A randomized trial of artemether-lumefantrine versus mefloquine-artesunate for the treatment of uncomplicated multi-drug resistant Plasmodium falciparum on the western border of ThailandReport as inadecuate




A randomized trial of artemether-lumefantrine versus mefloquine-artesunate for the treatment of uncomplicated multi-drug resistant Plasmodium falciparum on the western border of Thailand - Download this document for free, or read online. Document in PDF available to download.

Malaria Journal

, 4:46

First Online: 22 September 2005Received: 16 July 2005Accepted: 22 September 2005

Abstract

BackgroundThe use of antimalarial drug combinations with artemisinin derivatives is recommended to overcome drug resistance in Plasmodium falciparum. The fixed combination of oral artemether-lumefantrine, an artemisinin combination therapy ACT is highly effective and well tolerated. It is the only registered fixed combination containing an artemisinin. The trial presented here was conducted to monitor the efficacy of the six-dose regimen of artemether-lumefantrine ALN in an area of multi-drug resistance, along the Thai-Myanmar border.

MethodsThe trial was an open-label, two-arm, randomized study comparing artemether-lumefantrine and mefloquine-artesunate for the treatment of uncomplicated falciparum malaria with 42 days of follow up. Parasite genotyping by polymerase chain reaction PCR was used to distinguish recrudescent from newly acquired P. falciparum infections. The PCR adjusted cure rates were evaluated by survival analysis.

ResultsIn 2001–2002 a total of 490 patients with slide confirmed uncomplicated P. falciparum malaria were randomly assigned to receive artemether-lumefantrine n = 245 or artesunate and mefloquine n = 245 and were followed for 42 days. All patients had rapid initial clinical and parasitological responses. In both groups, the PCR adjusted cure rates by day 42 were high: 98.8% 95% CI 96.4, 99.6% for artemether-lumefantrine and 96.3% 95% CI 93.1, 98.0% for artesunate-mefloquine. Both regimens were very well tolerated with no serious adverse events observed attributable to either combination.

ConclusionOverall, this study confirms that these two artemisinin-based combinations remain highly effective and result in equivalent therapeutic responses in the treatment of highly drug-resistant falciparum malaria.

Electronic supplementary materialThe online version of this article doi:10.1186-1475-2875-4-46 contains supplementary material, which is available to authorized users.

Robert Hutagalung, Lucy Paiphun, Elizabeth A Ashley, Rose McGready, Alan Brockman, Kaw L Thwai, Pratap Singhasivanon, Thomas Jelinek, Nicholas J White and François H Nosten contributed equally to this work.

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Author: Robert Hutagalung - Lucy Paiphun - Elizabeth A Ashley - Rose McGready - Alan Brockman - Kaw L Thwai - Pratap Singhasivano

Source: https://link.springer.com/







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