Efficacy of Artemisinin-Based Combination Treatments of Uncomplicated Falciparum Malaria in Under-Five-Year-Old Nigerian Children Ten Years Following Adoption as First-line Antimalarials.
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Date
2018
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Abstract
The efficacies of 3-day regimens of artemether–lumefantrine (AL), artesunate–amodiaquine (AA), and
dihydroartemisinin–piperaquine (DHP) were evaluated in 910 children < 5 years old with uncomplicated malaria from six
geographical areas of Nigeria. Parasite positivity 1 day and Kaplan–Meier estimated risk of persistent parasitemia 3 days
after therapy initiation were both significantly higher, and geometric mean parasite reduction ratio 1 day after treatment
initiation (PRRD1) was significantly lower in AL-treated children than in AA- and DHP-treated children. No history of fever,
temperature > 38 C, enrollment parasitemia > 75,000 μL−1
, and PRRD1 < 5,000 independently predicted persistent
parasitemia 1 day after treatment initiation. Parasite clearance was significantly faster and risk of reappearance of asexual
parasitemia after initial clearance was significantly lower in DHP-treated children. Overall, day 42 polymerase chain
reaction–corrected efficacy was 98.3% (95% confidence interval [CI]: 96.1–100) and was similar for all treatments. In a
non-compartment model, declines of parasitemias were monoexponential with mean terminal elimination half-life of 1.3
hours and unimodal frequency distribution of half-lives. All treatments were well tolerated. In summary, all three treatments evaluated remain efficacious treatments of uncomplicated malaria in young Nigerian children, but DHP appears
more efficacious than AL or AA.