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|Title: ||Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial.|
|Authors: ||Kamya, Moses R.|
Rwakimari, John B.
Staedke, Sarah G.
Talisuna, Ambrose O.
Rosenthal, Philip J.
Artemisinin-based compound therapy (ACT)
|Issue Date: ||18-May-2007 |
|Publisher: ||Public Library of Science|
|Citation: ||Kamya M.R., Yeka A., Bukirwa H., Lugemwa M., Rwakimari J.B., Talisuna A., Greenhouse, B., Nosten, F., Wabwire-Mangen, F., Staedke, S.G., Rosenthal, P.J., Dorsey, G. (2007) Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial. PLoS Clinical Trials, 2(5)|
|Abstract: ||Objectives: To compare the efficacy and safety of artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) for treating uncomplicated falciparum malaria in Uganda.
Design: Randomized single-blinded clinical trial.
Setting: Apac, Uganda, an area of very high malaria transmission intensity.
Participants: Children aged 6 mo to 10 y with uncomplicated falciparum malaria.
Intervention: Treatment of malaria with AL or DP, each following standard 3-d dosing
regimens. Outcome measures: Risks of recurrent parasitemia at 28 and 42 d, unadjusted and adjusted by genotyping to distinguish recrudescences and new infections.
Results: Of 421 enrolled participants, 417 (99%) completed follow-up. The unadjusted risk of recurrent falciparum parasitemia was significantly lower for participants treated with DP than for those treated with AL after 28 d (11% versus 29%; risk difference [RD] 18%, 95% confidence interval [CI] 11%–26%) and 42 d (43% versus 53%; RD 9.6%, 95% CI 0%–19%) of follow-up. Similarly, the risk of recurrent parasitemia due to possible recrudescence (adjusted by genotyping) was significantly lower for participants treated with DP than for those treated with AL after 28 d (1.9% versus 8.9%; RD 7.0%, 95% CI 2.5%–12%) and 42 d (6.9% versus 16%; RD 9.5%, 95% CI 2.8%–16%). Patients treated with DP had a lower risk of recurrent parasitemia due to non-falciparum species, development of gametocytemia, and higher mean increase in hemoglobin compared to patients treated with AL. Both drugs were well tolerated; serious adverse events were uncommon and unrelated to study drugs.
Conclusion: DP was superior to AL for reducing the risk of recurrent parasitemia and gametocytemia, and provided improved hemoglobin recovery. DP thus appears to be a good alternative to AL as first-line treatment of uncomplicated malaria in Uganda. To maximize the benefit of artemisinin-based combination therapy in Africa, treatment should be integrated with aggressive strategies to reduce malaria transmission intensity.|
|Appears in Collections:||Research Articles (Health-Sciences)|
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