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Increased Sensitivity of Plasmodium falciparum to Artesunate/Amodiaquine Despite 14 Years as First-Line Malaria Treatment, Zanzibar

Artemisinin-based combination therapies (ACTs) are first-line treatments for uncomplicated Plasmodium falciparum malaria. ACT resistance is spreading in Asia but not yet in Africa. Reduced effects of ACT partner drugs have been reported but with little information regarding widely used artesunate/am...

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Autores principales: Msellem, Mwinyi, Morris, Ulrika, Soe, Aungpaing, Abbas, Faiza B., Ali, Abdul-Wahid, Barnes, Rory, Frumento, Paolo, Ali, Abdullah S., Mårtensson, Andreas, Björkman, Anders
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Centers for Disease Control and Prevention 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392451/
https://www.ncbi.nlm.nih.gov/pubmed/32687050
http://dx.doi.org/10.3201/eid2608.191547
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author Msellem, Mwinyi
Morris, Ulrika
Soe, Aungpaing
Abbas, Faiza B.
Ali, Abdul-Wahid
Barnes, Rory
Frumento, Paolo
Ali, Abdullah S.
Mårtensson, Andreas
Björkman, Anders
author_facet Msellem, Mwinyi
Morris, Ulrika
Soe, Aungpaing
Abbas, Faiza B.
Ali, Abdul-Wahid
Barnes, Rory
Frumento, Paolo
Ali, Abdullah S.
Mårtensson, Andreas
Björkman, Anders
author_sort Msellem, Mwinyi
collection PubMed
description Artemisinin-based combination therapies (ACTs) are first-line treatments for uncomplicated Plasmodium falciparum malaria. ACT resistance is spreading in Asia but not yet in Africa. Reduced effects of ACT partner drugs have been reported but with little information regarding widely used artesunate/amodiaquine (ASAQ). We studied its efficacy in Zanzibar after 14 years as first-line treatment directly by an in vivo, single-armed trial and indirectly by prevalences of different genotypes in the P. falciparum chloroquine-resistance transporter, multidrug-resistance 1, and Kelch 13 propeller domain genes. In vivo efficacy was higher during 2017 (100%; 95% CI 97.4%–100%) than during 2002–2005 (94.7%; 95% CI 91.9%–96.7%) (p = 0.003). Molecular findings showed no artemisinin resistance–associated genotypes and major increases in genotypes associated with high sensitivity/efficacy for amodiaquine than before ASAQ was introduced. Thus, the efficacy of ASAQ is maintained and appears to be increased after long-term use in contrast to what is observed for other ACTs used in Africa.
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spelling pubmed-73924512020-08-06 Increased Sensitivity of Plasmodium falciparum to Artesunate/Amodiaquine Despite 14 Years as First-Line Malaria Treatment, Zanzibar Msellem, Mwinyi Morris, Ulrika Soe, Aungpaing Abbas, Faiza B. Ali, Abdul-Wahid Barnes, Rory Frumento, Paolo Ali, Abdullah S. Mårtensson, Andreas Björkman, Anders Emerg Infect Dis Research Artemisinin-based combination therapies (ACTs) are first-line treatments for uncomplicated Plasmodium falciparum malaria. ACT resistance is spreading in Asia but not yet in Africa. Reduced effects of ACT partner drugs have been reported but with little information regarding widely used artesunate/amodiaquine (ASAQ). We studied its efficacy in Zanzibar after 14 years as first-line treatment directly by an in vivo, single-armed trial and indirectly by prevalences of different genotypes in the P. falciparum chloroquine-resistance transporter, multidrug-resistance 1, and Kelch 13 propeller domain genes. In vivo efficacy was higher during 2017 (100%; 95% CI 97.4%–100%) than during 2002–2005 (94.7%; 95% CI 91.9%–96.7%) (p = 0.003). Molecular findings showed no artemisinin resistance–associated genotypes and major increases in genotypes associated with high sensitivity/efficacy for amodiaquine than before ASAQ was introduced. Thus, the efficacy of ASAQ is maintained and appears to be increased after long-term use in contrast to what is observed for other ACTs used in Africa. Centers for Disease Control and Prevention 2020-08 /pmc/articles/PMC7392451/ /pubmed/32687050 http://dx.doi.org/10.3201/eid2608.191547 Text en https://creativecommons.org/licenses/by/4.0/This is a publication of the U.S. Government. This publication is in the public domain and is therefore without copyright. All text from this work may be reprinted freely. Use of these materials should be properly cited.
spellingShingle Research
Msellem, Mwinyi
Morris, Ulrika
Soe, Aungpaing
Abbas, Faiza B.
Ali, Abdul-Wahid
Barnes, Rory
Frumento, Paolo
Ali, Abdullah S.
Mårtensson, Andreas
Björkman, Anders
Increased Sensitivity of Plasmodium falciparum to Artesunate/Amodiaquine Despite 14 Years as First-Line Malaria Treatment, Zanzibar
title Increased Sensitivity of Plasmodium falciparum to Artesunate/Amodiaquine Despite 14 Years as First-Line Malaria Treatment, Zanzibar
title_full Increased Sensitivity of Plasmodium falciparum to Artesunate/Amodiaquine Despite 14 Years as First-Line Malaria Treatment, Zanzibar
title_fullStr Increased Sensitivity of Plasmodium falciparum to Artesunate/Amodiaquine Despite 14 Years as First-Line Malaria Treatment, Zanzibar
title_full_unstemmed Increased Sensitivity of Plasmodium falciparum to Artesunate/Amodiaquine Despite 14 Years as First-Line Malaria Treatment, Zanzibar
title_short Increased Sensitivity of Plasmodium falciparum to Artesunate/Amodiaquine Despite 14 Years as First-Line Malaria Treatment, Zanzibar
title_sort increased sensitivity of plasmodium falciparum to artesunate/amodiaquine despite 14 years as first-line malaria treatment, zanzibar
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392451/
https://www.ncbi.nlm.nih.gov/pubmed/32687050
http://dx.doi.org/10.3201/eid2608.191547
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