) and from 9 to 15% (P = 0.02) with artemether-lumefantrine and artesunate-amodiaquine, respectively. Mean asexual parasitaemia half-life increased significantly from 1.1 h to 1.3 h within 2 years (P < 0.0001). Conclusions These data indicate declining parasitological responses through time to the two ACTs may be due to emergence of parasites with reduced susceptibility or decrease in immunity to the infections in these children. Trial registration Pan African Clinical Trial Registration PACTR201508001188143, 3 July 2015; PACTR201508001191898, 7 July 2015 and PACTR201508001193368, 8 July 2015 PACTR201510001189370, 3 July 2015; PACTR201709002064150, 1 March 2017; https://www.pactr.samrca.ac.za Electronic supplementary material The online version of this article (10.1186/s40249-019-0577-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akintunde Sowunmi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria. .,Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria. .,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria. .,Department of Clinical Pharmacology, University College Hospital, Ibadan, Ibadan, Nigeria.
| | - Godwin Ntadom
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Kazeem Akano
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria.,Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Folasade O Ibironke
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Ibadan, Nigeria
| | | | - Chimere Agomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
| | - Onikepe A Folarin
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Grace O Gbotosho
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria.,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria.,Department of Pharmacology and Toxicology, University of Ibadan, Ibadan, Nigeria
| | - Christian Happi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Stephen Oguche
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Jos, Jos, Nigeria
| | - Henrietta U Okafor
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Pediatrics, Institute of Child Health, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Martin Meremikwu
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Calabar, Calabar, Cross River State, Nigeria
| | - Philip Agomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Nigeria Institute of Medical Research, Lagos, Nigeria
| | - William Ogala
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
| | - Ismaila Watila
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Specialist Hospital, Maiduguri, Nigeria
| | - Olugbenga Mokuolu
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics and Child Health, University of Ilorin, Ilorin, Nigeria
| | - Finomo Finomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Federal Medical Centre, Yenagoa, Nigeria
| | - Joy C Ebenebe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nigeria
| | - Nma Jiya
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Uthman Dan Fodio University, Sokoto, Nigeria
| | - Jose Ambe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | - Robinson Wammanda
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
| | - George Emechebe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Imo State University Teaching Hospital, Orlu, Nigeria
| | - Wellington Oyibo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
| | - Francis Useh
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
| | - Temitope Aderoyeje
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Ibadan, Nigeria
| | | | - Omobolaji T Alebiosu
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Sikiru Amoo
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Oluwabunmi K Basorun
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Olubunmi A Wewe
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Chukwuebuka Okafor
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Odafe Akpoborie
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Bayo Fatunmbi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,World Health Organization, Country Office, Kampala, Uganda
| | - Elsie O Adewoye
- Department of Physiology, University of Ibadan, Ibadan, Nigeria
| | - Nnenna M Ezeigwe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
| | - Ayoade Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
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Sowunmi A, Akano K, Ayede AI, Adewoye EO, Ntadom G, Fatunmbi B, Gbotosho GO, Folarin OA, Happi CT. Early rising asexual parasitaemia in Nigerian children following a first dose of artemisinin-based combination treatments of falciparum malaria. BMC Infect Dis 2017; 17:110. [PMID: 28143417 PMCID: PMC5286790 DOI: 10.1186/s12879-016-2173-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/27/2016] [Indexed: 01/03/2023] Open
Abstract
Background Early rising asexual parasitaemia (ERAP), initially defined as ‘an increase in the parasite count over the baseline pre-treatment level during the first 24 h of treatment’ of falciparum malaria with artemisinin derivatives is well documented, but there is no characterization of its risk factors, kinetics, molecular features or relationship to late-appearing anaemia (LAA) in acute falciparum malaria in African children following oral artemisinin-based combination therapies (ACTs). Methods ERAP was defined as ≥5% increase in pre-treatment parasitaemia within 8 h of initiating treatment. Parasitaemia was quantified pre-treatment and 1–2 hourly for 8 h, and less frequently thereafter for 6 weeks following randomized treatment of acutely malarious children with artesunate-amodiaquine, artemether-lumefantrine or dihydroartemisinin-piperaquine. Risk factors were determined by stepwise multiple logistic regression model. Kinetics of release into and of elimination of asexual parasites and DNA clones from peripheral blood were evaluated by method of residuals and non-compartment model, respectively. Parasite population changes were evaluated morphologically and by molecular genotyping. Results ERAP occurred in 205 of 416 children. A parasitaemia <100,000/μL and parasitaemia 1 day post-treatment initiation were independent predictors of ERAP. In children with ERAP: mean and peak time of increase in parasitaemia were 105.6% (95% CI 81–130.1) and 2.5 h (95% CI 2.2–2.7), respectively. Mean lag time, half-time and rate constant of release were 0.2 h (95% CI 0.2–0.3), 1 h (95% CI 0.9–1.1), and 0.9 h−1 (95% CI 0.8–1), respectively. Schizonts and young gametocytes were seen only in peripheral blood of few children with ERAP. In age-, gender-, baseline parasitaemia- and treatment-matched children with and without ERAP, parasite DNA clearance time and area under curve of number of DNA clones versus time were significantly higher in children with ERAP indicating peripheral retention of released parasites followed by elimination. DNA clone elimination was monoexponential. Conclusion ERAP is common, occurs rapidly as first order process and may be due to mobilization of parasites from deep tissue following a first dose of ACTs of acute childhood falciparum malaria. Trials registration Pan African Clinical Trial Registry PACTR201508001188143, 3 July 2015; PACTR201510001189370, 3 July 2015; PACTR201508001191898, 7 July 2015 and PACTR201508001193368, 8 July 2015.
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Affiliation(s)
- Akintunde Sowunmi
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria. .,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria. .,Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria.
| | - Kazeem Akano
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | | | - Elsie O Adewoye
- Department of Physiology, University of Ibadan, Ibadan, Nigeria
| | - Godwin Ntadom
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Bayo Fatunmbi
- World Health Organization, Regional Office for the Western Pacific, Phnom Penh, Cambodia
| | - Grace O Gbotosho
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria.,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Onikepe A Folarin
- Department of Biological Sciences, Redeemer's University, Ede, Nigeria.,African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Nigeria
| | - Christian T Happi
- Department of Biological Sciences, Redeemer's University, Ede, Nigeria.,African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Nigeria
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Sowunmi A, Akano K, Ayede AI, Ntadom G, Adewoye EO, Fatunmbi B, Aderoyeje T. Therapeutic efficacy and effects of artesunate-amodiaquine and artemether-lumefantrine on malaria-associated anaemia in Nigerian children aged two years and under. Infect Dis Poverty 2016; 5:70. [PMID: 27384596 PMCID: PMC4933999 DOI: 10.1186/s40249-016-0165-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 06/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Artemisinin-based combination therapies are recommended as first-line treatments for uncomplicated falciparum malaria, but there is little evaluation of their efficacy and effects on uncomplicated malaria-associated anaemia in children aged 2 years and under. METHODS Parasitological efficacy and effects on malaria-associated anaemia were evaluated in 250 malarious children aged 2 years and under, and efficacy was evaluated in 603 malarious children older than two but younger than 5 years of age following treatment with artesunate-amodiaquine (AA) or artemether-lumefantrine (AL). Kinetics of the disposition of parasitaemia following treatment were evaluated using a non-compartment model. Late-appearing anaemia (LAA) was diagnosed using the following criteria: clearance of parasitaemia, fever and other symptoms occurring within 7 days of starting treatment, adequate clinical and parasitological response on days 28-42, haematocrit (HCT) ≥ 30 % at 1 and/or 2 weeks, a fall in HCT to < 30 % occurring at 3-6 weeks, absence of concomitant illness at 1-6 weeks, and absence of asexual parasitaemia detected using both microscopy and polymerase chain reaction (PCR) at 1-6 weeks. RESULTS Overall, in children aged 2 years and under, the PCR-corrected parasitological efficacy was 97.2 % (95 % CI 92.8-101.6), which was similar for both treatments. In children older than 2 years, parasitological efficacy was also similar for both treatments, but parasite prevalence 1 day after treatment began was significantly higher, and fever and parasite clearance times were significantly faster in the AA-treated children compared with the AL-treated children. Declines in parasitaemia were monoexponential with an estimated elimination half-time of 1 h. Elimination half-times were similar for both treatments. In children aged 2 years and under who were anaemic at presentation, the mean anaemia recovery time was 12.1 days (95 % CI 10.6-13.6, n = 127), which was similar for both treatments. Relatively asymptomatic LAA occurred in 11 children (4.4 %) aged 2 years and under, the recovery from which was uneventful. CONCLUSION This study showed that AA and AL are efficacious treatments for uncomplicated falciparum malaria in Nigerian children aged 2 years and under, and that AA clears parasitaemia and fever significantly faster than AL in children older than 2 years. Both treatments may cause a relatively asymptomatic LAA with uneventful recovery in a small proportion of children aged 2 years and under. TRIALS REGISTRATION Pan African Clinical Trial Registry PACTR201508001188143, 3 July 2015; PACTR201510001189370, 3 July 2015; PACTR201508001191898, 7 July 2015 and PACTR201508001193368, 8 July 2015 http://www.pactr.org .
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Affiliation(s)
- Akintunde Sowunmi
- />Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- />Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Kazeem Akano
- />Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | | | - Godwin Ntadom
- />Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Elsie O. Adewoye
- />Department of Physiology, University of Ibadan, Ibadan, Nigeria
| | - Bayo Fatunmbi
- />World Health Organization, Regional Office for the Western Pacific, Phnom Penh, Cambodia
| | - Temitope Aderoyeje
- />Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
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