Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon

BACKGROUND: The use of drug combinations, including non-artemisinin-based and artemisinin-based combination therapy (ACT), is a novel strategy that enhances therapeutic efficacy and delays the emergence of multidrug-resistant Plasmodium falciparum. Its use is strongly recommended in most sub-Saharan...

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Autores principales: Whegang, Solange Youdom, Tahar, Rachida, Foumane, Vincent Ngane, Soula, Georges, Gwét, Henri, Thalabard, Jean-Christophe, Basco, Leonardo K
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2010
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834703/
https://www.ncbi.nlm.nih.gov/pubmed/20170477
http://dx.doi.org/10.1186/1475-2875-9-56
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author Whegang, Solange Youdom
Tahar, Rachida
Foumane, Vincent Ngane
Soula, Georges
Gwét, Henri
Thalabard, Jean-Christophe
Basco, Leonardo K
author_facet Whegang, Solange Youdom
Tahar, Rachida
Foumane, Vincent Ngane
Soula, Georges
Gwét, Henri
Thalabard, Jean-Christophe
Basco, Leonardo K
author_sort Whegang, Solange Youdom
collection PubMed
description BACKGROUND: The use of drug combinations, including non-artemisinin-based and artemisinin-based combination therapy (ACT), is a novel strategy that enhances therapeutic efficacy and delays the emergence of multidrug-resistant Plasmodium falciparum. Its use is strongly recommended in most sub-Saharan African countries, namely Cameroon, where resistance to chloroquine is widespread and antifolate resistance is emerging. METHODS: Studies were conducted in Cameroonian children with acute uncomplicated P. falciparum malaria according to the standard World Health Organization protocol at four sentinel sites between 2003 and 2007. A total of 1,401 children were enrolled, of whom 1,337 were assigned to randomized studies and 64 were included in a single non-randomized study. The proportions of adequate clinical and parasitological response (PCR-uncorrected on day 14 and PCR-corrected on day 28) were the primary endpoints to evaluate treatment efficacy on day 14 and day 28. The relative effectiveness of drug combinations was compared by a multi-treatment Bayesian random-effect meta-analysis. FINDINGS: The results based on the meta-analysis suggested that artesunate-amodiaquine (AS-AQ) is as effective as other drugs (artesunate-sulphadoxine-pyrimethamine [AS-SP], artesunate-chlorproguanil-dapsone [AS-CD], artesunate-mefloquine [AS-MQ], dihydroartemisinin-piperaquine [DH-PP], artemether-lumefantrine [AM-LM], amodiaquine, and amodiaquine-sulphadoxine-pyrimethamine [AQ-SP]). AM-LM appeared to be the most effective with no treatment failure due to recrudescence, closely followed by DH-PP. CONCLUSION: Although AM-LM requires six doses, rather than three doses for other artemisinin-based combinations, it has potential advantages over other forms of ACT. Further studies are needed to evaluate the clinical efficacy and tolerance of these combinations in different epidemiological context.
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spelling pubmed-28347032010-03-09 Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon Whegang, Solange Youdom Tahar, Rachida Foumane, Vincent Ngane Soula, Georges Gwét, Henri Thalabard, Jean-Christophe Basco, Leonardo K Malar J Research BACKGROUND: The use of drug combinations, including non-artemisinin-based and artemisinin-based combination therapy (ACT), is a novel strategy that enhances therapeutic efficacy and delays the emergence of multidrug-resistant Plasmodium falciparum. Its use is strongly recommended in most sub-Saharan African countries, namely Cameroon, where resistance to chloroquine is widespread and antifolate resistance is emerging. METHODS: Studies were conducted in Cameroonian children with acute uncomplicated P. falciparum malaria according to the standard World Health Organization protocol at four sentinel sites between 2003 and 2007. A total of 1,401 children were enrolled, of whom 1,337 were assigned to randomized studies and 64 were included in a single non-randomized study. The proportions of adequate clinical and parasitological response (PCR-uncorrected on day 14 and PCR-corrected on day 28) were the primary endpoints to evaluate treatment efficacy on day 14 and day 28. The relative effectiveness of drug combinations was compared by a multi-treatment Bayesian random-effect meta-analysis. FINDINGS: The results based on the meta-analysis suggested that artesunate-amodiaquine (AS-AQ) is as effective as other drugs (artesunate-sulphadoxine-pyrimethamine [AS-SP], artesunate-chlorproguanil-dapsone [AS-CD], artesunate-mefloquine [AS-MQ], dihydroartemisinin-piperaquine [DH-PP], artemether-lumefantrine [AM-LM], amodiaquine, and amodiaquine-sulphadoxine-pyrimethamine [AQ-SP]). AM-LM appeared to be the most effective with no treatment failure due to recrudescence, closely followed by DH-PP. CONCLUSION: Although AM-LM requires six doses, rather than three doses for other artemisinin-based combinations, it has potential advantages over other forms of ACT. Further studies are needed to evaluate the clinical efficacy and tolerance of these combinations in different epidemiological context. BioMed Central 2010-02-19 /pmc/articles/PMC2834703/ /pubmed/20170477 http://dx.doi.org/10.1186/1475-2875-9-56 Text en Copyright ©2010 Whegang et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Whegang, Solange Youdom
Tahar, Rachida
Foumane, Vincent Ngane
Soula, Georges
Gwét, Henri
Thalabard, Jean-Christophe
Basco, Leonardo K
Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon
title Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon
title_full Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon
title_fullStr Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon
title_full_unstemmed Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon
title_short Efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in Cameroon
title_sort efficacy of non-artemisinin- and artemisinin-based combination therapies for uncomplicated falciparum malaria in cameroon
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834703/
https://www.ncbi.nlm.nih.gov/pubmed/20170477
http://dx.doi.org/10.1186/1475-2875-9-56
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