Journal Article

Efficacy and safety of artemisinin-based combination therapy and the implications of Pfkelch13 and Pfcoronin molecular markers in treatment failure in Senegal

Sy, Saidou Abdoul, Ndiaye, Daouda, Diallo, Mamadou Alpha, Ndiaye, Yaye Die, Sy, Mouhamad, Badiane, Aida Sadikh, Dieye, Baba, Ndiaye, Mouhamadou, Gomis, Jules François, Seck, Mame Cheikh, Sow, Djiby, Dème, Awa Bineta, Diallo, Ibrahima, Yade, Mamadou Samb, Diongue, Khadim

2020

Overview

In 2006, Senegal adopted artemisinin-based combination therapy (ACT) as first-line treatment in the management of uncomplicated malaria. This study aimed to update the status of antimalarial efficacy more than ten years after their first introduction. This was a randomized, three-arm, open-label study to evaluate the efficacy and safety of artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ) and dihydroartemisinin-piperaquine (DP) in Senegal. Malaria suspected patients were screened, enrolled, treated, and followed for 28 days for AL and ASAQ arms or 42 days for DP arm. Clinical and parasitological responses were assessed following antimalarial treatment. Genotyping ( msp1 , msp2 and 24 SNP-based barcode) were done to differentiate recrudescence from re-infection; in case of PCR-confirmed treatment failure, Pfk13 propeller and Pfcoronin genes were sequenced. Data was entered and analyzed using the WHO Excel-based application. A total of 496 patients were enrolled. In Diourbel, PCR non-corrected/corrected adequate clinical and parasitological responses (ACPR) was 100.0% in both the AL and ASAQ arms. In Kedougou, PCR corrected ACPR values were 98.8%, 100% and 97.6% in AL, ASAQ and DP arms respectively. No Pfk13 or Pfcoronin mutations associated with artemisinin resistance were found. This study showed that AL, ASAQ and DP remain efficacious and well-tolerated in the treatment of uncomplicated P. falciparum malaria in Senegal.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 631/326/417 / 692/699/255/1629 / Adolescent / Amodiaquine / Amodiaquine - administration & dosage / Amodiaquine - adverse effects / Amodiaquine - pharmacology / Antimalarials - administration & dosage / Antimalarials - adverse effects / Antimalarials - pharmacology / Artemether / Artemether, Lumefantrine Drug Combination - administration & dosage / Artemether, Lumefantrine Drug Combination - adverse effects / Artemether, Lumefantrine Drug Combination - pharmacology / Artemisinin / Artemisinins - administration & dosage / Artemisinins - adverse effects / Artemisinins - pharmacology / Artesunate / Child / Child, Preschool / Combination therapy / Dihydroartemisinin / Drug Combinations / Female / Genotyping / Humanities and Social Sciences / Humans / Infant / Infant, Newborn / Malaria / Malaria, Falciparum - drug therapy / Malaria, Falciparum - parasitology / Male / Microfilament Proteins - genetics / multidisciplinary / Mutation / Patients / Plasmodium falciparum - classification / Plasmodium falciparum - drug effects / Plasmodium falciparum - genetics / Protozoan Proteins - genetics / Quinolines - administration & dosage / Quinolines - adverse effects / Quinolines - pharmacology / Science / Science (multidisciplinary) / Senegal / Sequence Analysis, DNA / Single-nucleotide polymorphism / Treatment Failure / Vector-borne diseases