Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial
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 intensit...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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Public Library of Science
2007
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| _version_ | 1797089665751187456 |
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| author | Kamya, MR Yeka, A Bukirwa, H Lugemwa, M Rwakimari, J Staedke, S Talisuna, A Greenhouse, B Nosten, F Rosenthal, P Wabwire-Mangen, F Dorsey, G |
| author_facet | Kamya, MR Yeka, A Bukirwa, H Lugemwa, M Rwakimari, J Staedke, S Talisuna, A Greenhouse, B Nosten, F Rosenthal, P Wabwire-Mangen, F Dorsey, G |
| author_sort | Kamya, MR |
| collection | OXFORD |
| description | 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. |
| first_indexed | 2024-03-07T03:07:20Z |
| format | Journal article |
| id | oxford-uuid:b2fd9496-c724-48e8-a593-09cf57b118be |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:07:20Z |
| publishDate | 2007 |
| publisher | Public Library of Science |
| record_format | dspace |
| spelling | oxford-uuid:b2fd9496-c724-48e8-a593-09cf57b118be2022-03-27T04:15:49ZArtemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:b2fd9496-c724-48e8-a593-09cf57b118beEnglishSymplectic Elements at OxfordPublic Library of Science2007Kamya, MRYeka, ABukirwa, HLugemwa, MRwakimari, JStaedke, STalisuna, AGreenhouse, BNosten, FRosenthal, PWabwire-Mangen, FDorsey, G 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. |
| spellingShingle | Kamya, MR Yeka, A Bukirwa, H Lugemwa, M Rwakimari, J Staedke, S Talisuna, A Greenhouse, B Nosten, F Rosenthal, P Wabwire-Mangen, F Dorsey, G Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial |
| title | Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial |
| title_full | Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial |
| title_fullStr | Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial |
| title_full_unstemmed | Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial |
| title_short | Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial |
| title_sort | artemether lumefantrine versus dihydroartemisinin piperaquine for treatment of malaria a randomized trial |
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