1. A pooled analysis of the duration of chemoprophylaxis against malaria after treatment with artesunate-amodiaquine and artemether-lumefantrine
- Author
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Clarissa Moreira, Jean-Bosco Ouédraogo, Ghyslain Mombo-Ngoma, Elisabeth Baudin, Elizabeth Juma, Abdoulaye Djimde, Emmanuelle Espie, Bakary Fofana, Frederic Nikiema, Nines Lima, Jamie T. Griffin, Michael T. Bretscher, Grant Dorsey, Clara Menéndez, Corine Karema, Estrella Lasry, Philippe J Guerin, Adoke Yeka, Bertrand Lell, Prabin Dahal, Kasia Stepniewska, Lucy C Okell, Umberto D'Alessandro, Azra C. Ghani, Quique Bassat, Raquel González, Sarah G. Staedke, Halidou Tinto, and Innocent Valea
- Subjects
medicine.medical_specialty ,Artemether/lumefantrine ,030231 tropical medicine ,Amodiaquine ,Lumefantrine ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,parasitic diseases ,Medicine ,0303 health sciences ,biology ,030306 microbiology ,business.industry ,Incidence (epidemiology) ,Artesunate/amodiaquine ,Plasmodium falciparum ,medicine.disease ,biology.organism_classification ,3. Good health ,chemistry ,Chemoprophylaxis ,business ,Malaria ,medicine.drug - Abstract
Artemether-lumefantrine (AL) and artesunate-amodiaquine (AS-AQ) are the most commonly-used treatments against Plasmodium falciparum malaria in Africa. The lumefantrine and amodiaquine partner drugs may provide differing durations of post-treatment prophylaxis, an important additional benefit to patients. Analyzing 4214 individuals from clinical trials in 12 sites, we estimated a mean duration of post-treatment protection of 13.0 days (95% CI 10.7-15.7) for AL and 15.2 days (95% CI 12.8-18.4) for AS-AQ after allowing for transmission intensity. However, the duration varied substantially between sites: where wild type pfmdr1 86 and pfcrt 76 parasite genotypes predominated, AS-AQ provided ∼2-fold longer protection than AL. Conversely, AL provided up to 1.5-fold longer protection than AS-AQ where mutants were common. We estimate that choosing AL or AS-AQ as first-line treatment according to local drug sensitivity could alter population-level clinical incidence of malaria by up to 14% in under-five year olds where malaria transmission is high.
- Published
- 2019
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